Reflections on Psychiatry & Psychology

OCD is often diagnosed late (6–10 years) due to varied symptoms and stigma. Depression frequently co-occurs and may obscure OCD. Standard treatment is ERP plus SSRIs; other medications may be added. Emerging evidence suggests ketamine may help treatment-resistant OCD.

Introduction:  In the intricate landscape of neuroscience, the lateral habenula (LHb) stands out as a critical structure in understanding depression. This blog explores the LHb's role, its connection to depressive symptoms, and how ketamine therapy offers new hope. The Lateral Habenula: A Critical Brain Structure The lateral habenula (LHb) is a small, symmetrical, paired nucleus located deep within the brain, nestled between the two thalamic bodies. It is intricately connecte

The 2024 Oxford Ketamine Conference gathered global experts to discuss ketamine’s science and clinical use in mental health. Key themes included its rapid antidepressant effects, mechanisms of action, and improving treatment approaches, highlighting interdisciplinary collaboration and future research.

Psychosocial treatment for bipolar disorder includes psychoeducation, CBT, social rhythm therapy, family therapy, and group work. These target stress, routines, cognition, and relationships to reduce relapse. Early intervention and stress prevention—especially after childhood adversity—may improve course and outcomes.

Treatment The treatment of BD is complex.   Psychosocial treatments are necessary but rarely sufficient for controlling relapse or acute symptoms.  From my observations, the treatment of BD is as much of an art as it is a science, with different researchers and clinicians having different ideas as to what is the appropriate formulation.   Critically important is the assessment of suicide throughout the treatment.  Suicidal ideation and suicide completion is a very real possib

Stress is closely linked to bipolar disorder (BD), though its role in causation is unclear. BD is highly heritable. The Kindling theory suggests early stress triggers first episodes, after which episodes may become autonomous or stress-sensitized. Early trauma predicts earlier onset, greater severity, and poorer outcomes.

The Comorbidity of Bipolar Disorder and Stress disorders   Comorbidity is common in BD, further complicating the diagnosis.  In one study, a comorbid disorder was found in all of the samples, and in 59% the condition preceded the onset of BD symptoms (Kessler, Rubinow, Holmes, Abelson, & Ahao, 1997).  Common among the comorbid disorders are anxiety, substance abuse, ADHD, Oppositional-Defiant Disorder, Bulimia, Social Phobia, Panic Disorder, and Obsessive Compulsive Disorder 

It is generally agreed in the literature that stress affects the course and severity of Bipolar Disorder. Diagnosis is particularly difficult, because those with BD often do not recognize their episodes and so do not report their presence.

Introduction Ketamine, an NMDA receptor antagonist, has shown promise in the treatment of various psychiatric disorders, including depression and PTSD. Its rapid-acting therapeutic effects have made it an appealing option in clinical settings under strict supervision. However, the trend towards take-home ketamine, facilitated through prescriptions for nasal sprays and oral lozenges, raises significant safety and efficacy concerns. This blog entry explores some of the reasons

Matthew Perry, celebrated for his iconic role on "Friends," tragically passed away on October 28, 2023, after being found unresponsive at the heated end of his swimming pool. His live-in personal assistant discovered him upon returning from errands. Despite immediate efforts to revive him, Perry was pronounced dead by emergency personnel at 4:17 p.m. Mr. Perry battled several health issues including chronic obstructive pulmonary disease (COPD), diabetes, and had a history of

Zurzuvae, the first FDA-approved oral pill for postpartum depression, is taken for 14 days and can reduce symptoms within days. Costing about $15,900, access may be limited despite its rapid action compared with traditional antidepressants.

The “988 Lifeline” service was launched in July 2022, progressing from the narrow focus on suicide prevention as the “National Suicide Prevention Lifeline” to a wider attention of forms of acute distress (and also requiring a much simpler dial code).  A recent study on 988 Lifeline reveals that while it has received millions of calls, texts, and online messages, it might not be living up to its full potential. The researchers found that people dealing with severe psychologic

Methylfolate, the active form of folate (B9), supports serotonin and dopamine production and may help depression, especially in people with MTHFR variants or treatment-resistant cases. It can cause GI upset or insomnia and should be used cautiously, especially with SSRIs, under medical supervision.

In areas where cannabis is legal, more young people are driving under its influence than alcohol. Misconceptions about impairment, lack of clear THC limits, and normalization of use raise road safety concerns, highlighting the need to balance legalization with prevention.

After 30+ years serving San Diego, Point Loma Shelter Island Drug and Point Loma Cabrillo Drug closed. Crime and PBM “clawbacks” strained the small, personal pharmacies. Owner Michael Saad sold to a chain after years of 12-hour days. Loyal patrons will miss the care.

The serotonin theory of depression has been around for a good 60 years and is often used as justification for the use of antidepressants, specifically selective serotonin re-uptake inhibitors (SSRIs). Understandably, a review published recently by psychiatric researcher Joanna Moncrieff, which concluded that there was no consistent evidence of an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin act

Zuranolone (Zurzuvae) is the first oral GABA-modulating antidepressant for postpartum depression. Taken for 14 days, it can improve symptoms within 3 days; benefits may last weeks. Common side effects include drowsiness and dizziness.

There are several exciting developments in the field of antidepressants, with various drugs currently in the pipeline. still in various stages of development. Clinical trials are ongoing to evaluate their safety, effectiveness, and potential side effects.

A 2022 study confirmed brain zaps as real antidepressant-withdrawal symptoms. Restarting or slowly tapering meds may help. Most improve over time, but some suffer for years. Despite this, psychiatry has shown little response.

Nutraceuticals—herbs and vitamins like ashwagandha, kava, chamomile, and CBD—may ease mild anxiety but aren’t a substitute for professional treatment. Consult a healthcare provider.