Motivational Interviewing for Change

Peter Forster Best Practices, Physical Conditions and Health

We were inspired, as we often are, by the discussion in the most recent session of our bipolar 101 group to add some more content on our webpage about motivational interviewing and motivational enhancement therapy. These techniques are so often relevant to the people that we work with because mood disorders are frequently associated with difficult problems such as substance …

Neuroscience Based Nomenclature

Peter Forster Best Practices, Psychobiology, Treatments of Depression

Neuroscience Based Nomenclature is an initiative by a number of prestigious organizations supporting research in neuroscience and psychiatry to change the way that we talk about psychotropic / psychiatric medications. Why this might be useful is illustrated by conversations that are likely familiar to all psychiatrists… A severely depressed patient with bipolar 1 is discussing her need for a change …

Antidepressant Selection Based on Symptom Clusters

Peter Forster Best Practices, Major Depression, Testing

Can we do a better job of antidepressant selection based on symptom clusters, analyzed using machine learning techniques? Perhaps so. And if so we will avoid a great deal of unnecessary suffering as people try one medication after another until the find the right medication or combination of medications to treat their depression. That is the premise behind an ambitious …

TMS Effectiveness Updated

Peter Forster Best Practices, Major Depression, Treatments of Depression

TMS effectiveness for depression is clear. But now there are more machines for providing TMS and more protocols. Is deep TMS better than regular TMS?  Or is deep TMS just a marketing phrase? A major review article in JAMA Psychiatry updated our understanding of alternatives to the initial protocol for TMS. JAMA Psychiatry is the most prestigious journal in psychiatry, …

Measurement Based Care Controversies

Peter Forster Best Practices

Measurement based care often evokes controversies. A brilliant colleague, Carol Heckler, who is something of a local expert in psychopharmacology, interrupted a conversation I was having with another psychiatrist to say that she thought that standardized rating scales were useless. Echoing comments that I’ve heard from many of my patients, she said “how can you reduce human experience to a number?” This …

Long Term Depression Psychotherapy

Peter Forster Best Practices, Major Depression, Treatments of Depression

Effective psychotherapy for depression that has lasted for years is needed because chronic depression (lasting two years or longer) develops in up to a third of people with an episode of major depression. Chronic depression is associated with more suicidality, more impairment in functioning, and more hospitalizations. Chronic depression psychotherapy is often less effective than therapy for other forms of depression. …

Atypical Antipsychotics with Mood Stabilizers

Peter Forster Best Practices, Bipolar Treatment

Many people with bipolar receive atypical antipsychotics with mood stabilizers. As in many areas of medicine, we have relatively little data about longer-term outcomes when people receive this combination. If an atypical antipsychotic is added to a mood stabilizer to control a manic episode, how long should that combination be prescribed? A recent study conducted by the Canadian Mood and …

Antidepressant Response Linked to Norepinephrine Transporter Genotype

Peter Forster Best Practices, Major Depression, Testing, Treatments of Depression

A large study of patients treated with venlafaxine found that antidepressant response was linked to the norepinephrine transporter (NET) genotype. The study looked at response in a sample of 350 individuals over the age of 60 with severe depression (MADRS greater than or equal to 15) who were treated with venlafaxine up to a dose of 300 mg a day. …

Insomnia Relief

Peter Forster Best Practices, Insomnia, Insomnia Treatment

How to find insomnia relief is a question that many people we work with struggle with. A recent editorial in JAMA Psychiatry and the accompanying research article suggests that the online program that we’ve been recommending to our patients for years (SHUTi) is the treatment of choice for insomnia. We have been extremely pleased with the results from this program which can …

CBT for Insomnia Reduces Depression

Peter Forster Best Practices, Insomnia, Insomnia Treatment

An online sleep program using CBT for insomnia (Cognitive Behavioral Therapy for Insomnia – CBTi) has been shown to reduce depression in a study published in the April 2016 edition of Lancet Psychiatry. CBT for Insomnia CBTi is the most effective program for treating chronic insomnia and chronic insomnia is a major risk factor for developing depression. Unfortunately, CBTi is …