Reflections on Psychiatry & Psychology

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

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.

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.

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.

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.

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.

Cravings for drugs or alcohol are controlled by a variety of brain chemicals, including norepinephrine, dopamine, and glutamate.  Many people describe their cravings as coming out of nowhere, as if these chemicals pop into their brains and create a cravings spontaneously. These chemicals and the manifestations of cravings are actually triggered by stimuli from external environmental cues and internal mood states, particularly anxiety, irritability, and dysphoria.  Environment

Pharma has saved millions but is driven by profit. New drugs are priced high to recoup R&D costs; when patents expire, generics get cheaper. Companies often use tactics to extend profits beyond patent life.

Joe was in his mid-fifties, an accomplished attorney who has been suffering from recurrent depression since his early adulthood. The depression was difficult to treat; many different medications have been tried, including mood stabilizers (medications for bipolar disorder), but those were prescribed such a long time ago that Joe had  a hard time remembering how he was feeling when they were prescribed. All he knew that for at least the last ten years he was only depressed, so

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.

Drug labels can mislead: meds are named for first uses, but act by mechanism. Topiramate (Topamax) began as seizure and migraine treatment, yet is also used off-label for mood stabilization or weight loss, among others.

“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.