Pre-Diabetes Weight Gain and Depression

Insulin Resistance, Pre-Diabetes, Central Obesity, Elevated Triglycerides and Depression

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Three different findings associated with insulin resistance and pre-diabetes are predictive of developing depression according to a study published online from the American Journal of Psychiatry. Study Summary MedPage Today (9/23/2021) writes that, “Three surrogate measures for insulin resistance all showed a significant link with developing a major depressive disorder [MDD] over a nine-year follow-up period,” researchers concluded. The 601-participant study …

Bipolar 101

Gateway Bipolar 101 Group – July 2021

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Next week will commence another round of our 6 week Bipolar 101 group for Gateway clients/patients hoping to learn more about how to manage the impact of their moods with more grace and awareness. Bipolar 101 is an online, six session group that covers topics such as general knowledge of the disorder, medications, substance use, early detection of episodes, healthy …

SSRI Doses and Effectiveness – High Dose vs Low Dose, Is There a Difference?

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One of the questions that has bedevilled clinicians ever since the introduction of the first SSRI (Prozac, fluoxetine) is whether there is any relationship between SSRI doses and effectiveness. In other words, do higher doses result in greater effectiveness. I can recall about 20 years ago reading the first clinical trial looking at this question. It was an article published …

Psychotherapy is Important for Depression Prevention

Peter Forster Best Practices, Major Depression, Treatments of Depression Leave a Comment

Psychotherapies — particularly cognitive-behavioral approaches used as adjunctive treatments — can play a critical role in helping people with a history of depression avoid relapse. For many people, major depression is a chronic illness. Even when they are no longer depressed, people who have had several episodes of depression have to be concerned about a significant risk of a recurrence …

Bipolar Therapy with Family

Psychotherapy for Bipolar

Peter Forster Best Practices, Bipolar Treatment, GPS Leave a Comment

People with bipolar disorder are much less likely to receive psychotherapy (26-50% of patients in one study got therapy) as opposed to psychiatric medications (46-90% were treated with medications) according to a study sponsored by the Depressive and Bipolar Support Association. This is not surprising since many mental health professionals were taught when we were in training that bipolar depression …

Limbic and Prefrontal Connectivity and Treatment Selection for Depression

Peter Forster Basic Science, Best Practices, Major Depression, Psychobiology, Treatments of Depression

Boadie Dunlop, M.D., M.S., and Helen Mayberg, M.D., both of Emory University School of Medicine, and colleagues assessed resting-state functional connectivity between the subcallosal cingulate cortex (SCC) and three other brain regions—the dorsal midbrain, the ventrolateral prefrontal cortex and anterior insula, and the ventromedial prefrontal cortex—in 122 patients with depression. The patients were then randomized to 12 weeks of cognitive-behavioral …

Try Cognitive Behavioral Therapy for Insomnia First

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Although there is reason for optimism about some of the newer medications for insomnia (orexin antagonists) that are coming to market, it remains true that sleeping medications are not the right answer for many people with insomnia. Cognitive behavioral therapy for insomnia (CBTi) has several advantages as an initial treatment. Cognitive Behavioral Therapy for Insomnia First We have been writing …

generic medications

Generic Medications

Peter Forster Best Practices, Costs of Treatment Leave a Comment

I have long been a strong proponent of generic medications. Recently, however, several of my patients have expressed concerns about the generic medications that they have received. This led me to do some research on generic pharmaceutical companies. The first thing to know about generics is that they are made by many different manufacturers in many different countries. This is …

TSH or Free T4 for Assessing Thyroid Function?

Peter Forster Best Practices, Physical Conditions and Health, Testing Leave a Comment

There are many reasons why thyroid status is important in a clinic treating people with mood disorders. For one thing, hypothyroidism and hyperthyroidism can mimic some of the symptoms of mood disorders. For another, lithium, a medication we often prescribe, is associated with hypothyroidism in a significant minority of patients taking the medicine. One of the questions we wrestle with …

Inflammation Testing and Antidepressant Selection

Peter Forster Best Practices, Major Depression, Physical Conditions and Health, Testing Leave a Comment

Inflammation and C Reactive Protein Inflammation is often seen in people with depression. And there is evidence to suggest that it predicts treatment response. The most widely accepted standard test to measure inflammation is the C-reactive protein, or CRP. This is a protein that is produced by the liver in inflammatory states. The American Heart Association and the Centers for …