Can we do a better job of antidepressant selection based on symptom clusters, analyzed using machine learning techniques? Perhaps so. And if so we will avoid a great deal of unnecessary suffering as people try one medication after another until the find the right medication or combination of medications to treat their depression. That is the premise behind an ambitious …
Bipolar 101 An Online Course
Bipolar 101, an online course hosted by Gateway Psychiatric begins March 17, 2017: Bipolar 101 – The Basics and Beyond. The class is based on the acclaimed Barcelona Bipolar Disorders Program. Bipolar 101 – An online course will cover topics such as: It will be taught by Dr. Peter Forster and Gina Gregory, and will have an interactive format with plenty of …
Online Recovery Resources
Accessing Online Recovery Resources from Afar Recently I had a patient relocate to Spain who had been in recovery from alcohol for one year. She was very concerned about leaving her recovery community and was surprised to learn that she could continue to access support online from afar. Initially she was skeptical about accessing support online. However, after trying out …
TMS Effectiveness Updated
TMS effectiveness for depression is clear. But now there are more machines for providing TMS and more protocols. Is deep TMS better than regular TMS? Or is deep TMS just a marketing phrase? A major review article in JAMA Psychiatry updated our understanding of alternatives to the initial protocol for TMS. JAMA Psychiatry is the most prestigious journal in psychiatry, …
Measurement Based Care Controversies
Measurement based care often evokes controversies. A brilliant colleague, Carol Heckler, who is something of a local expert in psychopharmacology, interrupted a conversation I was having with another psychiatrist to say that she thought that standardized rating scales were useless. Echoing comments that I’ve heard from many of my patients, she said “how can you reduce human experience to a number?” This …
Depression Biology and Treatment
New research on depression biology and treatment highlights the rapid increase in knowledge in this area in the last decade. In this post we will summarize some of these research findings briefly. This brief tour will take us to a newly discovered protein that may be a vital link between stress and depression. A genome wide search for changes associated …
Long Acting Injectable Aripiprazole for Bipolar
Long acting injectable aripiprazole for bipolar one patients has been shown to significantly reduce the risk of a recurrence of a mood episode in a 52 week placebo controlled clinical trial. Poor adherence to treatment is a significant problem in patients with bipolar disorder, putting patients at increased risk of recurrence of mood episodes, hospitalization, and suicide. One other study …
TMS for Anxiety
“How effective is TMS for anxiety?” The young woman with a remarkable history of serious adverse effects from multiple trials of psychiatric medications for anxiety recently asked me this question. This post summarizes the results of a thoughtful literature search using the UCSF medical library, data from the Medical Affairs departments for two of the TMS manufacturers, and clinical experience …
Long Term Depression Psychotherapy
Effective psychotherapy for depression that has lasted for years is needed because chronic depression (lasting two years or longer) develops in up to a third of people with an episode of major depression. Chronic depression is associated with more suicidality, more impairment in functioning, and more hospitalizations. Chronic depression psychotherapy is often less effective than therapy for other forms of depression. …
Marijuana Potency and Psychiatric Adverse Effects
The steady increase in THC content raises a question about the relationship between marijuana potency and psychiatric adverse effects which is summarized in an article in Current Psychiatry by Joseph M. Pierre, MD, Health Sciences Clinical Professor in the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA in the February 2017 issue. The table below summarizes data about …