This blog post provides information about Doxy.me a HIPAA compliant tele-psychiatry platform that we use at Gateway Psychiatric. Doxy.me is a simple and secure Web-based video solution designed for telemedicine. Doxy.me automatically works with popular internet browsers, such as Google Chrome and Mozilla Firefox, without requiring additional downloads or plug-ins to install. Doxy.me does not work with Safari or Internet Explorer. …
Testosterone for Older Men
Does testosterone supplementation help older men with low testosterone improve their quality of life, mood and energy? Some of the “low T” advertisements on TV made it seem like the magic hormone that conquered aging. More recently the FDA has been expressing its concern about over-prescribing by, among other things, adding black box warnings on the labels of gel formulations of …
Norepinephrine dopamine and depression
In an elegant set of studies published in February 2016 in Nature Neuroscience the team of Bruno Giros, a researcher at the Douglas Mental Health University Institute and Professor of Psychiatry at McGill University, reports the first-ever connection between noradrenergic neurons and vulnerability to depression. The study involved research using probably the most well developed animal model for depression – chronic or …
Lithium and Genes
Several studies have suggested that lithium response has a genetic component. Whether someone with bipolar will respond to treatment with lithium seems to be strongly associated with the presence or absence of a family history of response to the medication. A recent article in the Lancet reports the results of a genome-wide association study of lithium response in 2563 patients collected …
Buprenorphine for Depression – A Combination Approach
While we were in the midst of a seeming epidemic of concern about opiate prescribing and possible overuse of opiates by physicians, it is ironic that we are also seeing a small stream of articles being published about the potential effectiveness of opiate agonists in treating patients with treatment resistant depression. I’ve been interested in this topic since Enoch Callaway, …
Lowering Medication Costs – Update
The New York Times recently reviewed two websites that offered to substantially reduce the cost of psychiatric medications for those without adequate insurance coverage. We’ve updated the section of this website that provides links to information about lowering the costs of medications and that mentions the option of purchasing medications from Canada as well as information about these two sites. …
Pramipexole in Unipolar and Bipolar Depression
For many years we’ve been impressed with the response in some patients with bipolar depression to relatively high doses of pramipexole. Pramipexole is an agent that enhances dopamine neurotransmission and has been approved for the treatment of Parkinson’s disease. There are relatively few medications that significantly affect dopamine, one of the three monoamine neurotransmitters associated with depression and pramipexole is …
Rapastinel for Depression
The U.S. Food and Drug Administration (FDA) has granted Breakthrough Therapy designation to rapastinel, which follows the medication receiving a 2014 Fast Track Designation from the FDA. Rapastinel, an investigational medication for adjunctive treatment of major depressive disorder, is an intravenous drug that is a novel NMDA receptor agonist. It is being developed by Allergan. The Breakthrough Therapy designation is a new …
Functional Brain Imaging and Antidepressant Response
One of the most exciting initiatives currently in the important area of the treatment of depression is the International Study to Predict Optimized Treatment in Depression (iSPOT-D). This large multi-center initiative is based on a private industry and academic partnership that is designed to both identify best practices in the treatment of depression and also commercialize them. The most recent publication from this …
SSRI Dose Response
It has long been unclear whether higher doses of SSRIs are associated with greater response. What has been clear is that higher doses are associated with significantly increased side effects. In fact previous research, whether individual studies or meta-analyses have failed to find a significant dose response with the result that many have felt that there is a flat dose response …