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In this episode of the JCP Podcast, Dr. Ben Everett speaks with Dr. Nina Schooler, a social psychologist whose career in psychiatric research spans more than six decades. Dr. Schooler began her work at the National Institute of Mental Health's Psychopharmacology Service Center in the early 1960s and has since contributed to landmark studies on antipsychotic treatment, maintenance therapy, tardive dyskinesia, long-acting injectables, negative symptoms, and coordinated specialty care for first-episode psychosis. As the field increasingly looks toward a paradigm of meaningful functional recovery that goes beyond symptom control, this conversation traces how today's clinical standards, from dose-reduction strategies to the RAISE early-intervention model, emerged from decades of trial design, unexpected findings, and hard-won methodological lessons. 🎯 KEY EPISODE HIGHLIGHTS: 🔍 THE ACCIDENTAL DISCOVERY IN THE FIRST PLACEBO STUDY [12:30] “the patients who'd been treated with placebo seemed in some ways to be doing better than the patients who had been treated with drug.” A counterintuitive early finding shows how unblinding and differential attention, not the drug itself, can distort perceived treatment effects in psychiatric trials. 🚧 WHY THE SICKEST PATIENTS ARE MISSING FROM NEGATIVE SYMPTOM TRIALS [1:04:00] “the patients we most want to include will not be included in the trial because participating in a clinical trial requires effort” A structural recruitment paradox helps explain why decades of negative symptom trials have struggled to enroll the patients most affected by the condition. 🤝 SCHIZOPHRENIA CARE AS “A TEAM SPORT” [1:19:30] “My sense of schizophrenia as a treatment target is that it's a team sport, and that it requires a team of people to engage with patients offering a range of treatments for which I see medication as the absolutely essential platform on which other things, can indeed build.” After six decades in the field, this framing captures why no single intervention, medication or psychosocial, succeeds alone in treating schizophrenia. CHAPTERS: 0:00 – Introduction: Six Decades of Schizophrenia Research 2:30 – Joining NIMH's Psychopharmacology Service Center in the 1960s 9:00 – Shifting Terminology and the Boundaries of a Schizophrenia Diagnosis 11:30 – A Social Psychologist's Lens on Early Treatment Outcomes 16:00 – Open Questions on Lifelong Treatment and Parallel VA Research 18:30 – The Hogarty-Goldberg Studies and the Two-by-Two Trial Design 27:30 – Expressed Emotion and the Camberwell Family Interview 32:30 – Controlled Trials Versus Real-World Adherence 34:00 – Tardive Dyskinesia and the Push to Lower Antipsychotic Doses 36:30 – Designing the Treatment Strategies in Schizophrenia Study 40:30 – Results: Medication's Value and a Young, Family-Involved Cohort 45:00 – Long-Acting Injectables: Adherence Myths and the PROactive Study 51:30 – Research Diagnostic Criteria for Tardive Dyskinesia and the AIMS Scale 56:30 – Negative Symptoms, Cognition, and the Risperidone Question 1:02:30 – The FDA Workshop and Consent Challenges in the CONSIST Study 1:06:00 – Digital Interventions, EMA, and Smartphone-Based Treatment 1:09:30 – Designing RAISE: A Cluster-Randomized Approach to First-Episode Care 1:15:30 – RAISE Results and the Challenge of Personalized, Team-Based Care 1:21:00 – From RAISE to SAMHSA: Scaling Coordinated Specialty Care 1:25:30 – Has RAISE Changed Community Practice? 1:28:00 – Toward Meaningful Functional Recovery: What Must Change Next LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep23-six-decades-schizophrenia-care-nina-schooler/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. Dr. Nina Schooler – LinkedIn https://www.linkedin.com/in/nina-schooler-11022870/ NIMH – Recovery After an Initial Schizophrenia Episode (RAISE) https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise NIMH overview of the RAISE initiative and coordinated specialty care model discussed at length in this episode. SAMHSA – Early Serious Mental Illness Treatment Locator https://www.samhsa.gov/find-help/locators/esmi Locator for coordinated specialty care programs, funded through the SAMHSA block grants described in this episode. #Schizophrenia #TardiveDyskinesia #LongActingInjectables #FirstEpisodePsychosis #Psychopharmacology

Dr. Benjamin Brody, an inpatient psychiatrist who built and now directs one of the earliest hospital-based ketamine treatment programs, joins Dr. Ben Everett to unpack the regulatory maze surrounding ketamine and the psychedelics now approaching FDA approval. Dr. Brody traces how he moved generic racemic ketamine from an overlooked anesthetic sitting on the hospital pharmacy shelf to a formally sanctioned inpatient treatment, and explains why esketamine's REMS-regulated pathway looks nothing like the largely unregulated market for take-home ketamine. As synthetic psilocybin nears a possible FDA decision and the field debates what role psychotherapy should play alongside these treatments, clinicians face fast-moving questions about safety monitoring, staffing, informed consent, and reimbursement. Drawing on his direct experience administering ketamine on the inpatient unit, Dr. Brody discusses self-escalation risk, the paradox reaction his team termed dysphoric dissociation, and what health systems should weigh before building a program of their own. 🎯 KEY EPISODE HIGHLIGHTS: ⚠️ THE NARROW LINE BETWEEN NEUROTROPHIC AND NEUROTOXIC [18:30] “But at higher doses, it actually becomes neurotoxic and, you know, there's histopathological changes that can be seen.” At therapeutic doses ketamine is safe and neurotrophic, but Dr. Brody warns that self-escalating doses can quickly cross into neurotoxic and bladder-damaging territory. 🧠 DEFINING DYSPHORIC DISSOCIATION [24:00] “This is a dysphoric piece or a dysphoric reaction that is layered on top of the dissociative experience for this small minority of patients.” Dr. Brody explains why his team coined a new clinical term to distinguish ketamine's rare, frightening paradox reaction from a psychedelic “bad trip,” and why naming it matters for informed consent. 🚫 THE CASE AGAINST TAKE-HOME KETAMINE [25:00] “The unambiguous answer is no, I do not think this is a good idea.” Citing self-escalation risk, a narrow therapeutic index, and a growing number of ketamine-associated deaths, Dr. Brody explains why he opposes direct-to-consumer telehealth ketamine prescribing. CHAPTERS: 00:00 – From Creative Writing to the Inpatient Unit 02:30 – A Day in the Life of an Inpatient Psychiatrist 05:30 – How Dr. Brody Came to Believe in Ketamine 12:00 – Ketamine vs. Classical Psychedelics: A Different Mechanism 14:00 – Two Regulatory Worlds: Racemic Ketamine and REMS-Regulated Esketamine 17:30 – Safety Signals: Self-Escalation and Dysphoric Dissociation 24:30 – The Case Against Take-Home Ketamine 29:30 – Psychedelics Enter the Medical Mainstream 33:30 – What to Expect When Psilocybin Gets FDA Approval 39:00 – Staffing and Consent for Hours-Long Sessions 43:00 – Set and Setting: Lessons from Building a Ketamine Program 48:00 – Is This Psychotherapy? Defining the Clinician's Role 54:00 – What Surprised Dr. Brody About Implementation 57:00 – Advice for Health Systems and Reasons for Optimism LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep22-regulatory-maze-ketamine-psychedelics-benjamin-brody/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. How Do We Get Ketamine Safety Right? Three Questions From a Clinical Service https://www.psychiatrist.com/jcp/how-do-we-get-ketamine-safety-right-3-questions-from-clinical-service/ Dr. Brody's 2025 JCP commentary on self-escalation, paradox reactions, and the regulatory gap between racemic ketamine and esketamine, discussed at length in this episode. COMPASS Pathways – COMP360 Psilocybin for Treatment-Resistant Depression https://compasspathways.com/our-work/comp360-psilocybin-treatment-in-trd/ The investigational psilocybin program discussed throughout the episode, including its phase 3 timeline and proposed psychological support model. Dr. Benjamin Brody – LinkedIn https://www.linkedin.com/in/benjamin-brody-md-3576bb4/ #Ketamine #Psychedelics #TreatmentResistantDepression #Psychopharmacology #REMS

Dr. Elizabeth Ballard, Director of Psychology and Behavioral Research and Director of Pre-Doctoral Training at the National Institute of Mental Health's Experimental Therapeutics and Pathophysiology Branch, joins the JCP Podcast to trace the full arc of suicide risk assessment and treatment. Dr. Ballard helped develop the Ask Suicide Screening Questionnaire (ASQ) and was first co-author on the individual patient data meta-analysis establishing ketamine's rapid antisuicidal effect. Suicide risk is assessed in some form during nearly every patient encounter, yet the tools clinicians use and the evidence behind current treatments remain works in progress. Dr. Ballard discusses the sensitivity-specificity trade-offs built into screening instruments, what ketamine research reveals about suicidality as distinct from depression, emerging biomarkers such as nocturnal wakefulness and electrophysiological signatures of hopelessness, and the ethical case for including suicidal patients in clinical research rather than excluding the population clinicians most need evidence for. 🎯 KEY EPISODE HIGHLIGHTS: 🩺 SCREENING IS A LIFE-OR-DEATH TRADE-OFF [11:00] “This is literally a life or death situation, and so you don't want people slipping through the cracks that aren't getting identified.” Ballard frames the sensitivity-specificity trade-off built into suicide screening tools like the ASQ as a stakes-defining design choice, not just a statistical one. 🎯 SUICIDE RISK IS MULTIFACTORIAL, SO WHERE DO YOU START [39:00] “There's so many factors that lead somebody in a moment of crisis to think about ending their lives.” Ballard argues clinicians can't treat every contributing factor at once, which is why her research isolates modifiable targets like hopelessness rather than suicide risk as a whole. ❤️ WHEN IN DOUBT, ASK [52:30] “When in doubt, ask. There's no harm in asking.” Ballard's single most actionable takeaway: approach suicide risk assessment with curiosity rather than treating it as a documentation exercise. CHAPTERS: 00:00 – Introduction: Dr. Elizabeth Ballard's Path to Suicide Research 05:30 – Building and Calibrating the ASQ Screening Tool 12:30 – The 2018 AJP Ketamine Meta-Analysis: Pooling Individual Patient Data 17:30 – Disentangling Ketamine's Effect on Suicidality from Depression 20:30 – Ketamine's Response Trajectory and IV vs. Esketamine Comparison 25:30 – Nocturnal Wakefulness as a Warning Sign for Suicidal Ideation 31:00 – MEG and Electrophysiological Signatures of Suicide Risk 34:00 – Concordance Across Suicide Risk Assessment Scales 38:00 – Hopelessness as a Distinct, Modifiable Treatment Target 41:00 – Neurofeedback and Episodic Future Thinking at Neu Hope 45:00 – Ethically Including Suicidal Patients in Clinical Research 52:00 – Closing Clinical Takeaway: Asking with Curiosity LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep21-rethinking-suicide-risk-screening-treatment-elizabeth-ballard/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. Ask Suicide-Screening Questions (ASQ) Toolkit – NIMH https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials Free NIMH toolkit for the screening instrument Dr. Ballard helped develop, discussed at length in this episode. Dr. Elizabeth Ballard – LinkedIn https://www.linkedin.com/in/elizabeth-ballard-943245350/ #SuicideRiskAssessment #Ketamine #SuicidePrevention #ClinicalResearchEthics #Hopelessness

Dr. David T. Liebers, MD, MPhil, MPP, a research assistant professor of psychiatry at the NYU Grossman School of Medicine and a research psychiatrist at the Nathan Kline Institute, joins Dr. Ben Everett to explore metabolic psychiatry: the growing evidence linking mitochondrial function, bioenergetics, and whole-body metabolism to psychiatric illness. Building on a previous conversation about GLP-1 receptor agonists, this episode broadens the lens to ketogenic diet interventions, SGLT2 inhibitors, and metformin, tracing how each may support brain energetics in depression, schizophrenia, and bipolar disorder. This conversation arrives as clinicians increasingly confront the metabolic burden of antipsychotic treatment alongside a widening evidence base for interventions originally developed for diabetes and heart failure. Dr. Liebers discusses recent trial data on ketogenic diets in serious mental illness, the mechanistic case for SGLT2 inhibitors as a psychiatric tool, expanding guidelines for metformin co-prescription, and why brain energetics may represent a legitimate and increasingly tractable therapeutic target, not a replacement for existing models of psychiatric illness, but an additional clinical perspective. 🎯 KEY EPISODE HIGHLIGHTS: 🏛️ THE “ERA OF FOOD AS MEDICINE” ISN’T NEW [12:30] “We have now entered the era of food as medicine.” Dr. Liebers traces today's food-as-medicine rhetoric back through nearly two centuries of psychiatric interest in diet's role in mental illness. 🧬 MITOCHONDRIAL DYSFUNCTION AS A TREATMENT TARGET [23:30] “The big challenge, I think, is identifying those interventions that can reliably improve, metabolic function in a way that can be measured and is suitable for randomized trial designs that let us talk about causation.” Dr. Liebers frames abnormal brain bioenergetics as a specific, measurable target for a subset of patients underserved by monoamine-based treatments. ⚖️ METFORMIN IS DRAMATICALLY UNDERUSED [55:30] “I think ten to fifteen percent of the people that should be or would qualify under the new guidelines to get metformin are actually on it.” Despite expanded 2025 consensus guidelines, Dr. Liebers' EHR data suggest most eligible patients are still not receiving metformin for antipsychotic-associated weight gain. CHAPTERS: 00:00 – Introduction: Building on the GLP-1 Conversation 02:30 – An Unconventional Path to Metabolic Psychiatry 10:30 – Diet in the Asylum Era: A History of Food as Medicine 18:00 – Why Metabolism Returned to Scientific View 23:30 – Imaging Brain Energetics: Bridging Peripheral and Central Metabolism 28:30 – The Stanford Pilot Trial and the Abrams Follow-On RCT 36:00 – Adherence, Meal Delivery, and the Path to GLP-1s 39:30 – GLP-1 Receptor Agonists in Psychiatric Practice 41:30 – Discovering SGLT2 Inhibitors: A Resident's Chance Encounter 45:00 – The Ketogenic Mechanism Behind SGLT2 Inhibition 49:30 – Trial Emulation and the Empagliflozin Pilot Study 52:00 – Metformin's Expanding Role in Antipsychotic-Associated Weight Gain 56:30 – SGLT2 Inhibitors as a Complement to Ketogenic Therapy 61:30 – Toward a Whole-Person Model: Diet, Drugs, and Exercise 66:00 – Confronting the Treatment Gap: Underused Medications 68:00 – The Future of Metabolic Psychiatry: Integration, Not Revolution 71:30 – Closing Thoughts and Sign-Off LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep20-feeding-mind-metabolism-psychiatry-david-t-liebers/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. Dr. David T. Liebers – LinkedIn https://www.linkedin.com/in/david-liebers-7b9706169/ Metabolic Mind https://www.metabolicmind.org/ Patient and clinician resource on ketogenic and metabolic therapies for mental illness, recommended by Dr. Liebers in this episode. The Emerging Role of GLP-1s in Psychiatry with Roger S. McIntyre, MD, FRCPC Listen to a previous episode from April 21, 2026 covering GLP-1s in Psychiatry #MetabolicPsychiatry #KetogenicDiet #SGLT2Inhibitors #Metformin #Mitochondria

Dr. Aderonke Pederson, an assistant professor of psychiatry at Harvard Medical School and a psychiatrist in the Depression Clinical and Research Program at Massachusetts General Hospital, joins the JCP Podcast to discuss how contact-based storytelling can function as a clinical intervention for reducing mental illness stigma and medical mistrust. Stigma and mistrust are measurable barriers that delay care-seeking and worsen outcomes, particularly among Black adults with moderate to severe depression or anxiety who are not currently engaged in mental health services. Dr. Pederson walks through the theoretical foundations of contact-based stigma reduction, her research on religiosity and heterogeneity within Black communities, and a self-administered, video-based mobile intervention now being tested in a randomized controlled trial to help close the engagement gap in primary care. 🎯 KEY EPISODE HIGHLIGHTS: 🧩 STIGMA AS A FUNDAMENTAL CAUSE OF HEALTH INEQUITIES [04:00] “Stigma has been described as a fundamental cause of health inequities.” Framing stigma this way means it remains a barrier to care even after every other access issue has been addressed. 🧬 WHY MEDICAL MISTRUST IS AN EXPECTED RESPONSE [05:30] “We expect mistrust if we have historical factors that have led to that mistrust.” Clinicians should validate and address the historical roots of mistrust before working to reduce it. 🗣️ NAMING STIGMA TO GET IT OUT OF THE ROOM [53:00] “It's in the room with you, and the question is, do you acknowledge its presence?” Recognizing stigma and mistrust as active forces in every clinical encounter is the first step to addressing them with patients. CHAPTERS: 00:00 – Introduction: When Story Becomes Clinical Intervention 03:30 – Stigma as a Fundamental Cause of Health Inequities 07:30 – From Basic Science to Psychosocial Mechanism: Where Stigma Intervenes 12:00 – The Engagement Gap: Disparities in Depression and Anxiety Care 16:00 – Religiosity and the Limits of Past Contact on Future Stigma 19:30 – Beyond Racial Categories: Heterogeneity and Migration 23:30 – The Power of Story: Why Narrative Changes Behavior 27:30 – Contact Theory: From Allport to the Psychiatric Ward 33:00 – Fisher's Narrative Paradigm and the Neuroscience of Story 36:30 – Shared Identity vs. Story Content 39:00 – Designing the App: A User-Centered Approach 45:00 – Inside the Clinical Trial: Reaching a Hard-to-Enroll Population 49:00 – Primary Endpoints and the Question of Durability 52:30 – Closing Thought: Naming Stigma to Address It LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep19-turning-stigma-into-stories-hope-aderonke-pederson/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. Dr. Aderonke Pederson - LinkedIn https://www.linkedin.com/in/aderonke-bamgbose-pederson-85345315/ #MentalHealthStigma #MedicalMistrust #HealthDisparities #DigitalTherapeutics #BlackMentalHealth

Dr. Crystal T. Clark, Associate Professor of Psychiatry at the University of Toronto and Canadian Research Chair in Reproductive Mental Health, joins the podcast to discuss the evidence-based management of bipolar disorder across pregnancy and the postpartum period. Dr. Clark, recently appointed head of the Department of Psychiatry at Women's College Hospital, has built her research career around closing the pharmacokinetic evidence gap for the mood stabilizers and antipsychotics used during pregnancy. For decades, clinical practice around perinatal bipolar disorder was shaped by stigma and a lack of data, leaving many women counseled to discontinue effective treatment or avoid pregnancy altogether. Dr. Clark reviews how physiological changes in pregnancy alter the clearance of lamotrigine, lithium, and atypical antipsychotics, why postpartum tapering requires close monitoring, how the Mood Disorder Questionnaire can help distinguish bipolar from unipolar postpartum depression, and what her research reveals about racial disparities in diagnosis among Black women. 🎯 KEY EPISODE HIGHLIGHTS: 🚫 THE STIGMA OF DISCOURAGING PREGNANCY [05:30] “No, there's no data. This is all stigma.” Dr. Clark names outright that generations of counseling women with bipolar disorder against having children was never grounded in evidence. 🧪 LAMOTRIGINE CLEARANCE CAN JUMP 300% IN PREGNANCY [16:00] “Elimination clearance really increases during pregnancy as much as two hundred to three hundred percent.” This pharmacokinetic shift explains why patients on a stable lamotrigine dose can relapse mid-pregnancy despite full adherence. 📊 HIGHER BIPOLAR PREVALENCE AMONG BLACK POSTPARTUM WOMEN [48:30] “When you looked at bipolar disorder, there was a higher prevalence amongst Black women.” This diagnosis-level finding, rare in perinatal mental health research, points to a gap in how bipolar disorder is recognized in Black patients. CHAPTERS: 00:00 – Introduction: A Career Built on Closing the Evidence Gap in Perinatal Bipolar Disorder 02:30 – The Discontinuation Era and the Stigma of Childbearing with Bipolar Disorder 08:30 – Reweighing the Risk-Benefit Calculus: Untreated Illness as Its Own Danger 13:30 – From Residency to Research: Uncovering the Pharmacokinetic Evidence Gap 18:00 – The Pharmacology of Pregnancy: How Lamotrigine, Lithium, and Antipsychotics Are Metabolized Differently 22:00 – From Algorithm to Practice: Applying and Titrating Lamotrigine Across Pregnancy and Postpartum 28:30 – Lithium in Pregnancy: Monitoring Levels and Revisiting the Ebstein's Anomaly Risk 35:00 – Atypical Antipsychotics: Quetiapine and Risperidone Pharmacokinetics 40:00 – Distinguishing Bipolar from Unipolar Postpartum Depression with the MDQ 45:30 – Racial Disparities in Perinatal Bipolar Disorder Diagnosis 50:00 – Designing a Postpartum Monitoring Plan for High-Risk Patients 54:00 – Future Directions: Formalizing the Lamotrigine Algorithm and Black Maternal Mental Health Research 57:30 – Closing Reflections: The Path Toward Diagnostic Precision LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep18-bipolar-disorder-pregnancy-postpartum-crystal-t-clark/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. Dr. Crystal T. Clark – LinkedIn https://www.linkedin.com/in/crystalclarkmd/ Rates of Major Depressive Disorder and Bipolar Disorder in Black and White Postpartum Women (JCP, 2024) https://www.psychiatrist.com/jcp/rates-major-depressive-bipolar-disorder-black-white-postpartum-women/ The 2024 study discussed at length in this episode's chapter on racial disparities in perinatal bipolar diagnosis. A Comparison of Symptoms of Bipolar and Unipolar Depression in Postpartum Women (J Affect Disord, 2022) https://pubmed.ncbi.nlm.nih.gov/35041868/ The MDQ-based screening study Dr. Clark walks through when discussing how to distinguish bipolar from unipolar postpartum depression. #BipolarDisorder #PerinatalPsychiatry #Psychopharmacology #PostpartumPsychosis #MaternalMentalHealth

In this episode, Dr. Ben Everett is joined by Dr. Joseph F. Goldberg, clinical professor of psychiatry at the Icahn School of Medicine at Mount Sinai and deputy editor-in-chief of the Journal of Clinical Psychiatry. Dr. Goldberg recently completed his term as president of the American Society of Clinical Psychopharmacology (ASCP), during which he led a 45-member international task force that produced a landmark series of consensus statements on deprescribing psychotropic medications, the principal findings of which were published in JAMA Network Open. The decision to stop a medication is among the most common—yet least formalized—clinical acts in psychiatry. Despite decades of prescribing guidance, the field has lacked systematic frameworks for determining when, why, and how to discontinue treatment. This episode examines the ASCP task force's Delphi methodology, the areas of consensus and expert disagreement, and the practical implications for managing polypharmacy, navigating discontinuation phenomena, counseling pregnant patients, and training the next generation of prescribers. 🎯 KEY EPISODE HIGHLIGHTS: 📋 MEDICINES AS EMPLOYEES: THE PERFORMANCE REVIEW FRAMEWORK [03:30] “I often like to think of medicines like employees on a payroll, and from time to time, it's a good thing to do a performance review of everybody on the payroll and ask what's your job, and are you doing it well, and is your job still there, or is that niche no longer present?” Dr. Goldberg's core framework reframes deprescribing as a structured, periodic clinical evaluation—shifting the default from indefinite continuation to deliberate reassessment. ⚠️ PSEUDOTREATMENT RESISTANCE: THE LAI LITMUS TEST [22:00] “Up to eighty percent of people don't take their medicines as prescribed, and oftentimes that could be quite substantial. It does run the risk of erroneously concluding this drug didn't work for you.” Before deprescribing in schizophrenia, the task force emphasizes ruling out non-adherence—including a strong recommendation to consider long-acting injectable antipsychotics as a diagnostic and therapeutic step. 🧠 THE PSYCHOLOGY OF STOPPING: MEDICATION AS TRANSITIONAL OBJECT [34:30] “To say I'm gonna take away this tangible thing that's meant to alleviate your suffering could mean I think you're doing pretty well and you don't need this anymore. Or it could also mean I'm not sure you're really suffering as much as you think you are.” The decision to deprescribe carries significant psychological weight for patients—and clinicians who overlook this dimension risk undermining therapeutic alliance and triggering distress independent of pharmacology. CHAPTERS: 00:00 – Introduction and Defining Deprescribing 07:00 – Why Now: ASCP's Task Force and the Political Landscape 13:30 – Delphi Methodology: Consensus and Divergence 15:30 – The Lithium Overdose Dilemma: When Stopping Defies a Rule 20:00 – Adherence, Pseudotreatment Resistance, and Schizophrenia 25:30 – Complex Polypharmacy and Medication Performance Reviews 29:30 – Valproate and Women of Reproductive Potential 34:00 – The Psychology of Stopping: Medication Attachment and Placebo 37:30 – Long Half-Life Drugs and Auto-Tapering 40:30 – Discontinuation Phenomena, Brain Zaps, and Hyperbolic Tapering 45:30 – Pregnancy, Special Populations, and Relapse Risk 49:30 – Training Gaps and the Future of Deprescribing Education LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep17-art-deprescribing-framework-ending-medication-joseph-goldberg/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. Dr. Joseph Goldberg – LinkedIn https://www.linkedin.com/in/joseph-goldberg-922b5317/ American Society of Clinical Psychopharmacology (ASCP) https://www.ascpp.org/ The organization that convened the 45-member international deprescribing task force discussed in this episode. ASCP Deprescribing Consensus Statement — JAMA Network Open https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2845497 The parent consensus paper on general principles of deprescribing psychotropic medications. #Deprescribing #Psychopharmacology #Polypharmacy #MedicationManagement #ClinicalPsychiatry

EPISODE DESCRIPTION Dr. Barbara O. Rothbaum, PhD, is a tenured professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, where she holds the Paul A. Janssen Chair in Neuropsychopharmacology. She is director of the Trauma and Anxiety Recovery Program, director of the Emory Healthcare Veterans Program, and as of 2025, science director of the Emory Center for Psychedelics and Spirituality. With more than 400 scientific papers and multiple books to her name, Dr. Rothbaum is one of the foremost authorities on PTSD treatment in the world. In this episode, she joins host Ben Everett to reflect on four decades at the frontier of PTSD research, from the earliest days of the field's recognition as a disorder to the cutting edge of psychedelic-assisted therapy and virtual reality exposure. PTSD remains one of psychiatry's most consequential and undertreated conditions, affecting a substantial portion of combat veterans, survivors of sexual trauma, and countless others who have never received an accurate diagnosis. In this conversation, Dr. Rothbaum covers the evidence base for first-line trauma-focused therapies — prolonged exposure, cognitive processing therapy, and EMDR — and the intensive outpatient model that has dramatically improved treatment retention. She then turns to the stalled landscape of PTSD pharmacotherapy, her translational research combining MDMA with prolonged exposure, the emerging role of psilocybin and ketamine, and the evolution of virtual reality exposure therapy from her laboratory's 1993 pilot to the Brave Mind system now deployed across more than 50 VA health systems. KEY EPISODE HIGHLIGHTS 🧠 PTSD TREATMENT IS ABOUT APPROACHING, NOT AVOIDING [09:00] "There's no way to the other side of the pain except through it." Dr. Rothbaum explains the core mechanism underlying all empirically supported PTSD therapies — and why avoidance is the central obstacle to recovery. 💊 SSRIs ARE NOT REALLY THE TREATMENT FOR PTSD [24:30] "I personally will think of them like weak coffee for PTSD. Maybe you can get a little bit of effect, maybe on mood, maybe on thinking." Despite being the only FDA-approved pharmacotherapy for PTSD, SSRIs fall well short of the evidence base for trauma-focused psychotherapy — and combination treatment offers no advantage. 🥽 VIRTUAL REALITY EXPOSURE THERAPY GIVES CLINICIANS TOTAL CONTROL [43:30] "If my patient's not ready for turbulence, I can guarantee there won't be turbulence. When they are ready for turbulence, I can guarantee there will be turbulence." From fear of heights to virtual Iraq and Afghanistan combat environments, VR allows therapists to precisely calibrate stimulus intensity — closing the gap between imaginal exposure and real-world treatment. CHAPTERS 00:00 - Introduction and Guest Biography 03:30 - Career Origins: Starting with Edna Foa 05:30 - A Career at the Intersection of Therapy, Technology, and Pharmacology 08:00 - First-Line Psychotherapies: PE, CPT, and EMDR 13:30 - Comparing the Therapies: Evidence and Patient Fit 15:30 - The Emory Healthcare Veterans Program and the IOP Model 21:00 - Recognizing PTSD in Primary Care 23:30 - Pharmacotherapy: The Limits of SSRIs 27:30 - Recent Drug Development Setbacks: MDMA and Brexpiprazole 31:00 - Translational MDMA Research and Combining with Prolonged Exposure 37:30 - Lessons from Australia's MDMA Approval 39:00 - The Broader Psychedelic Landscape: Psilocybin, Ketamine, and Others 43:00 - Virtual Reality Exposure Therapy and the Brave Mind System 49:30 - Resilience, Hope, and the Future of PTSD Treatment LINKS Full transcript and show notes https://www.psychiatrist.com/jcp/ep16-forty-years-ptsd-frontier-barbara-o-rothbaum/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Dr. Barbara O. Rothbaum — LinkedIn https://www.linkedin.com/in/barbara-rothbaum-9339546 Emory Healthcare Veterans Program https://www.emoryhealthcare.org/lp/veterans-ptsd The intensive outpatient program for post-9/11 veterans discussed throughout this episode. Wounded Warrior Project — Warrior Care Network https://www.woundedwarriorproject.org/programs/warrior-care-network Funds the four IOP programs, including Emory's, discussed in the episode. No cost to veterans. #PTSD #TraumaTherapy #MDMAAssistedTherapy #VirtualRealityTherapy #Veterans

In this episode of the JCP Podcast, host Dr. Ben Everett speaks with Dr. Jennifer L. Payne, Professor of Psychiatry and Neurobehavioral Sciences and Vice Chair of Research at the University of Virginia, where she directs the Reproductive Psychiatry Research Program. Dr. Payne holds a joint appointment in obstetrics and gynecology and has spent her career at the intersection of basic neuroscience and clinical care in perinatal psychiatry. She is widely recognized for her work on the biological underpinnings of postpartum depression, including epigenetic biomarkers that prospectively predict risk, and for her clinical and research contributions to the development of GABAergic therapeutics — from brexanolone to zuranolone — that are reshaping how the field understands and treats this condition. Postpartum depression affects roughly one in eight women following childbirth and remains one of the most underdiagnosed and undertreated conditions in medicine. Despite this, care has long defaulted to serotonergic antidepressants developed for major depression rather than agents designed around the biology of the postpartum period. In this episode, Dr. Payne explains why the precipitous drop in neuroactive steroids — particularly allopregnanolone — following delivery may be central to postpartum depression pathophysiology, how the GABA-A receptor is implicated in ways that are distinct from benzodiazepines, what the clinical proof-of-concept established by brexanolone means for the field, and why zuranolone's oral formulation is changing real-world access. Dr. Payne also discusses the epigenetic biomarker test her lab has developed with collaborator Dr. Zachary Kaminsky — work now moving toward FDA review — its ethical implications, and emerging parallels with premenstrual dysphoric disorder. KEY EPISODE HIGHLIGHTS 🔬 PREDICTING POSTPARTUM DEPRESSION BEFORE IT STARTS [12:30] "We can take blood in the third trimester, and we can say whether a woman is at high risk of developing postpartum depression by three months postpartum or at low risk." Dr. Payne describes the epigenetic biomarker test developed with Dr. Zachary Kaminsky — replicated in six independent samples and now advancing toward FDA review — that identifies postpartum depression risk from a third-trimester blood draw, enabling preventive planning before symptoms emerge. 🧠 WHY BREXANOLONE IS NOT JUST A BENZODIAZEPINE [24:15] "The benzodiazepines don't act on those extrasynaptic GABA receptors. So sometimes people have said to me that allopregnanolone and the new FDA-approved treatments for postpartum depression are really just a benzodiazepine, and that's not true." Dr. Payne explains the critical mechanistic distinction between benzodiazepines (synaptic GABA-A binding) and neuroactive steroids (extrasynaptic GABA-A binding), clarifying why this difference matters for setting the brain's overall inhibitory tone — a distinction clinicians should be prepared to address with patients. 💊 ZURANOLONE: FOURTEEN DAYS, SUSTAINED RESPONSE [31:00] "You take [zuranolone] for fourteen days, and you see response rates within three days, which again, is groundbreaking in terms of treating a depressive episode." The shift from a 60-hour inpatient IV infusion to a 14-day oral course has transformed real-world feasibility. Dr. Payne reviews the clinical profile of zuranolone — including rapid onset, sedation considerations, breastfeeding questions, and the practical barriers that still limit access. CHAPTERS 00:00 - Introduction and Guest Overview 02:45 - Scientific Origins: From Alzheimer's Disease to Postpartum Depression 06:30 - Why Postpartum Depression Is a Natural Model for Studying Depression Biology 08:00 - Screening, Underdiagnosis, and the Stigma Gap 09:30 - A Personal Account of Postpartum Depression and Advocacy 12:00 - Epigenetic Biomarkers: Predicting Risk Before Delivery 17:15 - Ethics, Autonomy, and the Case for a Predictive Blood Test 20:45 - Allopregnanolone and the Neuroactive Steroid System 23:30 - GABA-A Receptor Subtypes: Why Neuroactive Steroids Are Not Benzodiazepines 25:30 - DoD-Funded Research: Neuroactive Steroid Shunting and GABA-A Reconfiguration 29:30 - Brexanolone: Clinical Proof of Concept and Why It's No Longer Available 31:30 - Zuranolone: Mechanism, Practical Considerations, and Real-World Access 37:00 - PMDD as a Window into Shared Biology 39:30 - The GABAergic Hypothesis and the Future of Depression Subtypes 41:45 - Improving Screening and Educating OBGYNs 43:30 - Closing Remarks LINKS Full transcript and show notes https://www.psychiatrist.com/jcp/ep15-rethinking-postpartum-depression-biology-biomarkers-jennifer-l-payne/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. National Pregnancy Registry for Antidepressants: https://womensmentalhealth.org/research/pregnancyregistry/antidepressants/ Biomarkers: DNA methylation biomarkers prospectively predict both antenatal and postpartum depression: https://pubmed.ncbi.nlm.nih.gov/31843207/ Seeing the Future: Epigenetic Biomarkers of Postpartum Depression: https://pmc.ncbi.nlm.nih.gov/articles/PMC3857665/ Biomarker or pathophysiology? The role of DNA methylation in postpartum depression: https://pubmed.ncbi.nlm.nih.gov/24059792/ DOD Work in Segment II: Metabolites of Progesterone in Pregnancy: Associations with Perinatal Anxiety: https://pmc.ncbi.nlm.nih.gov/articles/PMC10530426/ Neuroactive steroid biosynthesis during pregnancy predicts future postpartum depression: a role for the 3α and/or 3β-HSD neurosteroidogenic enzymes? https://pubmed.ncbi.nlm.nih.gov/39885361/ #PostpartumDepression #NeuroactiveSteroidsGABA #PerinataMentalHealth #Zuranolone #EpigeneticBiomarkers

Dr. Gary W. Small, Director of Behavioral Health Breakthrough Therapies at Hackensack Meridian Health and Professor of Psychiatry and Behavioral Health at the Hackensack Meridian School of Medicine, shares decades of clinical and research insight as he discusses the early detection and treatment of age-related cognitive decline. In this episode, he explores the continuum from normal aging to mild cognitive impairment to dementia, the real-world role of biomarkers, the promise and limits of current pharmacologic options, and the lifestyle interventions—especially aerobic exercise—with the strongest data behind them. For most patients, cognitive decline unfolds gradually rather than suddenly, and the tools we have to detect it have outpaced the clarity of what to do next. Amyloid and tau assays, PET imaging, and APOE genotyping are increasingly available in primary care, but they raise as many questions as they answer, and disclosure can have real psychological consequences. Emerging evidence points to inflammation as a shared mechanism across many forms of decline, with anti-inflammatory drugs, curcumin, Omega-3s, sleep, and exercise all converging on the same target. Dr. Small frames a pragmatic, patient-centered approach: educate, contextualize tests, rule out reversible causes, treat symptomatically and aggressively when appropriate, and above all, move. 🧠 PROTECT, DON’T REPAIR [05:10]: “It’s easier to protect a healthy brain rather than try to repair damage once it becomes extensive.” Dr. Small articulates the case for early detection and prevention that has shaped his entire career. 🔬 TREAT THE PERSON, NOT THE SCAN [23:40]: “You don’t treat a blood test, you treat a person. The good news with some of these early anti-amyloid drugs—the brain scan looks great. The bad news is, you’re going to forget this conversation.” Dr. Small urges clinicians to resist reflexive, biomarker-driven treatment and instead anchor decisions in symptoms, goals, and risk–benefit conversations. 🏃 ONE RECOMMENDATION ABOVE ALL [44:50]: “Physical exercise. There’s no question about it. We have the strongest data on it… Get on the treadmill, or even better, get outside and take a brisk walk or jog.” Asked for a single, universal recommendation for brain health, Dr. Small is unequivocal. CHAPTERS: 00:00 - Introducing Dr. Gary W. Small 02:20 - From Math to Metaphysics to Medicine 03:30 - Finding a Path into Psychiatry 04:20 - The Road to Geriatric Psychiatry and the Case for Early Detection 06:10 - Defining the Continuum: Normal Aging, MCI, and Dementia 09:00 - Interpreting Cognitive Complaints and the Weight of Information 12:30 - The Biology of Cognitive Decline and the Role of Inflammation 16:00 - What Is Lost When We Wait, and the Curcumin Story 20:20 - The PCP’s Role in Early Intervention and Lifestyle Counseling 22:10 - Biomarkers and Imaging: From Research Tool to Clinical Reality 25:00 - Biomarker vs. Surrogate Marker 27:20 - Differential Diagnosis and the Brain as a Rheostat 29:30 - Pharmacologic Treatment: Symptomatic vs. Disease-Modifying Drugs 32:40 - Lifestyle Modification and the Evidence for Aerobic Exercise 35:40 - Train, Don’t Strain: Exercising the Mind Socially 37:50 - Knowing When to Refer and Building Specialist Relationships 41:00 - Comorbid Conditions and the Whole-Person Approach 42:40 - Looking Ahead: The Next 5–10 Years 44:20 - The Single Best Recommendation: Physical Exercise 45:30 - Closing Thoughts Links: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep14-early-detection-cognitive-decline-gary-w-small/ Journal of Clinical Psychiatry: https://www.psychiatrist.com/jcp/ Dr. Gary W. Small: https://www.hmhn.org/find-a-provider #CognitiveDecline #AlzheimersDisease #GeriatricPsychiatry #BrainHealth

Dr. Roger S. McIntyre, Professor of Psychiatry and Pharmacology at the University of Toronto, shares groundbreaking insights as he discusses the profound connection between metabolism and mental well-being. In this episode, he explores how GLP-1s treat psychiatric illness and common metabolic comorbidities. The historical reliance on serotonin, norepinephrine, and dopamine models has proven incomplete, and many individuals with psychiatric illness continue to struggle with inadequate care. New science suggests a deeper connection between metabolism and brain health which challenges long-held beliefs about disease causes. Emerging research highlights how metabolic disruptions contribute to mental health conditions, and that GLP-1 drugs offer a path forward as they could treat mental health conditions and common metabolic problems. In essence, they have the potential to bring about profound improvements in mental health and overall well-being. ⚠️ BEYOND NEUROTRANSMITTERS [07:53]: "For seven decades, we've really been at this altar of serotonin, norepinephrine and dopamine… That paradigm has been remarkably durable… but it's not been fully explanatory. Most people do not benefit adequately from current treatments." Explaining why traditional models are incomplete, Dr. McIntyre shows how new science offers hope. 💊 COMBAT MEDICATION SIDE EFFECTS [45:34]: "Clinicians would be certainly on a reasonable evidentiary base of practice if they were prescribing a GLP-1 to target, for example, clozapine-induced weight gain or clozapine-induced diabetes, that would be reasonable." Dr. McIntyre offers a proven strategy for mitigating adverse effects of psychiatric medications. 🚀 TRANSFORMING LIFESPANS [01:04:30]: "GLP-1s… have the potential to transform the health span and the lifespan of people living with mental illnesses by targeting on-label considerations today and potentially targeting the underlying pathophysiology of the brain-based disorder tomorrow. So stay tuned." Revealing the future of mental health, Dr. McIntyre presents a vision that offers new hope for long-term well-being. CHAPTERS: 00:00 - Why GLP-1 Drugs Are Transforming Mental Health Research 03:08 - The Career Shift That Linked Metabolism and Mood Disorders 06:45 - Moving Beyond Serotonin to Metabolism 13:18 - How GLP-1 Drugs Influence Brain Function and Neuroplasticity 23:40 - Can GLP-1 Medications Reach the Brain? What the Evidence Shows 32:00 - The Four Key Brain-Protective Effects of GLP-1 Therapies 34:54 - How GLP-1 Reduces Cravings, Addiction, and Food Noise 42:18 - When Clinicians Should Prescribe GLP-1s in Psychiatry Today 53:10 - Safety Risks and Drug Interactions Psychiatrists Must Consider 01:00:57 - The Future of Treatments in Psychiatry 01:04:27 - Summing Up GLP-1s and Mental Health Links: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep13-emerging-role-glp-1s-psychiatry-roger-s-mcintyre/ Journal of Clinical Psychiatry: psychiatrist.com/jcp/ Dr. Roger S. McIntyre: https://www.linkedin.com/in/roger-mcintyre-976bb167/ #GLP1Drugs #AddictionTreatment #DepressionTreatment #MentalIllnessPrevention

Dr. A. John Rush, renowned for leading the famous STAR*D depression study, addresses a critical challenge in modern psychiatry: while physicians often rely on their clinical intuition to treat complex depression, new data proves this approach has a significant blind spot. Experience alone can miss the full extent of a patient's suffering, leaving crucial progress untracked. Dr. Rush reveals a system to fix this clinical blind spot using the psychology of clinical measurement. He explains how doctors can implement simple assessment tools to gather objective data, leading to more precise treatment adjustments. This straightforward method gives physicians the power to see what is truly working and can significantly boost patient remission rates. 🎯 BIGGEST LESSON [12:17]: "By bringing measurement to the bedside, we bring precision and science. The evidence is very clear right now. We make better decisions about what to do with patients." 🎯 OTHER KEY TAKEAWAYS: ⚠️ THE HIDDEN GAP IN PSYCHIATRIC CARE [8:10]: "We don't know anything about in what order, in what combination, and by what methodology we implement that 'what'." Dr. Rush explains why knowing a treatment can work is only half the battle. This is the crucial gap between research and real-world results that most clinicians overlook. ✨ WHY 'PROVEN' TREATMENTS FAIL YOUR PATIENTS [20:45]: "Does this apply to everybody with depression, no matter how they show up? Absolutely not. That's where it really gets very, very interesting because now we're going from efficacy research to effectiveness research." Learn the critical difference between a treatment working in a controlled trial versus in your complex, real-world patient population. ⚡ THE LAW OF DIMINISHING RETURNS IN DEPRESSION [34:57]: "The more steps you take, the problem is, the less likely you are to get into remission. So remission rates were like 35% in the first step, 28% in the second step, 15% in the third step, 15% in the fourth step." Dr. Rush reveals the stark data from the STAR*D study. Use this critical insight to set realistic expectations with patients about the challenges of treatment-resistant depression. CHAPTERS: 00:00 - Introducing Dr. A. John Rush 02:20 - Why Dr. Rush Chose Psychiatry & a Career in Clinical Research 05:45 - How Cognitive Therapy Shaped Evidence-Based Psychiatry 07:10 - Strategies, Tactics, and the Research Gap 10:59 - Using AI & Clinical Data to Guide Treatment Decisions 18:39 - Why Clinical Trial Results Don't Match Real-World Patients 22:54 - Pragmatic Trials That Reflect Everyday Psychiatric Practice 30:48 - The STAR*D Trial: Sequencing Treatments for Depression 36:32 - Dose Optimization & Long-Term Depression Recovery 39:56 - Building a Learning Healthcare System in Psychiatry 43:48 - Dr. Rush’s Advice for Researchers and Clinicians Links: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep12-bridging-research-reality-mental-health-care-a-john-rush Journal of Clinical Psychiatry: psychiatrist.com/jcp/ Dr. A. John Rush: https://www.linkedin.com/in/a-john-rush-8aa46042/ American Psychiatric Association (APA) Website: https://www.psychiatry.org/psychiatrists/research/registry #Psychiatry #ClinicalResearch #Depression

Families expect cognitive decline as a normal part of getting older. We watch relatives lose their memories and accept the loss. Past medical trials regarding Alzheimer's disease failed 99 percent of the time, early signs of brain changes were missed, and precious years for early screening and treatment were lost. But new science changes this reality. Doctors now use blood tests and brain imaging for accurate diagnosis. They prescribe immunotherapy treatments that clear toxic brain plaques and slow cognitive decline by 30 percent. Dr. Marc Agronin shares his exact methods for geriatric psychiatry and dementia care. Learn how early medical intervention stops memory loss as he reveals his new research. 🎯 PRIMARY DISCOVERY[19:51]: "Someone goes from thinking, ‘I have a terminal disease,’ to ‘I have a manageable disease and I am going to continue to live and do things.’ Their whole mindset changes." Dr. Agronin reveals the exact medical advancements that give patients their lives back. 🩺 PRACTICE UPGRADE [30:56]: "We have all sorts of vital signs we check by routine. We need to have a cognitive vital sign that we check, and something like a Mini-Mental, Montreal Cognitive Assessment, something like that is practical to be done in primary care." Discover how doctors catch memory loss early with simple annual tests. ✨ MEDICAL MILESTONE [46:29]: "We see over the 18 months of the studies that the rate of decline in terms of both cognition and function is on average about 30 percent slower. And then we know that after 18 months, it is a very slow rate of reaccumulation." Hear how new monoclonal antibodies melt away brain plaques and stop memory loss. CHAPTERS: 00:00 - Meet Alzheimer’s Research Leader Dr. Marc Agronin 01:45 - Why a Career in Geriatric Psychiatry and Dementia Care? 06:17 - Why Alzheimer’s Research Is Entering a Breakthrough Era 08:07 - Why Alzheimer’s Disease Is Rising Worldwide 11:04 - How to Explain Alzheimer’s Diagnosis to Patients and Families 16:11 - The Biggest Scientific Breakthroughs in Alzheimer’s Disease 24:30 - How New Biomarker Guidelines Are Changing Alzheimer’s Diagnosis 29:57 - Why Early Screening for Cognitive Decline Matters 36:13 - Brain Health Habits That May Reduce Alzheimer’s Risk 42:50 - Current Alzheimer’s Medications and How They Help Cognition 45:45 - New Anti-Amyloid Treatments That Slow Alzheimer’s Progression 50:01 - Understanding ARIA Side Effects in Alzheimer’s Immunotherapy 54:09 - Emerging Alzheimer’s Treatments and Future Research Directions 01:02:09 - The Role of Empathy and Person-Centered Dementia Care Links: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep11-what-clinicians-should-know-about-alzheimers-treatment-marc-agronin/ Journal of Clinical Psychiatry: psychiatrist.com/jcp/ Dr. Marc Agronin: https://www.marcagronin.com/ Figure referenced at 53:35 comes from Figure 1 in the paper “Alzheimer’s Disease Drug Development Pipeline: 2025.”: https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/trc2.70098 #AlzheimersResearch #BrainHealth #GeriatricPsychiatry

Psychiatric hospitals admit patients for severe mental illness and high suicide risk every day. While mental health professionals treat acute suicidality during these intense crises, standard depression medications can take weeks to work. Traditional clinical psychiatry often leaves vulnerable patients in danger after hospital discharge. Medical teams need rapid suicide prevention treatments to help stabilize psychiatric inpatients quickly. Learn about potential improvements to inpatient suicide care as Dr. Brett Jones, Medical Head of the Bipolar Disorder Clinic at Toronto’s Center for Addiction and Mental Health, reveals the results of his research review into the best evidence-based medical interventions. 🎯 KEY EPISODE HIGHLIGHTS: 🛑 RESEARCH BLINDSPOT [10:25]: "I think there are a lot of studies out there. I was reading, I was seeing the evidence, but the consensus as to what would be the most effective treatment and for whom really wasn't there." Hear Dr. Jones explain the massive missing piece in psychiatric care. 🧠 CLINICAL BREAKTHROUGH [23:45]: "Some of the chronotherapy was something I actually didn't know about. That certainly is a low cost intervention. So that's quite promising if it turns out to be effective." See how simple sleep treatments change inpatient psychiatry. 🛠️ STRATEGIC ACTION [34:50]: "We showed a good effect with a digital version of DBT… So we're going to look at trying to replicate that in a multicenter study." Get the exact details on digital therapy for hospital units. CHAPTERS: 00:00 - Honoring Dr. Nolan Williams 03:07 - Career Path into Psychiatry and Suicide Research 07:59 - Why Inpatient Suicide Treatment Needs Better Evidence 12:59 - Key Limitations in Suicide Intervention Research 14:57 - Ketamine and Rapid Acting Treatments for Suicidality 19:48 - Emerging Treatments Beyond Traditional Depression Care 25:47 - Translating Research into Real World Inpatient Practice 30:38 - Major Research Gaps and Need for Better Clinical Trials 33:04 - Hospitalization as a Critical Window to Prevent Suicide 37:41 - Up Next: Dr. Marc Agronin Links: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep10-inpatient-treatment-suicidality-brett-jones/ Journal of Clinical Psychiatry: psychiatrist.com/jcp/ Inpatient Treatment of Suicidality: A Systematic Review of Clinical Trials: https://pubmed.ncbi.nlm.nih.gov/39832343/ Dr. Brett Jones: https://www.linkedin.com/in/brett-jones-1b308260/?originalSubdomain=ca Center for Addiction and Mental Health: https://www.camh.ca University of Toronto Psychiatry: https://psychiatry.utoronto.ca #AcuteSuicidality #InpatientPsychiatry #ClinicalResearch

Feeling tired despite a full night's sleep? The problem may not be the hours you get, but the quality of your breathing. According to sleep medicine expert and founding physician of SLIIIP, Dr. Avinesh Bhar, many people dismiss fatigue, snoring, or frequent waking, using caffeine and over-the-counter aids to cope. This masks a deeper problem. Undiagnosed sleep-disordered breathing, like sleep apnea, is a silent driver of serious health issues, from heart disease to mental health conditions. Ignoring the root cause makes other medical treatments less effective, creating a cycle of declining health. 90% of people with mental health conditions also struggle with sleep issues. Getting help is easy at SLIIIP.com. No travel required. Insurance accepted. 🎯 KEY EPISODE TAKEAWAYS: ⚠️ THE SURVIVAL MODE TRAP [08:49]: "If you don't sleep well, your whole day changes in perspective. You are in survival mode, and you can't be your best self. You can't perform." Are you just surviving instead of thriving? Watch this segment to understand the biological cost of poor sleep and why feeling "just okay" is a major red flag for your health. ✨ THE MENTAL HEALTH BREAKTHROUGH [29:24]: "If you're a therapist or psychiatrist managing mental health, you should also make sure the sleep is evaluated…otherwise, your improvements in mental health aren't going to reach the level that actually makes the patient feel like they've actually turned the corner.” Unlock better patient outcomes. See how integrating a sleep evaluation can be the missing piece in treating depression, anxiety, and PTSD effectively. ⚡️ THE 2-QUESTION DIAGNOSTIC [59:40]: "'Are you sleeping well? Are you waking up refreshed?' If you have a 'no' to either one of those questions, the patient needs an evaluation." This is the simple, powerful framework you need. Listen to this section to learn the exact questions that tell you if it's time to refer a patient (or yourself) to a sleep specialist and how easy it is via www.sliiip.com. SLIIIP is making advanced sleep care fast & convenient, offering patients same week appointments with board-certified sleep medicine physicians instead of the months‑long wait typical of traditional sleep labs. CHAPTERS: 00:00 - Introducing Dr. Avi Bhar 03:48 - From ICU to Sleep Medicine and What Clinicians Miss 06:52 - What Sleep Does Biologically and Why Quality Beats Hours 13:23 - Sleep Myths That Keep You Sick and Tired 16:24 - Sleep Hygiene That Works 19:54 - When to Suspect a Real Sleep Disorder Beyond Stress 23:00 - How Sleep Apnea Drives Heart, Metabolic, and Inflammatory Disease 27:51 - Sleep and Psychiatry 30:35 - Solving Access With Home Sleep Tests and Step-Based Care 39:33 - The Ideal Telemedicine Sleep Care Pathway 48:28 - Stop Masking Sleep Problems With OTC Aids and Melatonin 52:33 - When to Retest and How Treatment Lowers Long-Term Healthcare Costs 1:01:03 - Up Next: Dr. Brett Jones Key Takeaways: "Sleep is a reparative opportunity. It heals and repairs the trauma of the day. It's essential, not optional." "Quality and quantity of sleep matter. Sleeping 7-8 hours is good, but waking refreshed is key." "Sleep disturbances don't just coexist with illnesses; they can drive medical and psychiatric morbidity." "Evaluate sleep in patients with mental health issues. It's both a driver and symptom of psychiatric illness." "Speed and efficiency in sleep evaluation are crucial. It reflects the urgency and importance of the issue." Links: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep9-sleep-issues-psychiatric-practice-avinesh-bhar/ Journal of Clinical Psychiatry: psychiatrist.com/jcp/ SLIIIP: https://sliiip.com/ #SleepApnea #MentalHealth #SleepDisorders