Carlat Psychiatry

Pramipexole surpassed amantadine/ quetiapine in new RCT of 150 with treatment resistant #depression as aug: pubmed.ncbi.nlm.nih.gov/40659070 Quetiapine (100 mg) and pramipexole (0.375 mg) underdosed, See 7/4 post for better study of pramipexole in TRD at 2.5 mg/day.

Did the largest depression trial just test placebos? STAR*D lacked placebo, and most treatments in it failed in placebo-controlled trials: pubmed.ncbi.nlm.nih.gov/40511894 Exception is lithium augmentation, and maybe mirtazapine aug, which worked in small but not large placebo-trials.

ECT was more effective and better tolerated in older (≥ 85) than younger patients in this Swedish registry analysis: pubmed.ncbi.nlm.nih.gov/40640071 They controlled for severity and psychotic features, which also predict ECT response in depression.

💊 "Just increase the dose" might not cut it. When evidence confirms or challenges your instincts, that’s your cue to read closer. 📥 Follow Dr. Daniel Carlat on LinkedIn for more practical, unbiased #psychiatry: linkedin.com/in/danielcarla… #mentalhealth #ssri #depressiontreatment

Brexpiprazole (Rexulti) rejected for PTSD by FDA's advisory panel, voting 10:1. Why? ▪ Only 1 out of 2 phase III trials positive (large phase II trial also positive) ▪ Antipsychotic only tested as first-line, sertraline-combo, but risky meds better reserved for non-response.

There are three diets with #antidepressant potential: Nordic, Japanese, and Mediterranean. Only the Mediterranean is supported by RCTs, and this new cross-sectional study adds evidence to the Nordic: ncbi.nlm.nih.gov/pubmed/40620153 An antidepressant diet: chrisaikenmd.com/antidepressant…

𝐈𝐧𝐭𝐫𝐨𝐝𝐮𝐜𝐢𝐧𝐠 𝐭𝐡𝐞 𝐆𝐞𝐫𝐢𝐚𝐭𝐫𝐢𝐜 𝐏𝐬𝐲𝐜𝐡𝐢𝐚𝐭𝐫𝐲 𝐅𝐚𝐜𝐭 𝐁𝐨𝐨𝐤: This is your new go-to guide for geriatric psychiatry—clear, concise, and packed with practical tools to help you deliver exceptional care to older adults. thecarlatreport.com/products/708

High-salt intake is linked to depression. New 15-yr study is best designed yet, following 276,138 people who were free from depression at start; ncbi.nlm.nih.gov/pubmed/40623639 Doubt we’ll see definitive proof - RCTs would be unethical in humans - but animal studies have provided that.

Daridorexant (Quviviq) improved all sleep outcomes in new, phase III RCT of mild sleep apnea, without causing daytime fatigue: pubmed.ncbi.nlm.nih.gov/40660750 These orexin antagonists are generally safer than traditional hypnotics.

𝐆𝐫𝐢𝐞𝐟, 𝐏𝐚𝐫𝐞𝐧𝐭𝐢𝐧𝐠, 𝐚𝐧𝐝 𝐑𝐞𝐜𝐨𝐯𝐞𝐫𝐲 𝐀𝐟𝐭𝐞𝐫 𝐚 𝐃𝐢𝐬𝐚𝐬𝐭𝐞𝐫 Here's how families are responding mentally and emotionally to disaster, and how children process loss when a parent or caregiver dies. Full episode: thecarlatreport.com/.../5447-grief…... #DisasterRelief

𝐄𝐧𝐯𝐢𝐫𝐨𝐧𝐦𝐞𝐧𝐭𝐚𝐥𝐥𝐲 𝐈𝐧𝐝𝐮𝐜𝐞𝐝 𝐍𝐚𝐫𝐜𝐢𝐬𝐬𝐢𝐬𝐦 with Kellie Newsome, PMHNP and Chris Aiken, MD Full episode: thecarlatreport.com/.../5442-envir…... #narcissist #narcissisticpersonalitydisorder #psychiatry

Mediterranean diet treats depression, but can focusing on it worsen eating disorders (ED)? Possibly, but it is assoc w/ 75% lower ED risk in new study (causation unclear): pubmed.ncbi.nlm.nih.gov/40605615 What's your take? A diet for depression: chrisaikenmd.com/antidepressant…

What to know about FDA's change on XR stimulants: ▪ < age 6 = higher serum levels, more side effects/weight loss ▪ For ADHD < age 6, behavior/family therapy is first-line, and instant-release stimulants preferred over XR, methylphenidate preferred over amphetamine

Does propranolol treat #anxiety? There are surprisingly few trials of it, so this randomized placebo controlled trial - though small - is a welcome addition, where it augmented sertraline in panic (20mg/d): pubmed.ncbi.nlm.nih.gov/40615929 #psychiatry #pmhnp

Most seizures meds worsen cognition, but can levetiracetam (Keppra) improve it? These 6 RCTs tested it in cognitive decline, where it brought small gains in visual-spatial and executive functioning (125-500mg BID): pubmed.ncbi.nlm.nih.gov/40608289 (levetiracetam may treat mania & TD)

Light therapy treats bipolar depression in all seasons, but should you give it at 12pm or 8am? Both had similar benefits and manic risk in new RCT: pubmed.ncbi.nlm.nih.gov/40608475 Raise gradually to prevent mania (from 7.5-15min to 45-60min over 4-10 wk) How to chrisaikenmd.com/lighttherapy

Depression usually impairs medication adherence, but not in the case of opioid maintenance therapy, where it improves it: pubmed.ncbi.nlm.nih.gov/40528448 Buprenorphine/samidorphan showed promise in RCTs of depression (though it failed to earn FDA-approval due to negative trials)

Pramipexole lifted treatment resistant #depression with large effect size (0.87) in 48-wk, placebo-controlled augmentation trial of 150: pubmed.ncbi.nlm.nih.gov/40602411 Used 2.5mg as higher dose works better in TRD (vs 1.5mg) (but more side effects). How to use: thecarlatreport.com/articles/3083-…

N-Acetylcysteine (NAC) improved COVID outcomes in 11 RCTS: pubmed.ncbi.nlm.nih.gov/40418545 The antioxidant has psychiatric benefits for trichotillomania, #depression, and possibly addictions and renal health on lithium. How to use NAC: chrisaikenmd.com/supplements