Tag: psychotropics

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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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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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

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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.

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💥 Time to Rethink Valproate in Acute Mania

Valproate continues to be overvalued in the treatment of acute mania—and it doesn’t work as well as many assume.

Part of the problem? A single overhyped study, cleverly marketed by the pharmaceutical company, has shaped decades of prescribing habits and continues to be taught to psychiatry residents as gold-standard evidence.

But the data tells a different story.
The BALANCE study (British study of Lithium +/− Valproate) showed no significant long-term benefit to adding valproate to lithium over a 2-year period in bipolar disorder.

It’s time we stop relying on outdated assumptions and start practicing based on robust, long-term outcomes—not industry narratives.

📚 Evidence over tradition.
🧠 Teach residents the full picture.
💊 Prescribe with precision.

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Rapid cycling ≠ lithium failure

There’s a persistent myth in psychiatry that lithium doesn’t work for bipolar disorder with rapid cycling.

🧠 But here’s the truth:
Multiple literature reviews show lithium performs just as well as other antimanic agents in rapid cyclers. The issue isn’t lithium—it’s that rapid cycling is simply harder to treat overall.

Let’s stop excluding one of our most effective mood stabilizers based on outdated or anecdotal thinking. Patients with rapid cycling deserve full access to evidence-based treatment options—including lithium.

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New Mechanism, Promising Results: Novel PDE10A Inhibitor for Acute Schizophrenia

A novel PDE10A inhibitor just showed safety and efficacy in a large Phase 2 trial for acute schizophrenia. 👏

📌 PDE10A inhibitors represent a non-dopaminergic approach—targeting phosphodiesterase 10A to modulate both D1 and D2 pathways indirectly. This could be a game-changer for patients who don’t respond to or can’t tolerate traditional D2 blockers.

🔍 The trial demonstrated:
✅ Significant reduction in PANSS total scores
✅ Favorable side effect profile (no EPS or prolactin elevation)
✅ Oral formulation, once daily

This reinforces the urgent need to diversify our treatment mechanisms beyond dopamine antagonism. As treatment-resistant schizophrenia remains a major challenge, we’ll take all the innovation we can get.

🧠 Stay tuned—PDE10A could join the ranks of TAAR1 agonists and muscarinic agents in reshaping how we treat serious mental illness.

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The Benzo Balance: Short-Term Help, Long-Term Plan

1. Clarity and upfront expectations reduce long-term problems

“I’m prescribing this for 4–6 weeks. After that, we taper.”
We give the patient a clear framework and prevent long-term dependency from becoming the default trajectory. It builds trust while still honoring clinical caution. Patients usually appreciate this transparency.

2. Dose low. Time-limit strictly

This really is the heart of rational benzo use. When used short-term for acute anxiety, panic, alcohol withdrawal, catatonia, etc., they can be valuable. But once we drift into long-term, open-ended prescribing, the benefits decline and risks (dependence, cognitive impairment, falls, tolerance) mount.

3. Cold-turkey tapers can be dangerous

“Some well-meaning physician decides to pull someone off benzodiazepines in 2 weeks…”
And suddenly the patient is in crisis — not because the drug was inherently evil, but because the withdrawal was mishandled. Abrupt tapers, especially in someone on high doses or for years, can trigger rebound anxiety, insomnia, panic, even seizures or suicidality.

4. We need to hold both truths at once

  • Benzos are not long-term solutions for anxiety.
  • But abrupt discontinuation without a tailored plan is often worse than the original problem.

It’s not a complex principle, but it takes nuanced execution. You’re advocating for that middle path: compassionate, firm, individualized.

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