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Reflections on Psychiatry & Psychology


Ketamine for Chronic Pain? Evidence Still Missing
A large Cochrane review of 67 randomized trials (>2,300 patients) found no clear evidence that ketamine or other NMDA-receptor antagonists reduce chronic non-cancer pain. Evidence quality was rated low to very low, so current data do not reliably support ketamine as an effective pain treatment.
Alexander Papp, MD
Sep 7, 20252 min read


Prescription-Strength Nutritional Products for Mood and Brain Health
Prescription nutraceuticals sometimes used in psychiatry include Deplin and EnLyte (L-methylfolate formulations that support neurotransmitter production) and Vascepa and Lovaza (omega-3 fatty acids). They are not antidepressants but may be added to treatment to support mood and overall brain health.
Alexander Papp, MD
Apr 6, 20252 min read


Lithium and Alzheimer’s Disease: New Research Links Low Brain Lithium to Memory Loss
Researchers found that amyloid plaques in Alzheimer’s brains trap lithium, creating early lithium deficiency that may contribute to disease onset. In mice, low lithium worsened plaques and memory loss, while low-dose lithium orotate improved them. Human studies are still needed.
Alexander Papp, MD
Feb 2, 20252 min read


Ketamine and Postpartum Depression: A Promising New Treatment Option
Ketamine and postpartum depression: A landmark BMJ study found that a single dose of esketamine after childbirth reduced postpartum depression by 75% in at-risk mothers. Learn what this means for prenatal depression treatment and maternal mental health.
Alexander Papp, MD
Dec 1, 20243 min read


Does Naltrexone Block Ketamine’s Antidepressant Effect? The Opioid Receptor Problem in Ketamine Therapy
Does naltrexone block ketamine’s antidepressant effects? Stanford research shows opioid receptor blockade dampens ketamine’s mood and antisuicidal benefits. Point Loma Clinic in San Diego explains what this means for your treatment plan.
Alexander Papp, MD
Nov 3, 20243 min read


How the Aging Brain Processes Touch Differently: New Research on the Somatosensory Cortex
New research shows the aging brain remodels — not just declines. Discover how the somatosensory cortex changes with age, why some layers thicken while others shrink, and what parvalbumin neurons and myelin reveal about brain aging and touch processing.
Alexander Papp, MD
Oct 6, 20242 min read


Predicting Ketamine Treatment Outcomes: Key Findings and Implications
Can clinicians predict who will respond to ketamine for depression? A UCSD Veterans Affairs study identifies key baseline symptoms that predict ketamine non-response, informing better treatment planning. Learn more from Point Loma Clinic in San Diego.
Alexander Papp, MD
Sep 1, 20243 min read


The Resurgence of Psychedelic Psychiatry: An Exciting Yet Cautious Advance
Psychedelic psychiatry is moving from fringe research to mainstream clinical practice. An overview of psilocybin, MDMA, and ketamine — including benefits, risks, and what the evidence supports.
A. Papp MD & Julie Myers, PsyD, MSCP
Jul 7, 20243 min read


Advancing Treatment Approaches for Treatment-Resistant Depression
If multiple antidepressants haven't worked for you, you're not alone and you're not out of options. Why Antidepressants Fail: Lessons from the STAR*D Study Treatment-resistant depression (TRD) is a complex challenge in mental health, characterized by patients' inadequate response to standard antidepressant therapies. The landmark STAR*D study, which extensively evaluated treatment strategies for depression, revealed that a significant percentage of individuals do not respond
A. Papp MD & Julie Myers, PsyD, MSCP
Jun 2, 20242 min read


Unlocking the Brain: How the Lateral Habenula Influences Depression and Ketamine Therapy
The lateral habenula (LHb) stands out as a critical structure in understanding depression. This blog explores the LHb's role in the intricate landscape of neuroscience, its connection to depressive symptoms, and how ketamine therapy offers new hope by affecting this brain structure. 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 in
Alexander Papp, MD
Apr 28, 20242 min read


Ketamine and the Future of Mental Health: Insights from the 2024 Oxford International Conference
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.
A. Papp MD & Julie Myers, PsyD, MSCP
Mar 31, 20242 min read


How Stress and Bipolar Disorder Interact: Causes, Course, and Treatment
Stress and bipolar disorder (BD) interact bidirectionally. Stress, particularly in early life, appears to have lasting effects and marks for early onset of BD, although the exact mechanism is poorly understood. The relationship of stress to the onset of the disorder and its course has implications for treatment and management — and perhaps even prevention.
Julie Myers, PsyD, MSCP
Feb 24, 202419 min read


Understanding Methylfolate: Genetic Connection and Clinical Insights
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.
Alexander Papp, MD
Sep 24, 20232 min read


Don't Throw Out the Serotonin Theory Just Yet!
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
Alexander Papp, MD
Jun 25, 20232 min read


A New PAM on the Block
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.
Alexander Papp, MD
May 28, 20232 min read


The "Pipeline"
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.
Alexander Papp, MD
Apr 3, 20232 min read


Cough Medicine for Depression?
Dextromethorphan (DXM), found in cough meds, acts like mild ketamine. Combined with bupropion to slow its breakdown, it works quickly for depression. This combo was FDA-approved in 2022 as Auvelity.
Alexander Papp, MD
Jan 23, 20232 min read


Brain, Behavior, and Drugs
Drugs disrupt brain homeostasis by hijacking the dopamine-based reward system, producing powerful reinforcement and cravings. Repeated use causes brain adaptations, impaired impulse control, and stress-driven relapse. Genetics and environment increase risk, but recovery is possible through strengthened top-down control.
Julie Myers, PsyD, MSCP
Jun 26, 202213 min read


The Diagnosis of Bipolar II Disorder
Bipolar II disorder alternates between depression and hypomania but is hard to diagnose because patients often enjoy or fail to recognize hypomania and seek help only during depression. Recollections may be distorted, so collateral history from others is often crucial for accurate diagnosis.
Julie Myers, PsyD, MSCP
May 29, 20222 min read


Therapeutic Alliance as a Predictor of Outcome in Treatment of Cocaine Dependence
Study of 252 cocaine-dependent patients tested whether early therapeutic alliance predicts drug-treatment outcomes across several therapies. Alliance weakly predicted outcomes (better for depression than drug use). Design issues—many variables and mixed treatments—may have limited conclusions.
Julie Myers, PsyD, MSCP
Apr 24, 20224 min read
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