Your patient has anxiety, and you’ve tried the usual medications. You’ve rotated through your favorite SSRIs and SNRIs, tried some of the benzodiazepines, and even given buspirone a whirl to no avail. It’s time to go off-label.
Most treatment guidelines recommend cognitive behavioral therapy as first-line psychotherapy for anxiety disorders. In this article, Dr. Glen Spielmans will give you a brief primer of CBT techniques for panic disorder, social phobia, and obsessive-compulsive disorder, as well as review whether, for these conditions, CBT is indeed superior to other forms of therapy.
Abilify (aripiprazole), which has long been FDA-approved for both schizophrenia and manic episodes of bipolar disorder, was recently approved for augmentation of antidepressants in patients with treatment-resistant depression.
Clinical trials show which treatments work for “the average patient,” but we have little ability to predict which treatment will work best for any individual patient. QEEG (quantitative EEG) is a method in which a computer program reads EEG tracings and scores them along certain dimensions.
Anecdotally, adding an atypical antipsychotic to an antidepressant is a common practice for achieving a response in patients who have failed several medication trials. Do the data support this use of atypical antipsychotics?
To begin with, Dr. Friedman, I’d like to start with the diagnosis of PTSD. Given that patients sometimes come to us for disability evaluations and therefore have a secondary gain for getting the PTSD diagnosis, do you have any good tips for how we can be sure that we are making the proper diagnosis?
There is a strange disconnect between what we psychiatrists do in daily practice and what official antidepressant treatment guidelines recommend. Treatment guidelines typically say, essentially, that all antidepressants are equal in efficacy, but real psychiatrists have strong personal preferences, based on some combination of the scientific literature, the advice of experts, our clinical experience, and perhaps even the personalities of the last drug reps we saw in the office.