Reflections on Psychiatry & Psychology

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.

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.

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.

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.

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.

Years of trial-and-error approach can be averted by this relatively new tool in mental health assessment. The psychiatrist will be able to devise an effective treatment, without side effects.

Research shows a two-way gut–brain link: gut bacteria shape brain development and influence mood. Dysbiosis may contribute to anxiety and depression. Probiotics show mental health benefits, but aren’t yet FDA-regulated or reliable stand-alone treatments.

Suicide is the 10th leading US death. Predicting it is hard; only clozapine, lithium, and ketamine reduce risk. Genetics, stress, and access to means all contribute.

After quitting drugs, many feel bored because drugs flood the brain with dopamine, dulling natural rewards. With time and practice engaging in healthy activities, the brain can relearn to find pleasure in everyday life.

Lavender, used since antiquity, may ease anxiety. Its compounds (linalool, linalyl acetate) act on serotonin and NMDA receptors. Silexan (Calm-Aid) is a studied extract; consult your doctor due to potential drug interactions.

Hypervigilance to bodily sensations can trigger faster breathing and hyperventilation, lowering CO₂ and reducing oxygen delivery to tissues. This causes dizziness, tingling, and panic. Alcohol may give brief relief but worsens anxiety later; therapy can help.

“Brain zaps” are shock-like sensations during antidepressant withdrawal, especially with short–half-life SSRIs like Effexor or Paxil. Poorly studied, often abrupt-stop related; tapering helps only somewhat.

In 2019, Elijah McClain died after EMTs injected him with 500 mg ketamine during a police arrest. The text argues ketamine is not a sedative but a dissociative anesthetic that inhibits GABA indirectly and can raise heart rate and blood pressure. In a stressful arrest, this may worsen agitation and cardiac strain. It concludes ketamine should not be used to “sedate” detainees.