The Brain’s Story: Discussing Disorders and Treatment Mechanisms with Clients
Information that is complex, possibly difficult to understand, and sometimes theoretical in nature is better explained via the use of examples, relevant stories, or metaphors. People tend to better understand difficult concepts when they can identify and visualize them.

Empowering Clients to Make Wise Medication Decisions
Here are 3 factors influencing whether a client will submit to a trial of psychotropic medication – or any medication for that matter.

Lithium
Full disclosure: I’m a big fan of lithium. Lithium is a salt substance, and in the 1940s was tried as a salt substitute – although people were totally unaware of lithium’s toxic properties.

The Fentanyl Crisis: Protecting Children and Adolescents
Fentanyl is a completely laboratory-made opioid that is 100 times more potent than morphine, and 50 times more potent than heroin. And because it is odorless and tasteless, those purchasing substances directly from street vendors or online are unable to determine whether the product they’re seeking is potentially laced with fentanyl.

Augmenting Agents for Treatment-resistant Depression
Here’s an all-too-common circumstance shared with me by patients of mine: They’ve used three or maybe four antidepressants over the years, all produced noticeable effectiveness at least initially, but eventually effectiveness waned.

Assessment, Diagnosis and Medication Management of Bipolar Disorder: An Update
Let’s start with this: Bipolar disorder is quite difficult to diagnose accurately. Quite difficult. Establishing this diagnosis isn’t something to be decided upon on the first visit with a client, as this is utterly unrealistic. There are too many variables and moving parts linked to bipolar to establish diagnostic certainty early on.

Trazodone: Antidepressant? Primarily for Insomnia? Both?
Trazodone has operated under somewhat of a cloud of controversy, because although it is classified as a cyclic antidepressant, its “claim to fame,” so to speak, is linked to efficacy in treating insomnia. But what about trazodone’s antidepressants properties? Is it viable in treatment-resistant patients?

Buspar: Effective or Merely Placebo?
Buspar (buspirone) has baffled me from shortly after its release date in 1986, and still does so even to some extent today. Among my concerns are who is likely to respond to it, under what circumstances, and most importantly, although Buspar is approved for generalized anxiety disorder (GAD), does the drug treat anxiety at all?

Psychedelics
Psychedelic drugs have been utilized by various cultures for centuries to facilitate transcendental and varied spiritual or religious experiences. Psychedelics are also referred to as hallucinogens in that they affect a person’s mind by modifying perceptions, moods, and thought processes.

Antidepressant Selection for the First-time User
There are no definitive, authoritative practice guidelines for initiating antidepressant treatment. So, in the absence of a “this is THE way to go” approach, prescribers, and consultants like me develop our own algorithms and protocols for getting patients started.

The Overdiagnosis Problem
It begins with misdiagnosis. When it comes to mental health maladies, we — as a collective group of clinicians and practitioners regardless of our specific discipline — do occasionally get it wrong.

Psychopharmacology and Mental Health: Some Year-end Thoughts and Suggestions
We can read a 600- page text on the biochemistry of psychiatric medications; become enmeshed in the marvels of neuroscience; design highly complex drug regimens for patients; and still not know a thing until the patient swallows the first pill.

Complementary and Alternative Medicine Use (CAM) in Mental Health: An Update
Evidence-based pharmacological practice typically limits prescribing to agents that are either FDA-approved, or if used in an “off-label” way, are at a minimum, supported by highly reputable clinical trials. Natural supplements, however, don’t enjoy the benefits of patent protection and thus their manufacturers aren’t motivated to conduct expensive randomized control trials.

Polypharmacy
“Psychiatric patients are over-medicated.” I hear that a lot. Part of me agrees, yet another part of me realizes that this is not a simple black-or-white issue; instead, it is nuanced and complex.

Deprescribing Psychotropic Medication
Patients are often quick on the draw at wanting to abort medication causing side effects or other adverse conditions, and many prescribers will comply with discontinuing the drug(s) or at least lowering the dose.

Helping Clients Make Healthy Choices About Their Medications
I’ve identified 3 factors influencing whether a client will submit to a trial of psychotropic medication – or any medication for that matter.

Update on Marijuana
I’m certain it comes as no surprise that cannabis is the most used illicit substance in the United States. And I say “illicit” because the United States Drug Enforcement Administration still classifies marijuana as a Schedule I substance – rendering it an “illegal” drug on the Federal level.

Antidepressants: Dosage is Important
In every instance where someone is embarking on a trial of psychotropic medication, I ask two questions: “What are you wanting the medication to do for you,” and…

Today’s Marijuana and Its Troublesome Effects on Young People
You’re probably at least somewhat acquainted with the “golden age” of marijuana consumption, when free love ruled in the Haight Ashbury neighborhood of San Francisco during the 1960s, and hippies got stoned while listening to the music of The Doors, Led Zeppelin, and Jimi Hendrix.

The Impact of the Fentanyl Crisis on Children and Adolescents
Children under 14 are dying of fentanyl poisoning at a rate faster than any other age group, according to a new report from Families Against Fentanyl, a nonprofit group broadening awareness about the deadly opioid.

Two Exercises to Help You Avoid Getting Tricked by Anxiety and Worry
The hallmark of chronic anxiety is that people remain continuously fearful when they’re not in any objective danger in the moment. They get tricked into believing they have to think and respond in ways to fend off this danger when it’s only discomfort, they’re going through. Then by continuing to battle with the anxiety by fighting with it or fleeing from it, they wind up feeling worse rather than better.

Psychedelics As Mental Health Treatments
Psychedelic drugs have been utilized by various cultures for centuries to facilitate transcendental and varied spiritual or religious experiences. Psychedelics are also referred to as hallucinogens in that they affect a person’s mind by modifying perceptions, moods, and thought processes. Nowadays though, scientists and pharmacologists are investigating their potential for treating certain mental illnesses.

Unpacking Bipolar Depression
Since the presenting symptomology in such a client is often overwhelmingly depressive in nature, it can be a challenge for us clinicians to lean toward bipolarity as a possible differential.

Talking to Clients About Psychotropic Medication Side Effects
Whether it’s a new medication prescribed for a client, or one the client is already taking, I provide them a physical list of the common, most often reported side effects of that drug. I keep the list short — no more than 3 possible adverse effects.

8 Tips for Managing Antidepressant-induced Sexual Dysfunction
Depression robs people of their desire for sex, and sexual dysfunction, which includes diminished libido, decrease in arousal, vaginal dryness for women, and erectile dysfunction in men, is common in both genders with depression. And although this is bad enough, antidepressant use delivers a double whammy.

Psychopharmacology and Mental Health: Some Things to Consider
One can read a 600-page text on the biochemistry of psychiatric medications; become enmeshed in the marvels of neuroscience; design highly complex drug regimens for patients; and still not know a thing until the patient swallows the first pill.

Opioids for Depression? We’ll See
Opiates and opioids in particular, are primarily used for treating pain, but there is a long history of using these substances to manage mental illnesses. In the mid-1800s Victorian era, Laudanum (known as tincture of opium today), was used for depression and hysteria, as well as to soothe small children, with 25 drops selling for a single penny.

Serotonin and Depression
Back in the 1960s, a theory – or to be more accurate – a hypothesis was proposed that low levels of brain serotonin were a cause of depression. Serotonin after all, is a key brain neurotransmitter which purportedly plays a role in the regulation of mood – one of its many regulatory roles. This was but one of several hypotheses put forth as a possible cause of depression.

Omega-3 Fatty Acids
Omega-3s tout broad benefits in both physical and mental health and have even been incorporated into a few treatment guidelines in psychiatry. However, most of the products you’ll find on pharmacy shelves or nutritional outlets lack the proper ingredients or don’t have enough of them to be effective.

Antidepressants: Dosage Is Important
In every instance where someone is embarking on a trial of psychotropic medication, I ask two questions: “What are you wanting the medication to do for you,” and “how long do you see yourself taking it?” I ask these questions to determine how realistic the person is about what the medication can actually do for them, and how long it might take to do so.

Frequently Asked Questions
I’ve compiled a list of questions that I receive over and over again in the seminars and trainings I conduct, as well as in my clinical practice. Here’s hoping my answers help you if you use any of these medications or are a clinician counseling clients.

“Stretching the Truth” in the Therapeutic Relationship: It Happens
Clinical relationships, regardless of context, rely on honesty between clients and clinicians. We therapists and counselors depend on accurate information from clients to develop a diagnosis, and clients require accurate information from us to make decisions regarding the course and direction of their care. The thing is though… falsehoods, misrepresentations, and yes even some lies will occupy the therapeutic relationship.

Melatonin: Getting the Most Out of It
We’re all familiar with Count Dracula, right? And we’re equally familiar with the lore that vampires only come out at night? Well, melatonin works in much the same way — it only comes out at night too.

4 Characteristics of Depression That Can Help Confirm an Accurate Diagnosis
Depression is a complex phenomenon, and the circumstances associated with its emergence vary in every patient presentation to some degree. Symptoms such as helplessness, hopelessness, tiredness, lack of motivation and difficulty experiencing pleasure are too generic and not descriptive enough to confirm a diagnosis of depression.

Lithium Use in Children: Sensible Considerations and How to Talk to Parents
Irrespective of age, I am often referred challenging cases, replete with multiple and varying medication and behavioral dynamics.

The Overdiagnosis Conundrum
It begins with misdiagnosis. When it comes to mental health maladies, we — as a collective group of clinicians and practitioners regardless of our specific discipline — do occasionally get it wrong.

Where Does Lamictal Fit in the Treatment of Bipolar Disorder?
There’s a general consensus in the psychiatric community that bipolar depression is difficult to identify and differentiate from unipolar depression. It can be difficult to treat pharmacologically also.

Oppositional Defiance vs. Disruptive Mood Dysregulation Disorder: Similarities and Differences
If I were to choose a single word that best characterizes these 2 disorders it would be irritability. All children become irritable at one time or another during various phases of their growth and development, but irritability that exceeds what is generally expected for a child’s developmental age may be an indication of an underlying mental disorder.

5 Suggestions for Creating Positive Experiences with Children to Help Their Best Traits Emerge
How many rewarding and fruitful experiences are we providing and fostering for our children? And how much harder is it to provide these experiences when children do things that anger us?

5 Suggestions for Working with Older Adults
In the United States, 14 percent of adults are 65 or older, and the growing numbers in this population far exceed the number of psychiatrists specializing in treating them. Thus, PCPs and family medicine practitioners are increasingly shouldering the load for treating older adults.

Physical Medicine vs. Mental Health Medicine
By “medicine,” I’m not referring exclusively to substances or agents that are directly introduced into the body; I’m referring instead to the type of medicine practiced primarily on physical health maladies vs. mental health-related issues.

Motivational Interviewing Done Right
If you’re new to Motivational Interviewing, let me first offer up a definition: At its most basic, Motivational Interviewing begins as a conversation where you’re trying to help someone manage ambivalence that is preventing them from acting on a potentially problematic behavior.

Buspar: Operating In The Shadows
Buspar (buspirone) has baffled me from shortly after its release date in 1986, and still does so even today. Among my concerns are who is likely to respond to it, under what circumstances, and most importantly, although Buspar is approved for generalized anxiety disorder (GAD), does the drug treat anxiety at all?

Silexan: For Adult Generalized Anxiety Disorder
My longtime beef with alternative medicines is that the vast majority of them simply don’t measure up to their marketing and sales hype from an efficacy perspective, and their risk of drug-drug interactions when combined with common prescription medications.

Helping Clients Follow Through With Their Medications
I’ve found there are 3 factors influencing whether a client will submit to a trial of psychotropic medication – or any medication for that matter. And though often expressed differently, it comes down to these…

Lithium: A Psychiatric Gem
Simple disclosure from me regarding lithium: I’m a big fan of the drug. First off, lithium is a salt substance, and in the 1940s was tried as a salt substitute – although people were totally unaware of lithium’s toxic properties. Fast-forwarding to 1949, doctors happened upon the discovery that lithium had medical properties, and that it could be used to treat bipolar disorder and non-bipolar (unipolar) depression.

Tele-Treatment
For 30 years, clients have presented themselves to my office intent on seeking help and relief from a veritable array of mental and psychosocial issues both past and present.

Trazodone: An Antidepressant? Primarily For Insomnia? Or Both?
Trazodone has long operated under a cloud of controversy, because although it is classified as a cyclic antidepressant, its “claim to fame,” so to speak, is linked to efficacy in treating insomnia, although it is not FDA-approved for this indication. But what about trazodone’s antidepressants properties?

Beating Worry and Anxiety by Not Getting Tricked
Regardless of age, people tend to become anxious when a situation, issue, or circumstance seems beyond their control. In simple terms it sort of goes like this: “I don’t know what to do about this, it’s upsetting me, and I’m very uncomfortable and confused and can’t envision a positive outcome.”

Child and Adolescent Substance Abuse: How To Proceed
Remember the scare tactics associated with drugs of abuse potential a few years ago? “Just say no to drugs,” “This is your brain on drugs,” – which depicted an egg frying in a pan?

Evaluating Suicide Risk and Proper Documentation
After decades in the psychotherapy trenches, I’ve come to believe the issue of suicide is something that will remain a clinical mystery, much less ever be solved. The most recent numbers released by the CDC reveal 48,000 people succumbed to suicide in 2018, and since 1999, the suicide rate has risen 35 percent.

Lifestyle Interventions for Treatment-Resistant Depression
Treatment-resistant depression (TRD) typically refers to an inadequate response to at least one antidepressant trial of adequate dose and duration among patients experiencing major depressive disorder (MDD). Or is it two antidepressant trials?

Talking to Clients About The Neuroscience Behind Their Disorders and Medications
Information that is complex, possibly difficult to understand, and sometimes theoretical in nature is better explained via the use of examples, relevant stories, or metaphors. People tend to better understand difficult concepts when they can identify and visualize them.

Teen-onset and Adult-onset ADHD: Real Diagnoses?
Although what we clinically refer to as ADHD has morphed from “minimal brain dysfunction” in the 1960s-1970s and then “ADD” in the 1980s-1990s, one factor has remained constant: ADHD has, from the very beginning, been characterized as a neurodevelopmental disorder, which means its genesis is in early childhood – according to DSM-5.

Non-Medication Approaches for Opiate and Opioid Disorders
I stress the importance of non-medication approaches to all of my opioid-dependent clients. For once the detox and maintenance phases of treatment are addressed via methadone maintenance, Suboxone or any other medication-assisted strategy…

A New Warning for Ambien and Other “Z” Drugs
Primary insomnia is comprised of three components — difficulty getting to sleep, trouble staying asleep and early morning awakenings. People with chronic sleep difficulties may experience all three of these components. The nonbenzodiazepines Ambien (zolpidem), Sonata (zaleplon) and Lunesta (eszopiclone) are the most commonly used drugs in the treatment of primary insomnia, but they’re not without their problems.

Spravato To The Rescue?
On March 5, 2019, the FDA approved Spravato (esketamine) nasal spray as additive treatment with antidepressants for treatment-resistant depression (TRD). In previous newsletters, I’ve discussed intravenous ketamine as an effective, albeit potentially risky alternative in treatment-resistant cases of depression…

Spravato To The Rescue?
On March 5, 2019, the FDA approved Spravato (esketamine) nasal spray as additive treatment with antidepressants for treatment-resistant depression (TRD). In previous newsletters, I’ve discussed intravenous ketamine as an effective, albeit potentially risky alternative in treatment-resistant cases of depression…

The Opioid Epidemic… Unmasked
I’ll be very clear: Today’s crisis is unprecedented – and far surpasses opiate use when such substances were not regulated by prescription in the early 1900s, as well as the aforementioned 1960s. Today, more people succumb to drug overdoses than any other type of accidental death.

Practical Steps and Tips for Managing Bipolar Disorder
Let’s start with this: Bipolar disorder is quite difficult to diagnose accurately. Quite difficult. Establishing this diagnosis isn’t something to be decided upon in the first visit with a client, as this is utterly unrealistic. There are too many variables and moving parts linked to bipolar to establish diagnostic certainty early on.

Digital Distraction: Helping Kids Reconnect with the Real World and Themselves
Credible studies via UCLA, Stanford and Harvard Medical now describe in detail how excessive screen time is rewiring kids’ brains – particularly older children – to display inattentiveness, lack of focus, and disorganization; and these newly rewired brains are literally growing new branches to meet the demands of cyberspace…

Un-Prescribing Psychotropic Medication
Patients are often quick on the draw to wanting to cease taking medication that is causing side effects or other adverse circumstances, and most prescribers will comply with discontinuing the drug or at least lowering the dose. But what about patients continuing with medication(s) that are unnecessary, or may become riskier with advancing age?

Marijuana: Breaking It Down
Debate abounds as to the historical tenets of the word “marijuana” which is beyond the scope of this article. I believe we’d all be better off not using the term marijuana at all as mental health professionals, but of course, that’s not going to happen.

Psychopharmacology: Where Are We Entering 2019?
I’m devoting the first newsletter of this New Year to the current state of Psychopharmacology – a round-up so to speak – of the medication management trends that I believe best define where the profession is as we embark upon 2019. Here’s my review of the 5 key areas…

Alternative Medicine Use in Mental Health: An Update
Evidence-based pharmacological practice typically limits prescribing to agents that are either FDA-approved, or if used in an “off-label” way, are at a minimum, supported by highly reputable clinical trials. Natural supplements however, don’t enjoy the benefits of patent protection and thus have no motivation to conduct expensive randomized control trials.

Suicide Prevention: Behavioral Approaches for At-Risk Patients
In my 30-plus years of conducting psychotherapy with clients across all age ranges, I’ve not worked with a patient whose life ended via suicide, knock on wood. I have, however, had several clients with a history of suicidal ideation coupled with attempts, prior to coming to me…

3 Ramifications of Adult ADHD & How to Help Clients Manage Them
Adults who really have ADHD not only report significant impairment, but also a host of ramifications with having lived with the disorder for often 30-40 years or more. Here are three of them, which in my experience surface most often…

Suboxone For Opioid Dependence
Today, more people succumb to drug overdoses than any other type of accidental death. A confluence of circumstances is associated with this, but physician overprescribing, combined with easy availability of potent heroin from Mexico and fentanyl from China, have fueled the epidemic, in major part.

The 3 Best-Studied Augmentation Drugs for Treatment Resistant Depression
Here’s an all too common circumstance shared with me via e-mails or by patients of mine: They’ve used three or maybe four antidepressants over the years, all produced noticeable effectiveness at least initially, but eventually effectiveness went bye-bye. What to do?

Suicide: The Subtext of People’s Lives
On June 5 and June 8, 2018, respectively, fashion designer Kate Spade and food writer Anthony Bourdain committed suicide. They were but two of 120 people who end their lives this way on any given day.

Benzodiazepines: After Nearly 60 Years, Are They Still Viable?
Benzodiazepines, or benzos for short, marched onto the treatment scene like stormtroopers some 60 years ago when Librium became available for managing anxiety. But this new class of anxiolytics really began making waves when Valium was released 3 years later.

Antidepressant Discontinuation
Earlier this month, The New York Times Health section published an article titled: Many People Taking Antidepressants Discover They Cannot Quit.

Medications For PTSD
Every few years, I examine the current trends in the literature regarding the medication management of PTSD, while drawing on my own experiences with patients.

Working With Families
Yes, family work is time-consuming and cumbersome when it comes to scheduling appointments, and getting them together can be tantamount to herding cats.

Assessment And Diagnosis Of Adult ADHD: Doing It Right
Let’s start here: There is no such thing as new onset ADHD in adulthood. This is because ADHD is a neurodevelopmental disorder with onset beginning in childhood and extending into early adolescence. The diagnosable age range is generally considered to be between 6 and 12.

Getting Clients To Buy Into Treatment Through Metaphor and Analogy
The decision for someone to enter into therapy is often accompanied by its own catastrophizing elements — with thinking such as “something must be really wrong with me because I’ve been unable to figure this out for myself.”

Antidepressant Treatment Strategies For The First-Timer
In previous articles, I have often written about antidepressants. Ten percent of Americans use them, and I field more questions about these drugs than any other medication category in my nationwide seminars and trainings. What I haven’t addressed though is how to begin antidepressant treatment.

Are You Screening Your Patients For Loneliness?
The mental health field has worked hard, and rather successfully I might add, at de-stigmatizing maladies such as depression and anxiety. So much so that people I treat seem increasingly more comfortable stating upfront that they’re feeling depressed, overwhelmed, or anxious, for example. There’s less obfuscation and reticence, and they simply speak up.

Differentiating Between Medical Disorders & Mental Conditions
So you’re conducting an interview with a patient in your clinic or office setting and you’re up against the clock when it comes to doing a thorough, systematic mental health evaluation. The allotted time for the session is ticking away and you’re wondering whether the patient you’re seeing has a medical disorder that is influencing or responsible for at least some of the psychiatric symptoms you’re observing. Well, there are specific red flags indicating that you’re definitely dealing with something medical.

If You’ve Withdrawn From The World, Time to Come Back In
His first intravenous infusion left him bewildered and invigorated. The night of his first “trip” he amazed his parents by cleaning his room and heading outside for a walk for the first time in quite a while.

CBT for OCD
Obsessive-compulsive disorder (OCD) is essentially a condition manifesting as excessive carefulness accompanied by an exaggeration of possible danger. Having treated it for years, what never ceases to amaze me is how many diverse manifestations present to my office. However, if you’re not that familiar with this disorder or tend not to treat it, it centers on obsessive and compulsive clusters.

Standing Up To Depression: It’s The Little Things
Depression is a thief, robbing affected people of their ability to place their talents and abilities on display. Just as with Charlie Brown, they shrink their world, often by building a protective cocoon – insulating themselves from the threats and fears that the bigger world is known to deliver.

Adult ADHD: Treating It Effectively
Martin C, age 50, came to my office two weeks ago saying, “I think I have ADHD.” I asked, “Why are you coming in now, at age 50?” “Have there been any major changes in your life recently, any new stressor rearing its head?” Martin’s response was that he was experiencing poor attention, but had never been diagnosed with ADHD before coming to me.

Allow The Present To Serve You Well
Often, as I go about my activities of daily living, personal or professional, I encounter people who are seemingly not it the present — grocery store clerks, bank tellers, restaurant servers who ask me to repeat my order 2 or 3 times. After becoming adequately acquainted with a patient of mine, I can tell within a minute or two whether or not they’re actually “present” for a session we’re about to begin.

Opium…An Ancient Psychotropic
These days, opiates — and opioids in particular — are primarily prescribed to treat pain, but there is a long history of these drug classes being used to treat depression and other mental illnesses.

Medical Marijuana
I’m often asked to comment on marijuana from a medical perspective, so here goes…

Stopping the Misuse of Psychiatric Medication in Children and Adolescents
Remember the year 2000 film titled The Perfect Storm starring George Clooney and Mark Wahlberg? It chronicles the story of the commercial fishing boat the Andrea Gail, which finds itself caught between powerful weather fronts which the crew underestimates. A similar situation — although in a very different vein — has resulted in considerable overuse of psychiatric medication in children.

Medication Management of Anxiety in Substance Abusers
Substance abuse is complex to say the least, and the precursors associated with what leads people down this road have been the subject of debate and controversy for decades on end.

Talking To Clients About Psychotropic Medication Side Effects
Last week, one of the employees at the condo building where I reside posed this question to me: “Joe, I’ve been prescribed the antidepressant Cymbalta. I’ve been taking it before I go to bed for 2 weeks now and I’m having a lot of difficulty getting to sleep.”

Psychotropic Medication in Chronic Pain Treatment
Nowadays, opiate medications are primarily used to treat pain states, but there is a storied history of using these drugs to treat depression and other mental illness. In the absence of pain, opiates can induce euphoria – a welcome relief from melancholia.

The Two Newest Antidepressants: How Do They Stack Up?
If you’re a TV watcher, you’ve probably seen a flurry of recent advertisements for Trintellix lately. The ad describes and illustrates depression as a “tangle” of multiple symptoms, which presumably Trintellix will somehow untangle.

Stimulants For ADHD: We Can Group Them Around The Letter “P”
ADHD, with its attendant cognitive deficits, disrupts executive functioning in daily school activities, as well as activities at home or at play. Deficient executive functioning manifests as problems with self-restraint, managing time, motivation, organization, problem-solving and emotional self-regulation.

Confessions From A Guy Who Has Often Railed Against Antidepressants
My friend, Sandra, invited me over to her place for dinner one night a couple of weeks ago. She is a terrific conversationalist, so when we get together we have a tendency to flesh out subjects to their very fullest, way beyond what they probably deserve, but nevertheless, that us.

Kids With Depression: Key Dimensions To Look For And How To Proceed
Age is not a factor when it comes to psychiatric disorder emergence, and the clinical communities of the world reliably agree on this. For sure though, when it comes to assessment, evaluation, intervention strategies and particularly medication management, children and even adolescents should not be considered “little” adults.

Ketamine for Depression
So first, let’s be clear on what Ketamine is. Ketamine is officially classified as a preoperative general anesthetic for both human and animal use. It has absolutely no serotonin, norepinephrine or dopamine effects but instead is an NMDA receptor antagonist, similar to dextromethorphan and methadone, among others. If you remember the days of the “rave” phenomenon, ketamine was a popular psychedelic going by the moniker “special K.”

Exploring a Client’s Relationship with Their Medications
I conduct boo-coo medication consultations with clients, and when it comes to the drugs they’ve either tried in the past or are currently taking, a common refrain is that they’ve tried “everything” and none of the prescribed medications have worked to their satisfaction.

Assessing a Client for Bipolar Disorder: The 3 Best Questions to Get Started
There is not a mental disorder that generates more consternation when it comes to diagnostic assuredness than bipolar disorder, particularly on an initial evaluation. We clinicians are forever searching for better screening questions to more quickly hone in on a diagnosis, and of course, bipolar is no exception.

DSM-5 Nearly Three Years Later – Thumbs Up & Thumbs Down
In May of this year, DSM-5 will celebrate its third birthday. I’ve been using the manual for two years now, and I’ve reviewed it thoroughly. So here’s my assessment of its plusses and minuses, from a clinical perspective. I’ve categorized my comments as “Thumbs Up” and “Thumbs Down.”

Tele-Treatment
It was 2010 I believe, when I first read the very few articles that had been published on the subject of e-therapy in mental health practice. I remember thinking how neat and cool it could be to interface with a client in real time via e-mail or videoconferencing. After these initial thoughts though, I dismissed it as something way off in the future, given the possible glitches that could easily arise, as well as the legal and ethical issues associated with HIPPA compliance and other privacy concerns. Well, what strides we’ve made over the last 5 years!

Identifying Depression in Youth: What to Look For and How to Proceed
One in three American children meets established criteria for depression, with onset typically at 10-11 years of age. The problem with diagnosing it in youth is determining its etiology, namely, is it biological (brain-based) or environmental.

How to Withdraw From Psychotropics Safely and Effectively
More and more calls and e-mails are filtering into my office these days from folks who are interested in tapering and possibly even discontinuing their psychotropics. Read more.

The Intrusive Nature of OCD
I took on a new client, Bob, last week who has all the signs and symptoms of chronic OCD. The disorder, via his self-report, has manifested in different ways over many years, but here’s a recap of the latest occurrence that brought him to treatment.

Binge Eating Disorder: Is This for Real and Should It Be Medication-Managed?
In the Twitter world, the buzz term seems to be what’s “trending.” In the world of mental disorders, “bingeing” is increasingly gaining attention. We’ve long been familiar with binge drinking, but now we’ve got a new binge kid on the block — binge eating for which there are established DSM-5 criteria.

Self-Esteem and Image Issues May Be Part of the Problem
People enter into psychotherapy, counseling or consultation for all sorts of reasons. Some don’t ever get past the “sounding board” stage in their work with us; many – if not most – are unclear about what their goals are; some improve substantially, others only moderately by not coming clean and really opening up, while yet others just simply quit.

Performing at Your Peak as a Mental Health Clinician
I’ve often put forth the notion that if you dwell on the clients you don’t help or just drop out of treatment, over the course of a career, you’ll do a lot of dwelling. But of course, this statement has its limitations.

Pharmacogenetic Testing in Psychiatry
Drug prescribing has long been a trial-and-error phenomenon in both physical and psychiatric medicine. Physical medicine though has this advantage: science has provided us a whole lot more information about the body than it has about the brain, and this bears itself out in the track record of certain psychiatric medication classes.

ADHD: How to Deliver Quality Assessment and Treatment
Attention deficit hyperactivity disorder (ADHD) is big business. ADHD medication sales have grown about 8 percent each year since 2010 and are projected to grow at least 13 percent this year to a whopping $12.9 billion in sales. There are two major reasons for this…

The Benzodiazepines
I get lots of questions regarding the benzodiazepine class of antianxiety drugs. So here’s an article addressing benzodiazepine actions, clinical uses, advantages, disadvantages, side effects, withdrawal and new information regarding onset parameters associated with physical dependence.

Muddled Medication Management Often Equals Suboptimal Outcomes
Switching from antidepressant to antidepressant, along with concocting one drug cocktail after another for treating depression, serves as a catalyst for more medication resistance going forward; and increasingly, I’m being referred patients who have experienced such strategies.

Belsomra: Yes, Another Sleeping Pill
The newest player in the non-benzodiazepine sleeping pill space is Belsomra (suvorexant). It’s actually a new chemical formulation in that it does not exert its hypnotic effects by working at GABA, histamine or melatonin receptors. Instead, Belsomra does its work at orexin receptors. So what is orexin?

Psychopharmacology… Going Forward
Where Psychopharmacology heads in the future will be largely dependent upon how realistically it defines its goals. Given the multidimensional nature and complexity of what influences depression, is it at all reasonable to conclude that an antidepressant, or for that matter, any other medicinal substance will be able to arrest it, or at the least, manage it better than the agents available today?

The More Things Change…
For sure, you know the backend of this common proverb. I invoke this old saying with regard to the two newest antidepressants on the U.S. drug market – Fetzima® (levomilnacipran) and Brintellix® (vortioxetine). Let’s take a look at them…

DSM-5: Positives and Negatives
The DSM-5 was in development for more than 10 years. Its official release was announced in May, 2013 at the American Psychiatric Association’s annual meeting in San Francisco, California. New diagnoses have been added and others have been amended or combined. Some proposed criteria considered for inclusion stirred up so much public and professional ire they were eventually eliminated from the final draft.

Panicking Should Be An Option
Panic attacks are sudden, intense, physical and emotional spikes of Adrenalin that typically last 10 minutes or so. They rise to disorder proportions when someone hands over control to the panic by worrying excessively about when the next attack will occur and making life changes to avoid them.

The Best Ways to Beat Generalized Anxiety
We are all a bit anxious from time to time. The mere stresses of everyday life present with situations that we find perplexing and worrisome, igniting the classic fight-or-flight phenomenon. This is consistent with living life on its terms and not ours, that is, none of us really knows what’s in store for us on any given day…

Saying Goodbye to Sleeping Pills and Antidepressants
For most of us I believe, once we’ve made a firm decision to do something, we want results swiftly with as little pain and effort as possible. So it never surprises me when a patient of mine who has decided to distance himself from sleep agents or antidepressants asks how long it will take and how difficult the withdrawal process will be…

The Stark Reality of Medication Treatment-Resistance
Years of presenting Psychopharmacology seminars and writing this newsletter have resulted in my receiving thousands of e-mails.

Treating Melancholic, Vegetative Depression: Use the Side Effects of Antidepressants to Advantage
As I’ve often noted about treating depression, getting depressed people moving is essential. It’s even more essential for those spending inordinate amounts of time in bed and cutting themselves off from physical and other forms of social contact with others.

Identification and Treatment of Bipolar Disorder is Stuck – Here’s Why
Although considered highly prevalent, bipolar disorder is routinely misdiagnosed. Psychiatric literature is replete with data about over-diagnosis — particularly in pediatric populations — but this disorder is frequently under-recognized also.

It’s High Time for Rethinking Depression Models
If you routinely work with clients who are medicated with antidepressants as I do, I’d bet that you’ve heard this all too familiar refrain: “My antidepressant isn’t working the way it used to, can you tell me why?”

Mental Illness in Older Adults
With a rapidly aging population, prescribers and non-prescribers alike will no doubt be seeing more elderly patients as more and more baby boomers approach retirement.

Treating Anxiety with Antipsychotics and Anticonvulsants
The benzodiazepines have been the mainstay of anxiety management for several decades now. In the past decade or two, the antidepressants, particularly the serotonin agents, have entered the picture when it comes to managing anxiety pharmacologically.

What Do You Want the Drug to Do, and for How Long?
Anyone who has either recently started or is contemplating the use of antidepressants or benzodiazepine anti-anxiety agents should ask themselves: what is it am I wanting from the drug and for how long do I envision availing myself of its services.

Dissecting OCD
Since many of my newsletter followers, blog readers and colleagues are aware that the treatment of OCD (obsessive-compulsive disorder) has been a niche area of mine for years, I often get questions about it. Here’s a recent one…read more.

Bipolar Disorder Symptoms – Beyond The DSM
We know all the classic symptoms of manic-depressive illness and its unpredictable cycle of intense mood swings. Significant to bipolar though, and more often linked to the manic characteristics of the disorder, are ego issues, arrogance, an entitlement mentality, an inability to calculate consequences and a general lack of awareness.

A Path Toward the Successful Treatment of Depression
As an old saying goes, there’s more than one way to get downtown. The same is true for treating depression, but there are two factors that need investigation before a treatment course begins. And they are: a) what’s the individual’s relationship with their depression like, and b) how is the depression serving them.

Psychopharmacology and Mental Health: Some Thoughts and Suggestions
You can read a 600- page text on the biochemistry of psychiatric medications; become enmeshed in the marvels of neuroscience; design highly complex drug regimens for patients; and still not know a thing until the patient swallows the first pill….

The 4 Demons of Depression and How You Can Help Clients Overcome Them
I’ve identified 4 areas that are consistently problematic in the lives of depressed people. Here they are and how you can help.

The Story of Serotonin and the Synaptic Sea
One of the films in the famous Star Wars trilogy was The Empire Strikes Back. Keep this in mind as we embark upon my story of: Serotonin and the Synaptic Sea.

DSM-5 – What It Would Be Wise to Ignore
Well, the Board of Trustees of the American Psychiatric Association has done it — they’ve signed off on a DSM-5 containing changes that are fraught with flaws, replete with overkill and scientifically weak.

Psychopharmacology and Mental Health Trends – My Take
Every now and then I read some of the ubiquitous “threads” which discuss the trials and tribulations of those using psychotropic medications. The most frequent discussions are about antidepressants.

Strive to Thrive – 10 Suggestions To Help You Stay On Track
In this article we focus on 10 ways to help you thrive. Here goes with some suggested do’s and don’ts.

ADHD – Why Parents Shouldn’t Buy In to This Diagnosis at First
Nine-year-old Megan’s mother called me recently. The purpose of her call was to set up a consultation whereby I would offer medication options for Megan’s “ADHD”… read more

The Nuts and Bolts of Diagnosis
Have you ever sat at your desk, or work space, opened the DSM IV and seriously attempted to digest the criteria? What do you make of the exclusionary criteria, riders, modifiers, specifiers, or whatever these are called nowadays?

Diagnosing Bipolar Disorder: Index It
When’s the last time you’ve cast a critical eye toward the DSM IV criteria for Bipolar Disorder? Do the criteria for Bipolar I and Bipolar II assemble a clear, usable diagnostic path for you, or do you find yourself mired in exclusionary clauses, modifiers, specifiers, qualifiers, categorical systems, or whatever all of this extraneous stuff is called nowadays?

Antidepressant Effects on Sleep
I am often asked about the effects that antidepressants have on overall sleep architecture. Here’s the breakdown…

Treating Anxiety: What Works Best For What
The least convincing evidence for psychotropic medication use is for the treatment of the anxiety disorders. Here’s why.

5 Steps Alcoholics Can Take To Stop Drinking: On Their Terms
In Act 1, Scene 3 of Shakespeare’s masterpiece, Hamlet, Polonius speaks these words to his son Laertes: “This above all: to thine own self be true.” Substance abuse is fraught with manipulation, deception, denial and minimizing. Extracting the truth from a substance abuser is a yeoman’s task for the treating professional.

Intermezzo: The Micromanagement of Insomnia Has Arrived
Reaffirming the notion that there is indeed a pill for every ill, the U.S. Food and Drug Administration has approved Intermezzo® (zolpidem tartrate sublingual tablets) for use as needed for the management of insomnia associated with middle-of-the-night awakenings and difficulty returning to sleep. This is the first time the FDA has approved a drug specifically for this indication. The agency warns that Intermezzo® should be used only when there are at least four hours of bedtime remaining.

Psychotropic Medication Decision Making: Toss the Algorithms and Decision Trees Aside
At every Psychopharmacology seminar I present, the following occurs: an attendee approaches me with a question regarding drug selection. I’m provided a small measure of the client’s history and the attendee’s assessment of the client’s condition. Invariably, the next question is what medication I would recommend. The expectation is for me to help after a two or three minute conversation guided by rudimentary information at best.

Making Peace With The Sandman
Infants can sleep anywhere. As a frequent flyer, I notice this often. In spite of the hustle and bustle of getting the passengers onboard and the roar of jet engines upon takeoff, little ones find dreamland, often safely tucked away in the arms of a loved one. Sleep though is not a birthright and this can become painfully obvious as we age.

Omega-3 Fatty Acids
“Fat” has become a bad word in our society, but the fact is a particular type of fat is so essential, that our body’s cells can literally collapse without it. Fish oil — with its singular component omega-3 fatty acids in conjunction with other types of fat in the membranes that surround the cells — literally control cell behavior.

Antidepressants: Faulty Expectations and Implications For The Future
With ever-increasing regularity, and regardless of the referral source, people with garden variety psychosocial problems are presenting to my office seeking antidepressants.

Psychopharmacology: What Happened In 2011 and a Glimpse Ahead
Every December in this space, I summarize what transpired in the dynamic field of Psychopharmacology for the year and take a look down the road ahead. For 2011, here goes.

Making the Case For A More Streamlined DSM-5: A Few Suggestions
Our mental health bible is in need of a facelift. My diagnostic confidence is not bolstered by the DSM-IV-TR, and as proposed, the DSM-5 is not generating much enthusiasm for me either. So I got to wondering what a more user-friendly, more helpful DSM-5 would read like.

Rational Approaches for Managing Insomnia
Sleep simply does not come naturally to some people. We’re all wired differently and our circadian rhythms are environmentally influenced. Those who travel frequently or do shift work often report difficulties with the sandman.

Disruptive Mood Dysregulation Disorder: Yet Another Setback for Child Psychiatry
Child psychiatry has been on a zealous binge of creating diagnostic fads in recent years with three highly visible examples to its credit – childhood bipolar disorder, ADD and most recently, autism. Now, thanks to a scientific review group, there’s another possible contender, namely, Disruptive Mood Dysregulation Disorder (DMDD) that will be included in DSM-5.

Treatment-Resistant Bipolar Disorder: A Formidable Foe
Treatment resistance in bipolar disorder is very common. Even with optimal care, which includes medication combinations, 50 percent of bipolar individuals who achieve symptom remission will relapse within two years.

Treatment-Resistant Depression
The need for viable augmentation strategies to assist in the pharmacological management of treatment-resistant depression (TRD) has become so dire that clinicians seem to perk up to any option nowadays.

Frequently Asked Questions
Take a look at some of these common questions about psychotropic medications, weight gain and what questions should be asked when having a psychiatric medication evaluation.

Obsessive-Compulsive Disorder
Characterized by a series of persistent thoughts and compulsions, OCD is a chronic condition fraught with suffering, shame, guilt and self-doubt. It is often incapacitating as well.

Child and Adolescent Bipolar Disorder: Controversies, Concerns and Current Medication Trends
The diagnosis of bipolar disorder in children and adolescents is currently the most hotly debated issue in pediatric mental illness. Is the disorder overdiagnosed or underdiagnosed in this population group?

8 Tips for Managing Antidepressant-Induced Sexual Dysfunction
Ironic isn’t it? Depression robs people of their desire for sex, and antidepressants can make the situation even worse.

Viibryd™: The Next Blockbuster Antidepressant?
While smack-dab in the middle of my personal and professional planning during January of this year, the FDA went ahead and approved another antidepressant. As a psychopharmacology writer and speaker, this should teach me not to turn my back for even one second.

Polypharmacy: Friend, Foe, or Both?
“Psychiatric patients are over-medicated.” I hear that a lot, particularly from people who learn that I write a Psychopharmacology blog. Part of me agrees, yet another part of me realizes that this is not a simple black-or-white issue; instead, it is nuanced and complex.

Mental Health Disorders and Psychopharmacology: The Year 2010 In Review
Here are the highlights that I’ve taken away from researching several well-respected pieces of scholarly work regarding mental health disorders and Psychopharmacology during 2010.

Temper Dysregulation with Dysphoria…The Best Laid Plans
“The road to hell is paved with good intentions,” remember this old saying? Sometimes we spot a serious problem, and with the best of intentions, discover that our solution wreaks as much havoc as the original problem itself.

Recent Psychotropic Medication Arrivals: Can We Really Call Them New Drugs?
So what’s really new about Intuniv and Trazodone Extended Release? Not much. The release technology certainly isn’t, and as far as the improved side effects profile goes, maybe. They’re certainly no more effective than the immediate release products.

4 Key Reasons For Medication Non Compliance and How You Can Help
The basic tenet of non compliance is the failure to take medication according to prescribed directions. But it’s more than non adherence to directions, non compliance is also indicative of the misuse of medication.

The Placebo Effect
The placebo effect is likely as old as the healing professions themselves. This article discusses what it is, possible mechanisms for it and using the placebo effect.

6 Tips for Improved Relationships with Physicians
Non-medical clinicians train and practice in a world that is considerably different from that of physicians. We’ll look at tips to improve these relationships.

Are All Drugs Created Equal? Brand-Name vs. Generic Medications
Are low-priced generic medications as safe and effective as their brand-name counterparts?

Tips for Assessing and Treating Clinical Depression
Think of depression not as a diagnosis, but instead as a cluster of symptoms with many possible causes.

Work’in Blues
Depression in the workplace is a serious, costly illness. Here’s how employers and employees alike can cope.

Bad Boss!
4 steps to dealing with a difficult supervisor

Stop Saying ‘Yes’ When You Really Mean ‘No’
5 tips to help you become more assertive

Walking the Work-Family Tightrope
These 8 tips can help you to balance the demands of work with the needs of those you love

Six Ways to Beat Job Burnout
The thrill is gone at the office? Try these tips to get your work groove going again.

The Essential Dad
Tips for fathering — from infancy to adolescence.

Helping Clients Overcome Resistance to Psychotropic Medication: Part II
This article discusses two common reasons for resistance: Family Interference and Fear.

Man Power!
Try These 7 reinvigoration techniques to bring out your masculine side.

For Better or Worse – But Mainly For Better
Newlyweds, adopting these five qualities can help your marriage last for many, many years.

10 Ways to Get Your 40 Winks
Stop losing out to insomnia. Here are 10 highly effective tips for falling asleep — and staying asleep — with greater ease.

Helping Clients Overcome Resistance to Psychotropic Medication: Part I
The answer to a widely asked question: “How do I professionally and ethically handle the client that continues to resist psychotropic medication in spite of continuing symptoms?”

Rediscover Your Bliss
Six simple steps to help you reconnect with yourself today

Keep the Home Fires Burning
Five ways to put the spark back in your marriage — and keep it lit!

Facing Down Fear
Fear is universal; everyone experiences it from time to time. But the way we react to fear is not always appropriate.

Beat the Procrastination Bug
Eight powerful ways to get important things done – starting now!

Pediatric Anxiety Disorders: Pharmacological vs. Behavioral Treatment
Anxiety disorders are among the most common mental, emotional and behavioral problems to occur during childhood and adolescence.

Seasonal Affective Disorder (SAD): More Than Just the Winter Blues
Many of us notice increasing tiredness and difficulty getting out of bed as autumn turns to winter. In fact, for centuries, writers have portrayed the shorter days of the calendar year as a time of sadness, loss and lethargy. But for some people, winter causes a noticeable exacerbation of these symptoms, and their depression and lack of energy can become immobilizing.

One Child in Every Classroom: ADHD Affects Two Million American Kids — is Yours One of Them? Contributing author, Chattanooga Parent, Jan/Feb 2010

Boost Your Mood – Naturally!
Contributing author, Woman’s World Magazine, 12/28/09

Beyond Talk Therapy and ‘Happy Pills’: The Risks and Rewards of Alternative Treatments
Contributing author, Anchor Magazine, Fall 2009

The Alternative Remedy Frenzy
To read the volumes of ever-increasing information on this subject, the latest “natural” miracle cure is either on the horizon or already here. There are many claims to fame in this regard, but most of them fall by the wayside when subjected to scientific research.

Medicating Children With Bipolar Disorder
When it comes to stabilizing and maintaining remission of the constellation of symptoms associated with bipolar disorder, clinicians often disagree over an appropriate course of action.

Medications for Bipolar Disorder
Published in the Sept/Oct 2009 issue of Social Work Today magazine

Ten Factors that Every Clinician Should Know – and Share With Their Clients – About Antidepressants
Depression is a real illness, not a character flaw or weakness. We’ll take a look at this fact and many others.

Ten Tips For Helping Clients Communicate More Effectively With Their Mental-Health Medication Prescribers

The Interaction Between Families and Psychotropic Medication
Family members can have a significant influence on a client’s initial decision to attempt psychotropic medication. They can also influence the client’s willingness to adhere to a treatment regimen once it has been started.

Getting Enough Zzzzzzzz’s
A survey of 2,500 people by the American Psychological Association found that 80% of respondents say the economy is a significant source of stress and that it’s taking a toll on their health. Are you getting enough sleep?

A Priceless Ally – Cultivating a Positive Attitude
Attitude is more than the way you communicate your mood to others; it serves as you mind’s eye – the way you see the world, so to speak.

Anger Energy – Managing Anger Before It Manages You
Is anger always a big, bad, ugly, potentially destructive emotion? Absolutely not. When used constructively and productively, anger can be a very positive motivating force in your life.

The Sometimes Rocky Road Toward a Psychotropic Medication Evaluation
Client ambivalence is a common occurrence, but when faced with this, clinicians should take the opportunity to continue strengthening the therapeutic relationship as the decision making process unfolds.

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Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.

To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.