It can be challenging to manage chronic pain, even more so when our patients suffer from addiction. We can find ourselves walking a tightrope between the risk of relapse due to the inadequate treatment of pain, and the risk of relapse due to the use of opioid analgesics.

Dosages matter. The risk of death from an overdose with patients prescribed at least 100 mg daily morphine equivalent is about 7 times higher than a patient prescribed less than 20 mg of morphine a day.

Every five years or so, we do an update on PTSD treatments; the most recent was our August 2011 issue of TCPR, in which we declared that psychotherapy was the gold standard for treatment.

By and large, psychiatrists aren’t terribly comfortable when it comes to diagnosing and treating borderline personality disorder (BPD). Fortunately, diagnosing BPD is relatively easy and can often be done in 20–30 minutes. The key is to have a systematic approach, to ask high-yield questions, and to know how to efficiently follow up on responses.

The U.S. Food and Drug Administration approved Ingrezza (valbenazine) for the treatment of tardive dyskinesia (TD), a disabling movement disorder that afflicts 10%–20% of people on chronic antipsychotic ­medication.

We often prescribe antidepressants to patients who are suicidal, and unfortunately, some people use these very medications to try to kill themselves. It’s been known for some time that tricyclic antidepressants are among the most toxic in overdose, so we embraced the SSRIs and later medications in part because they are considered to be safer. But how safe are they?

Naltrexone is an opioid blocker that is FDA-approved for the treatment of alcoholism. However, it is also effective off-label for treating opioid use disorder. The medication comes in two forms: an oral pill (brand name ReVia) and an injectable version (XR naltrexone, or Vivitrol). XR naltrexone is composed of 380 mg of naltrexone, given as an intramuscular injection once a month. During that month, patients who try to use opioids will feel little if any high. This works well to prevent relapse if patients keep getting the shot.

People with alcohol use disorder are often smokers, and it can be very hard for patients to reduce their drinking and smoking simultaneously. In this study, the researchers hypothesized that topiramate, which has shown promise as an off-label treatment for nicotine and alcohol use independently, might work as a “silver bullet” for both ­problems.

As marijuana has gained acceptance—it can now be prescribed to treat a wide variety of medical conditions in 28 states and Washington, DC—there has also been a shift in attitudes toward other mind-altering substances that, despite their reputation as drugs of abuse, show promise as therapeutic agents.