Tag: depression treatment

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

🧠 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

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

Avoid Tianeptine: FDA Alerts Consumers to Risks

The U.S. Food and Drug Administration (FDA) has issued a critical health warning about the growing availability of tianeptine, a dangerous, unapproved substance being sold as a dietary supplement under names like Zaza, Tianna Red, Pegasus, and others.

Commonly referred to as “gas station heroin”, tianeptine mimics opioid-like effects and is being sold in convenience stores, gas stations, smoke shops, and online—posing serious health risks to the public.

⚠️ Why This Matters:

Tianeptine is not approved for any medical use in the U.S. Despite this, it is widely marketed for supposed benefits like mood enhancement, anxiety relief, or cognitive boost. These claims are not supported by clinical evidence, and the risks are significant.

🩺 Serious Health Risks Associated With Tianeptine:

⚠️ Death, particularly when combined with alcohol or other substances

⚠️ Respiratory depression (slow or stopped breathing)

⚠️ Seizures

⚠️ Loss of consciousness

⚠️ Confusion and agitation

⚠️ Opioid-like withdrawal symptoms

🛑 What You Can Do:

Report adverse reactions to the FDA via MedWatch: https://www.fda.gov/medwatch

Avoid any products labeled as containing tianeptine.

Do not trust unregulated supplements marketed for mental clarity or energy.

📌 Quick Summary:

  • Tianeptine = dangerous, unapproved opioid-like drug
  • Sold as a supplement under names like Zaza or Tianna Red
  • Linked to seizures, coma, and death
  • Avoid these products and warn others
  • Report side effects to the FDA MedWatch Program
0

The Importance of Distinguishing Suicidal Behaviors

This is the subject of a recent discussion I had with a colleague regarding the differences between a suicide attempt and a suicide gesture. Though these terms are sometimes used interchangeably in casual conversation or even in clinical documentation, they carry fundamentally different meanings—both in terms of patient risk and in how we, as clinicians, should respond.

Our conversation emerged from a case involving a patient with borderline personality disorder who presented to the emergency department after ingesting a small quantity of over-the-counter medication. The intent was unclear. Was this a serious attempt to end her life? Or was it a gesture—an act of desperation without the intention to die, but rather to communicate emotional distress?

The question is not academic. Our interpretation of the event determines our risk formulation, our documentation, our treatment planning, and even how we communicate with the patient and their support system. Yet, it is precisely in these gray areas that clinicians often struggle, and where outdated or stigmatizing language can do real harm.

Defining the Terms: Clinical and Functional Differences

A suicide attempt refers to an act of self-harm with at least some intent to die. The degree of lethality may vary, but what distinguishes an attempt is that the individual believed the act could result in death and engaged in it with that goal in mind—even if ambivalence was present. The National Institute of Mental Health (NIMH) and the Columbia-Suicide Severity Rating Scale (C-SSRS) define this with some specificity: any potentially self-injurious behavior with non-zerointent to die, regardless of outcome.

In contrast, a suicidal gesture is a behavior that mimics suicidal behavior or appears life-threatening but is typically not intended to be fatal. The function is often communicative or affect-regulating rather than aimed at death. Classic examples include superficial wrist-cutting, ingesting a sub-lethal dose of medication, or tying a noose but not tightening it. These acts often occur in interpersonal contexts and can be seen as efforts to signal pain, elicit help, or assert control in the face of perceived abandonment.

Why the Distinction Matters

It might be tempting to dismiss suicidal gestures as “attention-seeking” or “manipulative,” but this framing is both clinically dangerous and ethically fraught. Individuals who engage in gestures often experience intense psychological suffering, and repeated gestures are a well-established risk factor for future suicide attempts and completed suicide.

From a risk assessment standpoint, gestures should be taken seriously, especially when they become part of a pattern. While the intent to die may not be present in a given gesture, intent can shift quickly, particularly in individuals with mood disorders, personality pathology, or under the influence of substances.

From a treatment perspective, understanding the function of the behavior—whether it is to relieve affective tension, to communicate distress, or to punish oneself—is crucial to tailoring interventions. For instance, dialectical behavior therapy (DBT) explicitly targets self-harm and suicidal gestures as part of its hierarchy of treatment priorities, recognizing the urgency and potential danger of these behaviors even when lethality is low.

Conclusion: Clarify, Don’t Categorize

Ultimately, the conversation with my colleague reminded me that the real clinical challenge is not to label a behavior as a suicide attempt or a gesture, but to understand its meaning in the life of the patient. Both require empathy, structure, and a willingness to engage with complexity. Whether a patient wants to die or wants their suffering to be seen and acknowledged, both deserve serious clinical attention.

By sharpening our definitions and approaching these behaviors with nuance, we can better serve patients in crisis and avoid the pitfalls of assumptions—especially in emotionally charged clinical environments like emergency rooms, inpatient units, or high-acuity outpatient settings.

0

Why CBT Reigns as the Top Therapy for Mental Health

🧠💡 CBT Confirmed—Again: Landmark Meta-Analysis Reinforces Clinical Value Across Diagnoses
A massive meta-analysis in JAMA Psychiatry (2025) reaffirms what many of us observe in day-to-day care: Cognitive Behavioral Therapy (CBT) is one of the most effective, versatile, and enduring treatments for adult psychiatric conditions.

🔬 Study at a Glance

  • Pooled data from hundreds of RCTs
  • Assessed CBT’s efficacy across depression, anxiety disorders, PTSD, and eating disorders
  • Found significant, lasting effects across diagnostic categories
  • Highlighted condition-specific variation in effect sizes, but overall CBT consistently outperformed inactive controls

📚 Real-World Relevance
Imagine a patient with chronic panic disorder who’s failed two SSRI trials and prefers non-pharmacologic interventions. CBT remains a frontline solution—equally relevant for the young adult with bulimia or the veteran with PTSD. These aren’t just data points—they’re the cases we see every day.

🔄 How Does CBT Stack Up Against Other Therapies?
While the study primarily focused on CBT, it reinforces existing literature suggesting that CBT often matches or outperforms alternative modalities like psychodynamic therapy or interpersonal therapy in short-term efficacy—especially when structure, time-limited treatment, and measurable goals are critical.

🛠 Implications for Clinical Practice
✅ Why prioritize CBT?

  • It’s highly adaptable
  • Supported across diverse populations
  • Scalable via group therapy, digital tools, and telehealth

🚧 Barriers to Access:

  • Limited availability of trained therapists
  • Insurance coverage gaps
  • Patient preference for “talk therapy” without structure

✅ Strategies to Overcome Them:

  • Integrate CBT-informed principles into brief med management visits
  • Refer to digital CBT platforms when face-to-face access is limited
  • Advocate for reimbursement parity and expanded training programs

📎 Bottom Line
This study isn’t just academic—it’s a call to action. Prioritizing CBT in treatment planning can lead to better outcomes, broader reach, and more durable recovery. As clinicians, it’s on us to ensure our systems support its accessibility.

📖 Full Article:
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2832696

0

🧠 Esketamine + Antidepressants in TRD: Does the Combo Matter?

📢 New data from a real-world study of 50,000+ patients with treatment-resistant depression (TRD) published in JAMA Psychiatry:

📌 Study Question:
Does combining esketamine with an SSRI or SNRI affect long-term outcomes in TRD?

📊 Key Findings (5-Year Follow-Up):

  • ✅ Esketamine + SNRI:
     ↘️ Lower all-cause mortality
     ↘️ Fewer hospitalizations
     ↘️ Reduced depressive relapse
  • ✅ Esketamine + SSRI:
     ↘️ Lower incidence of suicide attempts
  • 🔒 Overall: Low rates of adverse outcomes in all groups

💡 Clinical Implications:

  • Not all combinations are equal—pairing matters.
  • Esketamine + SNRI may be preferred for reducing relapse/mortality
  • Esketamine + SSRI may be considered in patients at risk for suicide
  • Personalized treatment decisions can enhance outcomes in TRD

🔍 More than symptom relief—it’s about survival, stability, and safety.

0

Can Creatine Boost Therapy for Depression? New Study Says Maybe!

A recent 8-week double-blind, randomized, placebo-controlled trial investigated whether oral creatine monohydrate (5g/day) could enhance the effects of cognitive-behavioral therapy (CBT) in treating major depressive disorder (MDD)—especially in under-resourced areas where access to treatment is limited.

🔬 Why Does This Matter?
While CBT is a gold-standard therapy for depression, many patients do not achieve full remission. This study explored whether creatine—widely used for muscle and brain energy metabolism—could provide an extra boost to treatment.

🧠 Key Findings:
✅ Participants receiving creatine + CBT had greater reductions in depression symptoms (measured by the Hamilton Depression Rating Scale) compared to those receiving placebo + CBT
✅ Reported improvements in mood, energy levels, and cognitive function
✅ Creatine was well-tolerated, with no significant safety concerns
✅ CBT was delivered once weekly by trained therapists

⚠️ Study Limitations:
🔹 Small sample size—larger studies are needed to confirm these findings
🔹 Short trial duration—long-term effects are still unknown
🔹 Study population—results may not generalize to all individuals with MDD

💡 What’s Next?
If larger studies confirm these results, creatine could become an accessible, affordable adjunct to therapy, particularly in communities with limited mental health resources.

What do you think? Could a common fitness supplement help improve mental health? Let’s discuss! ⬇️

link to study: https://www.sciencedirect.com/science/article/pii/S0924977X24007405

0

Managing Mild to Severe Depression: A Guide to Treatment Approaches

It is crucial to recognize that none of the available medications or neuromodulation procedures, including electroconvulsive therapy (ECT) and psychedelics, are disease-modifying. This means that while these treatments can alleviate symptoms, they do not address the underlying causes of depression. Think of them like acetaminophen for a fever—it may temporarily reduce the fever, but without treating the underlying infection, the fever will return.

Neuromodulation refers to techniques that alter brain activity through electrical or magnetic stimulation. Examples include ECT, transcranial magnetic stimulation (TMS), and vagus nerve stimulation (VNS), all of which have been explored as treatments for severe depression.

Optimizing Depression Treatment for Different Severity Levels

Given this understanding, how can we best utilize these treatments to support patients during difficult times? The key is to acknowledge that medications and neuromodulation primarily serve as symptom management tools, most effectively used in the short term for severe cases.

Mild to Moderate Depression: Prioritizing Non-Medication Approaches

For individuals experiencing mild to moderate depression, medication should not be the first line of treFor individuals experiencing mild to moderate depression, medication should not be the first line of treatment. Many people can directly link their depressive symptoms to stressful life events. In such cases, the best initial approach includes:

  • Cognitive Behavioral Therapy (CBT) – Evidence-based therapy that helps reframe negative thinking patterns. Research has shown that CBT is as effective as antidepressants for mild to moderate depression, with relapse rates significantly reduced in those who complete therapy.
  • Lifestyle Modifications – Regular exercise and a healthy diet have strong evidence supporting their role in reducing depressive symptoms. A study published in JAMA Psychiatry found that individuals engaging in at least 150 minutes of moderate exercise per week had a 25% lower risk of developing depression.

For some, these interventions alone may be sufficient to overcome depression and maintain long-term well-being. If additional support is needed, natural supplements with reasonable evidence, such as St. John’s Wort and S-Adenosylmethionine (SAMe), may be considered for mild to moderate depression. However, these supplements are not without risks—St. John’s Wort can interact with many medications, including antidepressants and birth control pills, potentially reducing their effectiveness. SAMe may cause gastrointestinal discomfort or manic symptoms in individuals with bipolar disorder.

Severe Depression: When Medication and Neuromodulation Play a Role

For individuals with severe depression, particularly those at risk for self-harm or suicide, the risks and benefits of medication should be carefully weighed. Antidepressants and neuromodulation therapies have demonstrated the most significant impact in these cases. When selecting a medication, I prioritize those with a lower risk of concerning side effects, particularly sexual dysfunction. My initial choices often include:

  • Bupropion – A dopamine-norepinephrine reuptake inhibitor with a favorable side effect profile.
  • Vortioxetine – Known for its cognitive benefits and relatively low sexual side effects.
  • Mirtazapine – Can be beneficial for those with sleep disturbances or appetite loss.
  • Vilazodone – A serotonin modulator with a lower incidence of sexual dysfunction compared to SSRIs.

It is essential for patients starting antidepressants to be closely monitored, especially in the early weeks of treatment, to assess for side effects and response. Regular follow-ups with a healthcare provider can help adjust dosages or explore alternative treatments if needed.

Treatment Duration and Discontinuation Considerations

For those starting medication, I generally recommend continuing treatment for 6 to 12 months, followed by an assessment to determine whether tapering off is feasible. This process involves shared decision-making, considering:

  • Symptom severity and stability
  • Level of daily functioning
  • Patient’s goals and preferences

The goal is to ensure that the patient has developed effective coping strategies, engaged in therapy, and adopted a healthy lifestyle before considering medication discontinuation. If stopping medication is not advisable, we work to identify the lowest effective dose for long-term maintenance.

Final Thoughts

Depression treatment should be personalized and dynamic, evolving with the patient’s needs. By recognizing that medications and neuromodulation are tools for symptom management rather than cures, we can ensure they are used effectively—providing relief during crises while prioritizing long-term strategies for resilience and recovery.

0

Female Physicians at Higher Risk for Suicide: Key Findings

A February 26, 2025 study in JAMA Psychiatry reveals alarming trends in physician suicide rates:

📊 Key Findings

🔹 Female physicians face a significantly higher suicide risk compared to the general U.S. population.
🔹 Male physicians have a lower suicide risk than their nonphysician counterparts.

💡 Why This Matters

These statistics underscore a deeper systemic issue within healthcare
➡️ “Physicians face immense pressure, long hours, and high-stakes decisions, which contribute to burnout and mental health struggles.”

Failure to address these issues can lead to increased physician turnover, lower quality of care, and worsening healthcare outcomes for patients.

✅ What Can Be Done

✔️ Reduce stigma around mental health in medical culture.
✔️ Implement confidential mental health resources specifically for physicians.
✔️ Encourage work-life balance through adjusted schedules and peer support programs.
✔️ Offer routine mental health check-ins as part of employee wellness programs.

📞 Where to Get Help

🆘 If you or someone you know is struggling, help is available:
➡️ Call or text 988 for free, confidential support 24/7.
➡️ Visit the Physician Support Line at www.physiciansupportline.com — available 7 days a week with support from licensed psychiatrists.

💙 It’s time to support those who care for us.

0

Powered by WordPress.com.

Up ↑