1st International Symposium on Clinical Psychiatry

Opening

Highly effective, rarely prescribed

Why three of psychiatry's highest-impact treatments, lithium, clozapine, and ECT, remain at the margins of daily practice.

Dr. Prado Lima trained in psychiatry at CMME, Sainte-Anne Hospital, in Paris, and holds a PhD in biochemistry. He has built his career around treatment-resistant patients, those for whom the guideline treatments fail, and has written on how the evidence behind those guidelines gets made.

“The ultimate question here is, are we using evidence-based medicine or patent-based medicine?”

Pedro do Prado Lima, on the shift from lithium to divalproex · CNS Spectrums, 2017

• Frames the evening's question: why treatments with decades of evidence stay at the margins of practice
• A clinician-researcher's lens, from decades with patients for whom standard treatments fail

Interventional psychiatry

When nothing else works: ECT and the foundations of interventional psychiatry

TMS, esketamine, and ECT now form a field of their own. ECT is the oldest of the three, the most stigmatized, and still among the most effective treatments for severe depression.

• Demystifying ECT: what a modern course actually involves, from brief general anesthesia and a muscle relaxant to two or three sessions a week
• Indication and referral: which patients to send, and when
• What to tell the patient and family when you propose it, including an honest account of memory effects
• How ECT, TMS, and esketamine fit together when first-line treatments fail
• Running an ECT service safely and well, from a psychiatrist who trains ECT teams

First used in Rome in 1938 by Ugo Cerletti and Lucio Bini, ECT has outlived its reputation for one reason: for the most severely ill patients, few treatments work as well or as quickly.

Clozapine

Demystifying clozapine

The reference drug for treatment-resistant illness, and one of the most underused. Dr. Kauer-Sant'Anna uses it well beyond schizophrenia.

“We could use much more clozapine for bipolar patients than we use right now.”

Márcia Kauer-Sant'Anna, on The Psychiatry Letter podcast, June 2026

• Beyond schizophrenia: the bipolar patients most likely to respond, with chronic manic or mixed features, irritability, or impulsivity, with or without psychosis
• Lower doses: in her bipolar clinic, often less than half the usual schizophrenia dose, which changes tolerability and who can benefit
• The monitoring barriers that keep prescribers away, and what the neutropenia data actually show

Lithium

Lithium: the safest and most effective of psychotropics

The most effective treatment in mood disorders, and one of the least prescribed.

“If you can't or won't use lithium, you should get out of the business of treating bipolar illness.”

Frederick Goodwin, former NIMH director and Dr. Ghaemi's mentor. Dr. Ghaemi goes further: if you can't or won't use lithium, you can't treat psychiatric illness well in general.

• Dosing to clinical effect: what the serum level really tells you, and what it doesn't
• Lithium in depression, not just mania: what unbiased studies show
• The fears that keep prescribers away, toxicity and kidneys, and what the evidence answers

Closing

A conversation about diagnosis in psychiatry

Two clinicians on what comes before the prescription: recognizing the right illness.

“Treat the disease, not just the symptoms.”

The Hippocratic principle Dr. Ghaemi has defended for decades

• The error that delays everything: bipolar depression treated for years as unipolar
• When the diagnosis changes, the whole treatment changes, from drug choice to prognosis