Category Archives: First Comments

ADHD, Accidents, and Premature Death

Occasionally insurance companies make doctors fill out forms for  medications  not on their formularies, and on the form will be  a statement that asks the doctor to check a box if a ‘standard review timeline’ of 72 hours might seriously … Continue reading

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How lithium helps prevent suicide: one patient’s experience

How lithium helps prevent suicide: a patient’s experience   Lithium is one of the most effective anti-suicide medications psychiatrists have to treat patients with mood disorders. http://www.bmj.com/content/346/bmj.f3646   How it works is unknown. [i]   Recently, a patient of mine … Continue reading

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Psychopharmacology Made Simple: What’s it like when an SSRI[i] works?

Psychopharmacology Made Simple: What’s it like when an SSRI[1] works? What benefit can one expect from a medication? While it’s easy enough to find information online about side effects and diagnostic indications (approved uses), it’s much more difficult to learn … Continue reading

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Psychopharmacology Made Simple: What’s it like when Wellbutrin works?

Wellbutrin (bupropion) works quite differently from SSRIs such as Lexapro (escitalopram), the subject of a previous blog post. How does it work? Per UpToDate[1], “like other antidepressants the mechanism of bupropion’s activity is not fully understood”. [2]   Clinically, it’s … Continue reading

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What does hypomania look like?

Hypomanic states are rarely observed by the psychiatric clinician. Bipolar  patients are much more commonly depressed  (according to Judd et al, bipolar II patients spent only 1.3% of the time in hypomania over 13 years of follow-up). http://jamanetwork.com/journals/jamapsychiatry/fullarticle/207252  accessed 1/14/17 … Continue reading

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Trans-Atlantic differences on drinking in pregnancy, and the pleasures of literary fiction

The English have a somewhat more relaxed attitude towards drinking in pregnancy than we do in the States. From the RCOG: “It is recommended that you do not drink alcohol during the first three months of pregnancy. Drinking small amounts … Continue reading

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How long to give an SSRI to work ?

An important review article and meta-analysis, Early Treatment Responses of Selective Serotonin Reuptake Inhibitors (SSRIs) and clomipramine in pediatric OCD was published in the Journal of the American Academy of Child and Adolescent Psychiatry (October, 2016, p 851-859). http://www.jaacap.com/article/S0890-8567(16)31160-1/fulltext   The … Continue reading

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J shaped risk curves versus linear risk curves: drinking versus smoking

Too often, when I ask patients if they smoke cigarettes, I hear, “Oh, only 2 or 3 a day”, as if, not a problem, no big deal, like saying, “when I play Russian roulette, there’s only one bullet in the … Continue reading

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Thinking about sleep: Maiken Nedergaard and the function of deep sleep

All animals sleep, even flies (research with the fruit fly Drosophila revealed the presence of clock genes).  All mammals have REM (rapid eye movement) and non-REM sleep. Human infants sleep 16 hours/day (if their parents are lucky); adults sleep 8 … Continue reading

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Can I bring my medications on vacation?

A patient emailed me recently: he was going to a few countries in Europe. Could he take his medications with him? He was on a schedule II stimulant. I think it’s a good idea, before visiting a new country, to … Continue reading

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