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.
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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.
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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.
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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.
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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?
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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?
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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.