Category: Psychiatry

We say we care about mental health in America

We say we care about mental health in America.
But the data—and my front-line experience—say otherwise.

We are overmedicating, underfunding, and pathologizing poverty, trauma, and stress.
Instead of addressing why people are sick, we throw pills at symptoms.

🧠 In my latest article for Psychiatric Times, I make the case that we’ve built a system that profits off disease—not health.
We’re not solving the problem. We’re institutionalizing it.

If we want to make America healthy again, we need to stop doing the wrong things.

👉 Read the full piece here: https://www.psychiatrictimes.com/view/if-we-want-to-make-america-healthy-again-we-are-doing-the-wrong-thing

0

Is Antidepressant Withdrawal Overhyped? What the Evidence Really Says

In my clinical practice, I’ve often found myself scratching my head over the narrative surrounding antidepressant withdrawal.

I’m not denying that withdrawal is real—it is. And for a small subset of patients, it can be quite distressing. But what I am saying is this: it’s not nearly as common, dramatic, or dangerous as some online circles and sensational stories would have you believe.

I’ve seen countless patients abruptly stop antidepressants and experience no withdrawal symptoms. I’ve also aggressively tapered antidepressants in patients with bipolar disorder to prevent mood destabilization—again, with little to no evidence of withdrawal. This isn’t a one-off observation. It’s a consistent clinical pattern I’ve noted for years. So, I asked myself: What does the data actually say?

The Evidence

A 2024 meta-analysis published in JAMA Psychiatry examined 49 randomized controlled trials and finally gave us some clarity.

The results?
✅ People discontinuing antidepressants reported on average just one more symptom than those who either continued medication or discontinued a placebo.
✅ The most commonly reported symptoms in the first two weeks were dizziness, nausea, vertigo, and nervousness—exactly what I’ve seen clinically.
✅ Critically, the average number of symptoms fell below the threshold for what’s considered a clinically significant discontinuation syndrome.
✅ There was no link between discontinuation and worsening depression, suggesting that if mood symptoms return, it’s likely a relapse—not withdrawal.

Why This Matters

There are vocal groups online—often with clear anti-psychiatry agendas—who focus exclusively on rare, severe cases of withdrawal and present them as the norm. The goal is simple: to scare people away from psychiatry and evidence-based treatment using emotional testimonials instead of clinical reality.

Let’s be honest—those cases do exist, but they are not representative of what most patients experience.

As clinicians, we should remain cautious and responsible. Yes, we should taper medications thoughtfully. Yes, we should prepare patients for the possibility of withdrawal symptoms. But we also shouldn’t scare them into avoiding treatment—or make them feel trapped on medications for life.

Bottom Line

Antidepressant withdrawal can happen. It can be uncomfortable. But it’s rarely severe and almost never dangerous. The fear around it has been overstated by those with an ax to grind. We owe it to our patients to treat based on evidence, not anecdotes.

0

Brexpiprazole + Sertraline: A New Hope for PTSD Treatment

We’ve all seen it: PTSD that won’t budge. Patients try sertraline or paroxetine—the so-called “gold standards”—and walk away with little more than side effects and a sense of failure.

Enter a new contender: brexpiprazole + sertraline.

A recent Phase 3 randomized controlled trial might finally offer something real for those stuck in the PTSD trenches.

🚨 The Results

In a study across 86 sites with over 550 adults, adding brexpiprazole (2–3 mg) to sertraline (150 mg) led to a 5.6-point greater reduction on the CAPS‑5 (the gold-standard PTSD measure) compared to sertraline + placebo. That’s not a marginal win—it’s a clinically significant shift, especially in a treatment-resistant population.

Responder rates tell the story even clearer:

  • 68.5% of patients on the combo had ≥30% reduction in symptoms
  • Compared to 48.2% on sertraline alone
  • That’s a +20% absolute response rate boost

And the improvements weren’t just short-lived. Benefits held through 12 weeks, even during a post-treatment observation period. No relapse, no rebound—just stability.

🧩 More Than Symptom Checklists

It wasn’t just about PTSD symptoms. This combo also:

  • Improved psychosocial functioning (B-IPF scores)
  • Reduced anxiety and depression (HADS)
  • Lowered global illness severity (CGI-S)
  • Helped with all symptom clusters, including reexperiencing, avoidance, and hyperarousal

That’s rare. Most meds in psychiatry hit one or two domains and leave the rest hanging. This one made a dent where it counts: function, resilience, and real-world relief.

⚠️ What About Side Effects?

Brexpiprazole is still an atypical antipsychotic, so there’s baggage. But the trial data suggest it’s relatively well-tolerated:

  • Fatigue: 6.8%
  • Weight gain: 5.9%
  • Somnolence: 5.4%
  • Discontinuation due to AEs? Just 3.9%, vs 10.2% in placebo.

No new safety signals. No psychosis worsening. Not perfect, but not the metabolic disaster zone we see with other agents.

🚀 What’s Next?

The FDA is reviewing this combo

For those of us treating chronic PTSD, this may be a real tool—not just a shiny new molecule with good marketing.

Until then, it’s worth paying attention. Because when sertraline alone doesn’t cut it—and we know it often doesn’t—this combo could offer a lifeline.

0

🧠 Blog Post: The Dark Mirror—How Screen Time Drains Our Mental Health

It’s no secret that screen time affects our mental health—but we still underestimate just how deeply it cuts.

As a psychiatrist, I find myself glued to my phone far more than I’d like. I’m not scrolling TikTok—I’m answering emails, responding to messages, and compulsively checking patient updates. Yet, even in this “productive” digital use, I feel drained. The compulsion to keep checking leaves me feeling hollow and anxious.

Now imagine that same digital pull in the hands of a developing mind.

A recent study in JAMA examined over 4285 adolescents and found a clear link: teens with high levels of addictive digital media use were significantly more likely to report depression, anxiety, and suicidal thoughts.

The connection isn’t surprising. Much of what’s consumed online isn’t educational or uplifting—it’s filtered perfection, highlight reels, and influencer fantasy. The more time spent scrolling, the easier it is to feel like you’re falling behind in life, socially or emotionally.

It’s telling that Steve Jobs famously limited his own children’s access to screens, despite pioneering the very technology we now feel chained to.

This isn’t about demonizing devices—it’s about reclaiming our attention and protecting mental space, especially for young people.

We need digital hygiene just like we need physical hygiene. That means:

  • Setting screen-time boundaries
  • Promoting offline connection
  • Reframing how we compare ourselves to curated content

Mental health isn’t just shaped in the therapy room—it’s shaped by the world we scroll through every day.

0

Understanding Psychiatry: Science vs. Skepticism

🧠 “Psychiatry is a scam.” “Big Pharma controls your brain.” “Mental illness isn’t real.”

You’ve heard the takes. Now here’s the truth.

In my new article for Psychiatric Times, I dive headfirst into the controversy:
👉 Understanding Psychiatry: Navigating Skepticism and Science
https://www.psychiatrictimes.com/view/understanding-psychiatry-navigating-skepticism-and-science

I don’t dodge the hard questions—about overmedication, broken trust, and bad science—but I also push back against lazy anti-psychiatry takes that ignore the very real suffering of patients.

If you care about the future of mental health care, this one’s worth your time.

0

Mirtazapine: A unique tool in the antidepressant toolbox

Mirtazapine isn’t your typical SSRI—and that’s exactly why it can be useful in the right context.

✅ When to consider mirtazapine:

  • Depression with insomnia
  • Poor appetite or weight loss
  • Concern about sexual side effects
  • Patients struggling with GI intolerance to SSRIs

⚠️ When to avoid it:

  • Obesity or metabolic syndrome
  • Risk of daytime sedation
  • Orthostatic hypotension history

Mechanistically, it’s a noradrenergic and specific serotonergic antidepressant (NaSSA). It works via alpha-2 autoreceptor blockade, enhancing 5-HT1A transmission while avoiding 5-HT2/3 activity—translating to fewer GI and sexual side effects.

💡 Pro tip:
Sedation is dose-dependent and paradoxical:
Lower doses (7.5–15 mg) = more sedation
Higher doses (30–45 mg) = less sedation

In short, mirtazapine shines in cases where sleep, appetite, or tolerability limit other antidepressants—but use it strategically.

0

Reject dogma—embrace nuance in Psychiatry

🔹 Psychoanalysis should not be treated as sacred doctrine. Freud was a clever and influential thinker, but not a prophet.


🔹 Biological psychiatry is equally vulnerable to dogma. Not every symptom signals a disease, and not every distress warrants medication.


🔹 That said, evidence-based pharmacology has its place—especially when medications show clear, replicable benefits in defined clinical conditions.

The future of psychiatry lies in balanced thinking, not blind allegiance—to Freud, to biology, or to any single model of mind.

0

New JAMA Study Challenges Previous Concerns About Valproate and Paternal Risk

What we thought we knew may not hold up under scrutiny.

A recent JAMA Psychiatry study titled “Disorders and Paternal Use of Valproate During Spermatogenesis” has delivered surprising news:

There was no increased risk of neurodevelopmental disorders in children whose fathers were taking valproic acid around the time of conception.

This finding directly challenges earlier observational data that suggested a possible link, leading to cautionary guidance against prescribing valproate to men of reproductive age. But now, with a large, well-conducted study showing no signal of harm, we’re left reconsidering that initial recommendation.

As clinicians, we must remember:
🔍 Association is not causation.
🚧 Observational studies, while valuable, can mislead when confounding variables aren’t fully accounted for.
📚 Evidence evolves—and so must our clinical guidance.

This study not only impacts how we think about valproate use in men but also serves as a critical reminder about the limits of inference from non-randomized data.

👉 For patients with bipolar disorder or epilepsy who benefit from valproate, this offers some reassurance. We may not need to withhold an effective treatment based on unconfirmed reproductive risks.

📌 Bottom line: Always be skeptical. Always be curious. Always be willing to revise your practice when the data say it’s time.

link to the study: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2834363

0

Negative symptoms of schizophrenia remain one of the toughest challenges in treatment

These symptoms often include:
🔹 Decreased motivation (avolition)
🔹 Blunted or flat affect
🔹 Reduced emotional range
🔹 Paucity of speech (alogia)

Unlike positive symptoms, negative symptoms respond poorly to antipsychotic medications—even clozapine, our most effective agent for treatment-resistant illness, offers limited relief.

These deficits are often chronic, functionally disabling, and deeply impact quality of life.

Tackling negative symptoms will be the next frontier in improving long-term outcomes in schizophrenia. We need innovative approaches, novel mechanisms, and more research focused on this under-addressed domain.

0

Suicide is a tragically common outcome in schizophrenia

🔹 Up to 50% of patients attempt suicide
🔹 Around 10% die by suicide

The InterSePT trial directly addressed this crisis by comparing clozapine vs olanzapine in high-risk patients—all with recent suicidal ideation or attempts. Notably, only 27% were treatment-resistant.

✅ Clozapine led to a 25% reduction in suicidal behaviors—a game-changer.
📌 This led to FDA approval for clozapine in reducing suicidality in schizophrenia.

Let’s stop thinking of clozapine only as a last resort. Sometimes, it’s exactly what’s needed—not later, but now.

0

Powered by WordPress.com.

Up ↑