Mania and Depression Sequence

Peter ForsterBest Practices, Bipolar Treatment

One of the key features of bipolar disorder that, in our experience, is most useful in predicting treatment response is the usual sequence of manic (or hypomanic) and depressive episodes. For years we have used the mnemonics MDI and DMI as ways of categorizing patients’ course. But we could not find the reference to that idea. We are indebted to …

Lithium Prevents Suicide

Peter ForsterBipolar Treatment

This has been a year with lots of useful information highlighting the continued importance of some of the oldest treatments for bipolar disorder: lithium salts. A New York Times Magazine article (“I Don’t Believe in Good but I Believe in LIthium”) about bipolar focused on lithium, and another New York Times article a year before that asked the question “Should We …

“Biggest Loser” Misunderstandings

Peter ForsterPhysical Conditions and Health, Self Care

Last week on most everybody in my practice who has ever struggled with weight loss came in talking about the widely reported results of a follow-up study to the TV show “Biggest Loser.” And almost everybody’s conclusion from the media coverage was that it seemed the media was suggesting that it was a waste of time trying to lose weight. Most …

Mindfulness for Depression – Research Update

Peter ForsterBest Practices, Major Depression, Treatments of Depression

Mindfulness has received a lot of attention recently as an approach to improving mental health in a number of conditions. But is it really effective as part of a strategy for treating serious depression? And, if so, how can we best incorporate it into treatment, given the great difficulty that many people with depression have doing even a small amount …

“I am looking for a doctor who can treat me with Ketamine infusions for treatment resistant depression.”

Peter ForsterAbout GPS, Best Practices, Bipolar Treatment, Costs of Treatment, Treatments of Depression

I was inspired to write this blog post by the third patient in three days to contact me about Ketamine infusions. She wanted to know if I could provide her with Ketamine infusions for her treatment resistant depression. Ketamine infusions are one of the treatments for depression that we provide access to for our patients. Among the other treatments are …

California Healthcare Laws

Peter ForsterGPS

Over the last five years California has enacted a number of laws and regulations that seek to make the healthcare insurance system fairer, but keeping track of all of these laws is a real challenge. At a recent symposium I ran into a colleague of mine who reminded me of a law that requires insurance companies to continue coverage of …

Genetics of bipolar disorder – update

Peter ForsterPsychobiology

Unraveling the genetics of bipolar disorder has been a much more complicated task than anyone thought. Although the best estimates suggest that genetic factors account for the very high percentage of the risk of developing bipolar, with an estimated an estimated 0.7 to 0.8 heritability (Sullivan), it has been remarkably difficult to find genes with significant individual effects that are replicated …

Depression and Inflammation

Peter ForsterBasic Science, Major Depression, Psychobiology

Is depression one of a series of illnesses caused by inflammation? There has been a lot of interest in the last year in the idea that inflammation (activation of the body’s immune system) might be a cause as well as a consequence of depression. One theory suggests that depression might be an inflammatory disorder, rather than a disorder of altered neurotransmitter levels. Certainly …

Common Over the Counter Medications Linked to Dementia

Peter ForsterBest Practices, Insomnia Treatment

Common over-the-counter medications may increase your risk for dementia. That is the startling finding of a recently published journal article which used a number of approaches to examine the possible risk of using medications that have anticholinergic effects. This includes many psychiatric medications as well as many common over the counter antihistamine medications, medications for sleep, and for GI problems: …

Acceptance and Commitment Therapy Part 1: Acceptance and Willingness

Kelsey SchraufnagelAnxiety, Best Practices, Major Depression, Treatments of Depression

Acceptance and Commitment Therapy (or ACT, pronounced as the word, not A-C-T) is a comprehensive, empirically driven model developed by Steve Hayes, PhD and colleagues with nearly 200 randomized controlled trials (methodologically sound studies) supporting its efficacy for numerous problems and concerns. I recently attended the Anxiety and Depression Association of America conference in Philadelphia, where I offered a two-hour …