Blogs
Pharmacogenetic testing: A waste of time for predicting response
Q: I was wondering if you've used genetic testing to help choose an antidepressant. I have one patient who is...
Lithium orotate over the counter for bipolar illness?
Q: I have a question about Lithium Orotate 10 mg or other low dose. I have a few patients who cannot accept their...
Carbamazepine: The most overlooked mood stabilizer
An underappreciated medicationUse the slow release formBest clinical usesFormulations, mechanisms, dosing, and...
Truths and Fallacies of Psychopharmacology
Truths of Psychopharmacology 1. Your treatment is as good as your diagnosis. 2. Treat diseases, not symptoms. 3. All...
Pleae dose lithium just once daily – Really.
Question: Dr. Ghaemi recommends Lithium once daily dosing over twice daily to minimize renal side effects, based on...
Treatment of anxiety “disorders”
Obsessive-compulsive disorderPanic disorderGeneralized anxiety treatmentPost-traumatic stress disorder Anxiety is the...
Post-traumatic stress disorder (PTSD)
Diagnostic hierarchy and Post-traumatic stress disorder Trauma: Too broad a conceptTreatmentA DSM...
Antidepressants in bipolar depression: Ineffective at best, harmful at worst
Antidepressants, in the PL view, should not be used in bipolar illness. The only studies in which they have been...
The Antidepressant Efficacy Controversy
In recent years, there has been some controversy about whether or not antidepressants are as effective as many had...
Amphetamines: A Critique
The views presented here are described with citations to primary data in our review, downloadable below (1)....
Hippocratic Psychopharmacology
Hippocratic psychiatry NOT “First, do no harm” Nature heals Non-Hippocratic psychiatry Rules for a Hippocratic...
Childhood ADD: A Critique
Childhood ADHD Inattention in diagnosis of Childhood ADHD Social factors Identifying the real entity Treatment...
Adult ADD: A Critique
The adult ADHD diagnosisMood and anxiety factorExplanationsA separate condition?Not worth the risksSummary The adult...
Mixed depression
Depression with psychomotor excitation is not just a "major depressive episode" Clinicians use the...
Psychiatric Diagnosis: Beyond DSM
In the Hippocratic tradition, clinicians should treat diseases, not symptoms. Diagnosis thus becomes extremely...
Understanding anxiety
Anxiety is the “fever” of psychiatry. Fever is a completely nonspecific symptom, which happens in many illnesses, and...
Bipolar illness: Treatment
The basic principle of treating bipolar illness is simple: Maximize mood stabilizers; avoid antidepressants. The...
Understanding depression
“Depression” is not a diagnosis. It is a syndrome, a collection of signs and symptoms, like fever. It can happen in...
SSRI, SNRI – It’s the SAME. Just say “SRI”
Doctor: I’m giving you Cymbalta (duloxetine). Patient: I got manic and suicidal on SSRIs. Is it an SSRI? Doctor: Don’t...
Curbside Consult: Spontaneous remission in bipolar illness
Q. I saw a patient this week for an initial evaluation who has a historical diagnosis of bipolar disorder (likely type...
Curbside consult: Antidepressant-withdrawal mania
Q. I have an 18 year old female with a history of depression who had been stable on citalopram. She had never had a...
QA: The “Treatment Overlap” speech and giving an ultimatum in clinical care
Question: If you see a new patient and you're recommending discontinuation of amphetamines due to side effects (like...
QA: Borderline personality that goes away and lamotrigine deficiency syndrome
Question: In one of the last lectures I attended, our lecturer expressed his views, that borderline personality...
Are delusions rational?
A few decades ago, the Harvard psychologist Brendan Maher made an unusual claim. People with delusions use the same...
Invalidity of Adult ADD
The diagnosis of ADD is typically made when a person has marked inattention, or distractibility, along with “executive...
Living with uncertainty
When I was in psychiatry residency, one of the consistent teachings we received was that we needed to learn to become...
The diagnostic hierarchy concept: Why is it missing in psychiatry?
The concept of diagnostic hierarchy was explained for psychiatry a century ago by the German psychiatrist Karl...
How to mislead with meta-analysis: Lithium and suicide
A recent paper on lithium and suicide is an excellent example of how to mislead with meta-analysis. It is...
What is psychotic depression?
Q. Is psychotic depression yet another form of depression? Or is psychotic depression the same as manic depression?...
The Serotonin hypothesis debunked? Not really – It never meant anything
The serotonin hypothesis of depression, which became popular from the 1990s until now, is false, and has been known to...
Pharmacogenetic testing: A waste of time for predicting response
Q: I was wondering if you've used genetic testing to help choose an antidepressant. I have one patient who is...
Lithium orotate over the counter for bipolar illness?
Q: I have a question about Lithium Orotate 10 mg or other low dose. I have a few patients who cannot accept their...
Pleae dose lithium just once daily – Really.
Question: Dr. Ghaemi recommends Lithium once daily dosing over twice daily to minimize renal side effects, based on...
Curbside Consult: Spontaneous remission in bipolar illness
Q. I saw a patient this week for an initial evaluation who has a historical diagnosis of bipolar disorder (likely type...
Curbside consult: Antidepressant-withdrawal mania
Q. I have an 18 year old female with a history of depression who had been stable on citalopram. She had never had a...
QA: The “Treatment Overlap” speech and giving an ultimatum in clinical care
Question: If you see a new patient and you're recommending discontinuation of amphetamines due to side effects (like...
QA: Borderline personality that goes away and lamotrigine deficiency syndrome
Question: In one of the last lectures I attended, our lecturer expressed his views, that borderline personality...
What is psychotic depression?
Q. Is psychotic depression yet another form of depression? Or is psychotic depression the same as manic depression?...
Going underground
Q: I wanted to ask about integrating the things you teach into my learning and practice as an upcoming resident. Lots...
A 17 year old female refuses olanzapine…
Q: I have a 17 y/o girl that refuses to take olanzapine because at the John Hopkins clinic she was given a list of...
How do you treat melancholic depression?
Q; Never heard of chronic involutional melancholia. I give some activating drugs like venlafaxine or duloxetine for...
Four antidepressants and still not well
Q. The following patient was referred to me and is unfortunately a very typical case of the standards of current...
What is a disease-modifying drug?
Question: I would like to ask you one question regarding your differentiation between "symptomatic" drugs like...