The post-test for this issue is available for one year after the publication date to subscribers. By successfully completing the test you will be awarded a certificate for 2 CME credits.

How do you start a new patient on antidepressant treatment? We do this countless times in our practices, and reviewing the topic may feel a bit like returning to residency. However, it’s important to revisit our standard operating procedures from time to time to ensure we’re thinking carefully about our decisions during our busy days.

You’ve tried different SSRIs and then some, but your patient either can’t tolerate what you’ve prescribed or simply hasn’t experienced a lift in mood. Now what? Dr. Gitlin has some ideas.

Your patient has now failed four antidepressant medications, both alone and as cocktails. What else can you pull out of your bag of tricks? Dr. Becker suggests considering transcranial magnetic stimulation (TMS), which he maintains is underutilized. “Many of my colleagues right down the hall from me still don’t think of TMS for treatment or don’t know who to refer for it,” he says. “I think it should be more readily considered for a lot of patients out there.”

For a look at how TMS works, how effective it is, how it compares with electroconvulsive therapy (ECT), whether some brands of TMS machines are better than others, and what you have to do to make sure your patient’s health insurance plan picks up the tab, we spoke with Dr. Becker, who prescribes this treatment for some of his patients.

Dr. Gardiner recommends ConsumerLab.com to patients to “try to stop them from hurting themselves with mislabeled products or wasting their money” and to help determine whether a supplement might interfere with a medication he is prescribing.

NeuroStar just announced that the FDA has cleared an updated version of its TMS system. Called the NeuroStar Advanced Therapy System, its primary claim to fame is that patients can receive a full TMS treatment in only 19 minutes, as opposed to the 40 minutes required with NeuroStar’s original system.

After reading these articles, you should be able to…

The post-test for this issue is available for one year after the publication date to subscribers only. By successfully completing the test you will be awarded a certificate for 2 CME credits.

After reading these articles, you should be able to…

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.