Tag: medical education

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

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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.

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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.

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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.

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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.

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RFK Jr. Claims He’ll Identify the Cause of Autism by September

In a bold statement this week, Robert F. Kennedy Jr. announced that he will reveal the definitive cause of autism by September. Kennedy, a longtime critic of childhood vaccine programs, did not provide specific scientific details or a research plan, but implied that his administration would prioritize transparency and independent investigations into the condition’s origins.

The claim has sparked immediate controversy. Autism is a complex neurodevelopmental condition with a strong genetic foundation and a wide range of potential environmental influences—none of which have yielded a singular, definitive cause. The scientific consensus, built over decades of rigorous research, continues to support a multifactorial model rather than a simplistic explanation.

Many highly intelligent and dedicated scientists have spent years studying autism without identifying a single, unifying cause. One of the recurring issues that arises when politics intersects with science is a resistance to the idea that these are nuanced, multifaceted conditions. It’s not the most satisfying explanation—but it is consistent with the best evidence we have. My fear is that this type of investigation, under political pressure, could prematurely identify a false causal agent—such as vaccines—and reignite a harmful narrative that has already been thoroughly debunked.

Kennedy’s history of promoting vaccine-autism links adds further concern. The CDC, WHO, and a vast body of peer-reviewed research have all concluded there is no credible evidence connecting vaccines to autism. Suggesting otherwise not only undermines public trust in science and medicine—it risks the health of entire communities by fueling vaccine hesitancy.

For families and individuals affected by autism, the promise of discovering its origins is understandably compelling. But it’s critical that we approach that pursuit with scientific integrity, not political expediency.

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🚨 New Study Links Antidepressant Use to Significant Weight Gain Over 6 Years! 

A recent study published in Frontiers in Psychiatry reveals that individuals using antidepressants experienced notable weight gain over a six-year period.​

Key Findings:

  • Increased Weight Gain:​
    • Participants who used antidepressants showed an average weight increase of approximately 2% of their baseline body weight compared to non-users.​
  • Higher Obesity Risk:​
    • Those without obesity at the study’s start had double the risk of becoming obese if they used antidepressants throughout the six years.​

Implications:

With the widespread use of antidepressants and the global obesity epidemic, integrating weight management and metabolic monitoring into depression treatment plans is crucial.​

link: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1464898/full

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Challenges of Antidepressant Management in Primary Care

Discussions about the potential overprescribing of antidepressants must begin with an understanding of who is doing most of the prescribing. In the U.S., primary care physicians (PCPs) write the majority of antidepressant prescriptions, with estimates suggesting that 60–80% originate from primary care rather than psychiatry (Mojtabai & Olfson, 2011; Mark et al., 2014). This prescribing pattern reflects broader trends in mental health treatment, where primary care has become the frontline for managing depression and other mood disorders.

Several factors contribute to this dynamic:

  • Limited access to psychiatrists: Many patients, especially in rural or underserved areas, face long wait times or geographic barriers to seeing a psychiatrist.
  • Overlap with medical conditions: PCPs frequently manage conditions like chronic pain, insomnia, and fatigue, for which antidepressants may be considered as part of the treatment plan.
  • Continuity of care: Patients often have longstanding relationships with their primary care providers, making them more comfortable discussing mood symptoms in this setting.
  • Psychiatric referral limitations: Many psychiatrists focus on complex or treatment-resistant cases, meaning initial treatment often falls under primary care.

Challenges and Considerations

While primary care plays a crucial role in mental health treatment, concerns exist regarding the effectiveness of antidepressant management in this setting:

  • Suboptimal dosing and medication selection: Studies suggest that antidepressants prescribed in primary care settings may be dosed too low or not adequately adjusted, potentially leading to partial response or treatment failure (Carrasco & Sandner, 2005). Additionally, there is a higher likelihood of using older antidepressants, which may have a less favorable side effect profile.
  • Lack of therapy integration: Guidelines recommend a combination of medication and psychotherapy for moderate-to-severe depression (APA, 2010), yet PCPs may have limited time, training, or referral resources to ensure therapy is included.
  • Potential misdiagnosis: Depressive symptoms can overlap with other psychiatric and medical conditions, leading to misdiagnosis or inappropriate treatment. For example, bipolar disorder is often misdiagnosed as major depressive disorder in primary care, which can result in inadequate treatment and risk of mood destabilization (Hirschfeld et al., 2003).

Addressing These Challenges

Several strategies can improve antidepressant management within primary care settings:

  • Collaborative care models: Studies show that integrating mental health professionals within primary care teams leads to improved outcomes, including higher remission rates and better adherence (Archer et al., 2012).
  • Standardized screening and follow-up: Implementing tools like the PHQ-9 for monitoring depression severity can help guide treatment decisions and ensure timely adjustments.
  • Education and decision support: Providing PCPs with continuing education on psychiatric prescribing and decision-support tools can enhance treatment precision.
  • Improved access to therapy: Expanding tele-therapy options and embedding behavioral health providers in primary care clinics can help bridge the gap between medication and psychotherapy.

Conclusion

Given the high volume of antidepressant prescriptions originating from primary care, ensuring optimal management is critical to improving patient outcomes. Strengthening collaboration between PCPs and mental health specialists, enhancing diagnostic accuracy, and integrating therapy referrals can help address current limitations.

Call to Action: If you are a healthcare professional involved in prescribing antidepressants, what strategies have you found effective in improving patient outcomes? Share your insights and experiences below.

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What Happens When We Ignore Scientific Evidence?

When we reject the overwhelming scientific consensus that vaccines do not cause autism, we enter a dangerous world—one where facts are disregarded, misinformation thrives, and preventable diseases make a deadly comeback.

The Real Consequences of Vaccine Hesitancy

Vaccine hesitancy isn’t just a debate—it has real, measurable consequences

Measles Outbreaks: In early 2025, Texas experienced its most severe measles outbreak in nearly 30 years, with 198 confirmed cases as of March 7. The outbreak has resulted in 23 hospitalizations and one measles-related death—the first in the nation in a decade. The outbreak is primarily concentrated in rural Gaines County, where vaccination rates are notably low.

Whooping Cough Resurgence: Cases of pertussis (whooping cough) have increased in areas with lower vaccination rates, endangering infants who are too young to be fully vaccinated.

Polio’s Return: In 2022, a case of paralytic polio emerged in New York, decades after the disease had been eliminated in the U.S., traced back to vaccine hesitancy and low immunization coverage.

Ignoring evidence doesn’t just impact individuals—it threatens public health as a whole

Addressing Concerns: Why the Autism Myth Persists

Some parents worry about vaccine safety due to outdated or misleading claims, most notably a fraudulent 1998 study linking vaccines to autism. This study was retracted, and extensive research—including studies on hundreds of thousands of children—has confirmed no link between vaccines and autism. Yet, fear and misinformation persist, fueled by social media echo chambers and distrust in institutions.

While vaccine side effects do exist, they are typically mild (e.g., temporary soreness, fever) and far outweighed by the risks of the diseases they prevent. Scientific inquiry should always continue, but dismissing decades of rigorous research in favor of debunked myths endangers lives.

What Can We Do?

Combatting vaccine misinformation requires action. Here’s how you can help

✔ Speak Up: Correct misinformation when you see it, whether online or in conversations with friends and family.

✔ Rely on Experts: Trust reputable sources like the CDC, WHO, and medical professionals rather than social media influencers or unverified websites.

✔ Advocate for Science Education: Supporting critical thinking and scientific literacy helps build a society that values evidence over fear.

✔ Get Vaccinated: Lead by example—being up to date on vaccines protects you and those around you, especially vulnerable populations.

Science Is Not an Opinion

Truth is not subjective. If we abandon scientific evidence in favor of belief alone, we risk more than just vaccine-preventable diseases—we risk an era where facts no longer matter. The stakes are too high to let misinformation win.

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🌿 CBD for Psychosis? A Landmark Trial is Underway 🧠

A major new study—the Stratification and Treatment in Early Psychosis (STEP) trial—is set to investigate CBD as a potential treatment for psychosis on a larger scale than ever before. Led by Philip McGuire, MD, professor of psychiatry at Oxford University, STEP will involve 1,000 participants across 30 sites in 10 countries 🌍, making it one of the most ambitious trials of its kind.

🔬 Why it matters:
✅ CBD has shown promise in early studies for psychosis, but large-scale evidence is needed.
✅ STEP will combine three smaller trials to explore effectiveness, biomarkers, and precision treatment approaches.
✅ Nature Medicine named it one of 11 studies that will shape medicine in 2025.

🚀 Could CBD redefine psychosis treatment? The results could change the landscape of psychiatric care. Stay tuned!

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