A JAMA study found a significant rise in stimulant prescriptions between 2019 and 2022, with a 37.5% increase in total volume. This trend was particularly noticeable through telehealth, where stimulant prescriptions soared from 1.4% to 38.1%, peaking at 51.8% in mid-2020. The shift was largely influenced by COVID-19 pandemic policies, which eased telehealth restrictions. While antidepressant prescriptions also rose, opioid prescriptions declined by 17.2%. The study emphasizes the need to balance access with monitoring for potential misuse as telehealth policies evolve
Tag: psychotropics
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Inflammation: The Hidden Culprit Behind Your Mental Health Struggles
Over the past several years, a growing body of research has highlighted the role of inflammation in the development and progression of psychiatric disorders. A key biomarker frequently used in these studies is C-reactive protein (CRP), which can be measured through a simple blood test. For precise results, it’s important to order the ultra-sensitive CRP test when conducting this in a lab setting.
Recent findings from JAMA Psychiatry have revealed varying mental health trajectories for individuals with low-grade inflammation throughout childhood. Persistently elevated CRP levels, particularly peaking around age 9, were linked to an increased risk of developing psychosis, severe depression, and insulin resistance in adolescence and early adulthood.
This research suggests that a simple blood test could potentially identify children at higher risk for serious mental illnesses and cardiometabolic issues later in life, offering a window for early intervention.
The big question remains: how should we address this low-grade inflammation? My first recommendation is to focus on lifestyle modifications, particularly dietary changes that reduce inflammation, such as adopting a Mediterranean diet. Additionally, I believe chronic stress is a major contributor to inflammation. In modern American society, stress reduction is often overlooked, but finding effective ways to manage stress is crucial to mitigating long-term health risks.
Link to the article: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2822343
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Doctor’s Near-Death Experience: The Truth Behind Antidepressant Withdrawal – Fact or Fiction
These sensational headlines about near-death experiences coming off antidepressants are becoming far too common. While we must be cautious with prescribing, it’s equally important not to dissuade people from trying medications that could help them.
Yes, some patients experience withdrawal symptoms if medications are stopped abruptly without proper tapering. But many patients do not, and I’ve seen countless cases where people discontinue their antidepressants without any issues. Some may require prolonged tapers, while others can taper off much faster than alarmist articles would suggest.
It’s crucial to remember that while discontinuation can be uncomfortable, it’s rarely life-threatening. We do need to be mindful of how long we prescribe these medications, given they manage symptoms but don’t modify the underlying disease, and the long-term benefits are still debated.
Guidelines for deprescribing are helpful, but dramatic headlines about “nearly dying” when coming off these medications are not only inaccurate but harmful to those who could benefit from treatment. Let’s promote balanced, evidence-based discussion on this topic, focusing on proper discontinuation without sensationalizing the risks.
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Hidden Dangers: Unveiling the Link Between Medical Conditions and Suicide Risk
The article “Risk of Suicide Across Medical Conditions and the Role of Prior Mental Disorder” published in JAMA examines the association between various medical conditions and suicide risk, highlighting the influence of pre-existing mental disorders. Key findings include:
- Increased Suicide Risk in Certain Medical Conditions: The study identifies a significant rise in suicide risk among patients with specific conditions, such as cancer, chronic pain, neurological disorders, and respiratory diseases. Chronic illness often contributes to emotional distress, exacerbating the risk of suicide.
- Impact of Mental Health History: Individuals with a prior mental disorder are at an even higher risk of suicide when diagnosed with a medical condition. The presence of a mental disorder can amplify feelings of hopelessness, increasing vulnerability.
- Interconnected Nature of Physical and Mental Health: The research emphasizes the need for integrated care that addresses both the physical and psychological aspects of health, particularly for individuals with complex medical histories.
The article advocates for more robust screening for suicidal ideation in patients with both medical and mental health conditions and suggests collaborative treatment approaches to reduce suicide risk.
Link to article: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2822967
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Unraveling Mixed Depression: Navigating the Overlap of Mood and Energy
In mixed depression the individual is often irritable, and elevated. They have depressed mood with at least 3 manic symptoms but do not meet the full criteria for bipolar disorder. Here I avoid the antidepressant medications and chose to focus on two medications with evidence for their efficacy. I like lurasidone and aripiprazole here, and sometimes I consider ziprasidone as well.
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Mastering the Mind: Strategies for Tackling Anxious Depression
When treating anxious depression, SSRIs and SNRIs may not always provide sufficient relief. In such cases, I consider adding medications like quetiapine, which has a significant effect size for generalized anxiety disorder (GAD) and is FDA-approved as an augmentation strategy for depression at doses of 150–300 mg. However, due to its side effect profile, it’s advisable to limit the duration of quetiapine use when possible.
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Breaking Free: What to Do When Anxiety Won’t Let Go
The tried-and-true approach of recommending Cognitive Behavioral Therapy (CBT) along with a serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) doesn’t work for everyone. So, what are the alternatives? One often-overlooked option is hydroxyzine, which has effect sizes (0.4–0.5) similar to benzodiazepines but with a lower risk, particularly in older adults. For those seeking natural remedies, Silexan, available over the counter, is another possibility. Other medications that have shown efficacy in treatment-resistant depression include pregabalin, quetiapine, and eszopiclone. When it comes to social anxiety disorder, I’m a bit old-fashioned but still favor MAOIs in this area.
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Breaking Barriers: Streamlining Clozapine Access for Patients in Need
Happy Friday Everyone, todays post is a topic near and dear to my heart
Clozapine is the most effective medication available for treating schizophrenia. In my work in community mental health, many of my patients could greatly benefit from clozapine, but significant barriers make access difficult. A large portion of my patients are homeless and frequently lost to follow-up, which complicates the already burdensome REMS (Risk Evaluation and Mitigation Strategy) program. To ensure access to this life-saving treatment, adjustments to the REMS program are necessary. One solution could be eliminating the requirement to report completed monitoring and post results on a central database. Additionally, restrictions that delay pharmacies from distributing clozapine should be removed. Finally, we need to reevaluate the frequent and, quite frankly, excessive monitoring of absolute neutrophil counts (ANC). These changes could significantly improve access for patients who need this critical medication.
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PTSD by Any Other Name: Rethinking the Label to Break the Stigma
An advocacy group has proposed changing the name of post-traumatic stress disorder (PTSD) to post-traumatic stress injury (PTSI) for inclusion in the DSM-5 TR. However, in November 2023, the APA steering committee rejected the proposal, citing insufficient evidence to support the change. Advocates argue that the term “disorder” is both imprecise and carries stigma, which can discourage people from seeking timely care. This delay or avoidance of care can lead to serious consequences, including suicide attempts. The term “disorder” has long been controversial in psychiatry, and I’ve always favored the use of “disease” to help distinguish between true disease processes and challenges of living. I also believe that people may be more likely to seek help if they view the issue as a disease or injury. While this change may not happen soon, maintaining open dialogue about how to encourage treatment is essential.
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Oral Extended-Release Ketamine: Beyond the Hype or Just Another Hope?
Psychiatry’s fascination with ketamine continues, despite growing evidence that it may not be the miracle treatment some once hoped for. It’s clear that ketamine is not disease-modifying, meaning patients treated for depression with ketamine can still experience relapses. Even more concerning is that ketamine’s effects are short-lived, with the average time to relapse being just 2-4 weeks.
This brings us to recent studies on oral extended-release ketamine for treatment-resistant depression (TRD). In a proof-of-concept study, twice-weekly dosing of extended-release ketamine showed statistically significant and clinically meaningful improvements in depressive symptoms. The treatment was generally well-tolerated, with a side effect profile that included reduced dissociation and sedation, though there were increases in blood pressure. Having a tablet form of ketamine could make the treatment more accessible, but it also raises concerns about potential abuse and diversion.
In my view, this is another symptom management tool for patients with TRD. However, the challenge remains that patients will likely need to continue ketamine treatment long-term without a clear dosing regimen. Nonetheless, the results were promising enough to lead to a phase-3 trial using 180 mg doses twice daily.
Link to article: https://www.nature.com/articles/s41591-024-03063-x
