In surveys, it’s clear that most psychiatrists practice as unimaginatively as I typically do, meaning that their drug of first choice for most depressed patients is an SSRI (Petersen T, et al., Prog Neuropsychopharmacol Biol Psychiatry 2002; 26:177-187).
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How high can we safely dose common psychotropics? Given the poor performance of medication combinations in recent studies, it’s time for a close look at the safety and efficacy of raising doses, sometimes known as “dose optimization.”
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The controversy over pediatric bipolar disorder has heated up over the past year. A recent study offers evidence for those favoring “narrow” criteria for the pediatric bipolar diagnosis.
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In a study only partially funded by the manufacturer of Provigil (modafinil), 85 patients with bipolar depression, already taking mood stabilizers, were randomly assigned to augmentation with Provigil (N=41) or placebo (N=44).
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It was a sorely needed study: compare sibutramine (Meridia) with topiramate (Topamax) in patients with psychotropicassociated weight gain. Sibutramine is generally considered one of the most effective weight loss agents.
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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