As a medical expert and a professional counselor, Joe shares his knowledge on a variety of topics. Click on the titles below for the full article:
Medication Management of Anxiety in Substance Abusers
Substance abuse is complex to say the least, and the precursors associated with what leads people down this road have been the subject of debate and controversy for decades on end.
Talking To Clients About Psychotropic Medication Side Effects
Last week, one of the employees at the condo building where I reside posed this question to me: “Joe, I’ve been prescribed the antidepressant Cymbalta. I’ve been taking it before I go to bed for 2 weeks now and I’m having a lot of difficulty getting to sleep.”
Psychotropic Medication in Chronic Pain Treatment
Nowadays, opiate medications are primarily used to treat pain states, but there is a storied history of using these drugs to treat depression and other mental illness. In the absence of pain, opiates can induce euphoria – a welcome relief from melancholia.
The Two Newest Antidepressants: How Do They Stack Up?
If you’re a TV watcher, you’ve probably seen a flurry of recent advertisements for Trintellix lately. The ad describes and illustrates depression as a “tangle” of multiple symptoms, which presumably Trintellix will somehow untangle.
Stimulants For ADHD: We Can Group Them Around The Letter “P”
ADHD, with its attendant cognitive deficits, disrupts executive functioning in daily school activities, as well as activities at home or at play. Deficient executive functioning manifests as problems with self-restraint, managing time, motivation, organization, problem-solving and emotional self-regulation.
Confessions From A Guy Who Has Often Railed Against Antidepressants
My friend, Sandra, invited me over to her place for dinner one night a couple of weeks ago. She is a terrific conversationalist, so when we get together we have a tendency to flesh out subjects to their very fullest, way beyond what they probably deserve, but nevertheless, that us.
Kids With Depression: Key Dimensions To Look For And How To Proceed
Age is not a factor when it comes to psychiatric disorder emergence, and the clinical communities of the world reliably agree on this. For sure though, when it comes to assessment, evaluation, intervention strategies and particularly medication management, children and even adolescents should not be considered “little” adults.
Ketamine for Depression
So first, let’s be clear on what Ketamine is. Ketamine is officially classified as a preoperative general anesthetic for both human and animal use. It has absolutely no serotonin, norepinephrine or dopamine effects but instead is an NMDA receptor antagonist, similar to dextromethorphan and methadone, among others. If you remember the days of the “rave” phenomenon, ketamine was a popular psychedelic going by the moniker “special K.”
Assessing a Client for Bipolar Disorder: The 3 Best Questions to Get Started
There is not a mental disorder that generates more consternation when it comes to diagnostic assuredness than bipolar disorder, particularly on an initial evaluation. We clinicians are forever searching for better screening questions to more quickly hone in on a diagnosis, and of course, bipolar is no exception.
DSM-5 Nearly Three Years Later – Thumbs Up & Thumbs Down
In May of this year, DSM-5 will celebrate its third birthday. I’ve been using the manual for two years now, and I’ve reviewed it thoroughly. So here’s my assessment of its plusses and minuses, from a clinical perspective. I’ve categorized my comments as “Thumbs Up” and “Thumbs Down.”
It was 2010 I believe, when I first read the very few articles that had been published on the subject of e-therapy in mental health practice. I remember thinking how neat and cool it could be to interface with a client in real time via e-mail or videoconferencing. After these initial thoughts though, I dismissed it as something way off in the future, given the possible glitches that could easily arise, as well as the legal and ethical issues associated with HIPPA compliance and other privacy concerns. Well, what strides we’ve made over the last 5 years!
Identifying Depression in Youth: What to Look For and How to Proceed
One in three American children meets established criteria for depression, with onset typically at 10-11 years of age. The problem with diagnosing it in youth is determining its etiology, namely, is it biological (brain-based) or environmental.
How to Withdraw From Psychotropics Safely and Effectively
More and more calls and e-mails are filtering into my office these days from folks who are interested in tapering and possibly even discontinuing their psychotropics. Read more.
The Intrusive Nature of OCD
I took on a new client, Bob, last week who has all the signs and symptoms of chronic OCD. The disorder, via his self-report, has manifested in different ways over many years, but here’s a recap of the latest occurrence that brought him to treatment.
Binge Eating Disorder: Is This for Real and Should It Be Medication-Managed?
In the Twitter world, the buzz term seems to be what’s “trending.” In the world of mental disorders, “bingeing” is increasingly gaining attention. We’ve long been familiar with binge drinking, but now we’ve got a new binge kid on the block — binge eating for which there are established DSM-5 criteria.
Self-Esteem and Image Issues May Be Part of the Problem
People enter into psychotherapy, counseling or consultation for all sorts of reasons. Some don’t ever get past the “sounding board” stage in their work with us; many – if not most – are unclear about what their goals are; some improve substantially, others only moderately by not coming clean and really opening up, while yet others just simply quit.
Performing at Your Peak as a Mental Health Clinician
I’ve often put forth the notion that if you dwell on the clients you don’t help or just drop out of treatment, over the course of a career, you’ll do a lot of dwelling. But of course, this statement has its limitations.
Pharmacogenetic Testing in Psychiatry
Drug prescribing has long been a trial-and-error phenomenon in both physical and psychiatric medicine. Physical medicine though has this advantage: science has provided us a whole lot more information about the body than it has about the brain, and this bears itself out in the track record of certain psychiatric medication classes.
ADHD: How to Deliver Quality Assessment and Treatment
Attention deficit hyperactivity disorder (ADHD) is big business. ADHD medication sales have grown about 8 percent each year since 2010 and are projected to grow at least 13 percent this year to a whopping $12.9 billion in sales. There are two major reasons for this…
I get lots of questions regarding the benzodiazepine class of antianxiety drugs. So here’s an article addressing benzodiazepine actions, clinical uses, advantages, disadvantages, side effects, withdrawal and new information regarding onset parameters associated with physical dependence.
Muddled Medication Management Often Equals Suboptimal Outcomes
Switching from antidepressant to antidepressant, along with concocting one drug cocktail after another for treating depression, serves as a catalyst for more medication resistance going forward; and increasingly, I’m being referred patients who have experienced such strategies.
Belsomra: Yes, Another Sleeping Pill
The newest player in the non-benzodiazepine sleeping pill space is Belsomra (suvorexant). It’s actually a new chemical formulation in that it does not exert its hypnotic effects by working at GABA, histamine or melatonin receptors. Instead, Belsomra does its work at orexin receptors. So what is orexin?
Psychopharmacology… Going Forward
Where Psychopharmacology heads in the future will be largely dependent upon how realistically it defines its goals. Given the multidimensional nature and complexity of what influences depression, is it at all reasonable to conclude that an antidepressant, or for that matter, any other medicinal substance will be able to arrest it, or at the least, manage it better than the agents available today?
The More Things Change…
For sure, you know the backend of this common proverb. I invoke this old saying with regard to the two newest antidepressants on the U.S. drug market – Fetzima® (levomilnacipran) and Brintellix® (vortioxetine). Let’s take a look at them…
DSM-5: Positives and Negatives
The DSM-5 was in development for more than 10 years. Its official release was announced in May, 2013 at the American Psychiatric Association’s annual meeting in San Francisco, California. New diagnoses have been added and others have been amended or combined. Some proposed criteria considered for inclusion stirred up so much public and professional ire they were eventually eliminated from the final draft.
Panicking Should Be An Option
Panic attacks are sudden, intense, physical and emotional spikes of Adrenalin that typically last 10 minutes or so. They rise to disorder proportions when someone hands over control to the panic by worrying excessively about when the next attack will occur and making life changes to avoid them.
The Best Ways to Beat Generalized Anxiety
We are all a bit anxious from time to time. The mere stresses of everyday life present with situations that we find perplexing and worrisome, igniting the classic fight-or-flight phenomenon. This is consistent with living life on its terms and not ours, that is, none of us really knows what’s in store for us on any given day…
Saying Goodbye to Sleeping Pills and Antidepressants
For most of us I believe, once we’ve made a firm decision to do something, we want results swiftly with as little pain and effort as possible. So it never surprises me when a patient of mine who has decided to distance himself from sleep agents or antidepressants asks how long it will take and how difficult the withdrawal process will be…
The Stark Reality of Medication Treatment-Resistance
Years of presenting Psychopharmacology seminars and writing this newsletter have resulted in my receiving thousands of e-mails.
Treating Melancholic, Vegetative Depression: Use the Side Effects of Antidepressants to Advantage
As I’ve often noted about treating depression, getting depressed people moving is essential. It’s even more essential for those spending inordinate amounts of time in bed and cutting themselves off from physical and other forms of social contact with others.
Identification and Treatment of Bipolar Disorder is Stuck – Here’s Why
Although considered highly prevalent, bipolar disorder is routinely misdiagnosed. Psychiatric literature is replete with data about over-diagnosis — particularly in pediatric populations — but this disorder is frequently under-recognized also.
It’s High Time for Rethinking Depression Models
If you routinely work with clients who are medicated with antidepressants as I do, I’d bet that you’ve heard this all too familiar refrain: “My antidepressant isn’t working the way it used to, can you tell me why?”
Mental Illness in Older Adults
With a rapidly aging population, prescribers and non-prescribers alike will no doubt be seeing more elderly patients as more and more baby boomers approach retirement.
Treating Anxiety with Antipsychotics and Anticonvulsants
The benzodiazepines have been the mainstay of anxiety management for several decades now. In the past decade or two, the antidepressants, particularly the serotonin agents, have entered the picture when it comes to managing anxiety pharmacologically.
What Do You Want the Drug to Do, and for How Long?
Anyone who has either recently started or is contemplating the use of antidepressants or benzodiazepine anti-anxiety agents should ask themselves: what is it am I wanting from the drug and for how long do I envision availing myself of its services.
Since many of my newsletter followers, blog readers and colleagues are aware that the treatment of OCD (obsessive-compulsive disorder) has been a niche area of mine for years, I often get questions about it. Here’s a recent one…read more.
Bipolar Disorder Symptoms – Beyond The DSM
We know all the classic symptoms of manic-depressive illness and its unpredictable cycle of intense mood swings. Significant to bipolar though, and more often linked to the manic characteristics of the disorder, are ego issues, arrogance, an entitlement mentality, an inability to calculate consequences and a general lack of awareness.
A Path Toward the Successful Treatment of Depression
As an old saying goes, there’s more than one way to get downtown. The same is true for treating depression, but there are two factors that need investigation before a treatment course begins. And they are: a) what’s the individual’s relationship with their depression like, and b) how is the depression serving them.
Psychopharmacology and Mental Health: Some Thoughts and Suggestions
You can read a 600- page text on the biochemistry of psychiatric medications; become enmeshed in the marvels of neuroscience; design highly complex drug regimens for patients; and still not know a thing until the patient swallows the first pill….
The 4 Demons of Depression and How You Can Help Clients Overcome Them
I’ve identified 4 areas that are consistently problematic in the lives of depressed people. Here they are and how you can help.
The Story of Serotonin and the Synaptic Sea
One of the films in the famous Star Wars trilogy was The Empire Strikes Back. Keep this in mind as we embark upon my story of: Serotonin and the Synaptic Sea.
DSM-5 – What It Would Be Wise to Ignore
Well, the Board of Trustees of the American Psychiatric Association has done it — they’ve signed off on a DSM-5 containing changes that are fraught with flaws, replete with overkill and scientifically weak.
Psychopharmacology and Mental Health Trends – My Take
Every now and then I read some of the ubiquitous “threads” which discuss the trials and tribulations of those using psychotropic medications. The most frequent discussions are about antidepressants.
Strive to Thrive – 10 Suggestions To Help You Stay On Track
In this article we focus on 10 ways to help you thrive. Here goes with some suggested do’s and don’ts.
ADHD – Why Parents Shouldn’t Buy In to This Diagnosis at First
Nine-year-old Megan’s mother called me recently. The purpose of her call was to set up a consultation whereby I would offer medication options for Megan’s “ADHD”… read more
The Nuts and Bolts of Diagnosis
Have you ever sat at your desk, or work space, opened the DSM IV and seriously attempted to digest the criteria? What do you make of the exclusionary criteria, riders, modifiers, specifiers, or whatever these are called nowadays?
Diagnosing Bipolar Disorder: Index It
When’s the last time you’ve cast a critical eye toward the DSM IV criteria for Bipolar Disorder? Do the criteria for Bipolar I and Bipolar II assemble a clear, usable diagnostic path for you, or do you find yourself mired in exclusionary clauses, modifiers, specifiers, qualifiers, categorical systems, or whatever all of this extraneous stuff is called nowadays?
5 Steps Alcoholics Can Take To Stop Drinking: On Their Terms
In Act 1, Scene 3 of Shakespeare’s masterpiece, Hamlet, Polonius speaks these words to his son Laertes: “This above all: to thine own self be true.” Substance abuse is fraught with manipulation, deception, denial and minimizing. Extracting the truth from a substance abuser is a yeoman’s task for the treating professional.
Intermezzo: The Micromanagement of Insomnia Has Arrived
Reaffirming the notion that there is indeed a pill for every ill, the U.S. Food and Drug Administration has approved Intermezzo® (zolpidem tartrate sublingual tablets) for use as needed for the management of insomnia associated with middle-of-the-night awakenings and difficulty returning to sleep. This is the first time the FDA has approved a drug specifically for this indication. The agency warns that Intermezzo® should be used only when there are at least four hours of bedtime remaining.
Psychotropic Medication Decision Making: Toss the Algorithms and Decision Trees Aside
At every Psychopharmacology seminar I present, the following occurs: an attendee approaches me with a question regarding drug selection. I’m provided a small measure of the client’s history and the attendee’s assessment of the client’s condition. Invariably, the next question is what medication I would recommend. The expectation is for me to help after a two or three minute conversation guided by rudimentary information at best.
Making Peace With The Sandman
Infants can sleep anywhere. As a frequent flyer, I notice this often. In spite of the hustle and bustle of getting the passengers onboard and the roar of jet engines upon takeoff, little ones find dreamland, often safely tucked away in the arms of a loved one. Sleep though is not a birthright and this can become painfully obvious as we age.
Omega-3 Fatty Acids
“Fat” has become a bad word in our society, but the fact is a particular type of fat is so essential, that our body’s cells can literally collapse without it. Fish oil — with its singular component omega-3 fatty acids in conjunction with other types of fat in the membranes that surround the cells — literally control cell behavior.
Antidepressants: Faulty Expectations and Implications For The Future
With ever-increasing regularity, and regardless of the referral source, people with garden variety psychosocial problems are presenting to my office seeking antidepressants.
Psychopharmacology: What Happened In 2011 and a Glimpse Ahead
Every December in this space, I summarize what transpired in the dynamic field of Psychopharmacology for the year and take a look down the road ahead. For 2011, here goes.
Making the Case For A More Streamlined DSM-5: A Few Suggestions
Our mental health bible is in need of a facelift. My diagnostic confidence is not bolstered by the DSM-IV-TR, and as proposed, the DSM-5 is not generating much enthusiasm for me either. So I got to wondering what a more user-friendly, more helpful DSM-5 would read like.
Rational Approaches for Managing Insomnia
Sleep simply does not come naturally to some people. We’re all wired differently and our circadian rhythms are environmentally influenced. Those who travel frequently or do shift work often report difficulties with the sandman.
Disruptive Mood Dysregulation Disorder: Yet Another Setback for Child Psychiatry
Child psychiatry has been on a zealous binge of creating diagnostic fads in recent years with three highly visible examples to its credit – childhood bipolar disorder, ADD and most recently, autism. Now, thanks to a scientific review group, there’s another possible contender, namely, Disruptive Mood Dysregulation Disorder (DMDD) that will be included in DSM-5.
Treatment-Resistant Bipolar Disorder: A Formidable Foe
Treatment resistance in bipolar disorder is very common. Even with optimal care, which includes medication combinations, 50 percent of bipolar individuals who achieve symptom remission will relapse within two years.
The need for viable augmentation strategies to assist in the pharmacological management of treatment-resistant depression (TRD) has become so dire that clinicians seem to perk up to any option nowadays.
Frequently Asked Questions
Take a look at some of these common questions about psychotropic medications, weight gain and what questions should be asked when having a psychiatric medication evaluation.
Characterized by a series of persistent thoughts and compulsions, OCD is a chronic condition fraught with suffering, shame, guilt and self-doubt. It is often incapacitating as well.
Child and Adolescent Bipolar Disorder: Controversies, Concerns and Current Medication Trends
The diagnosis of bipolar disorder in children and adolescents is currently the most hotly debated issue in pediatric mental illness. Is the disorder overdiagnosed or underdiagnosed in this population group?
8 Tips for Managing Antidepressant-Induced Sexual Dysfunction
Ironic isn’t it? Depression robs people of their desire for sex, and antidepressants can make the situation even worse.
Viibryd™: The Next Blockbuster Antidepressant?
While smack-dab in the middle of my personal and professional planning during January of this year, the FDA went ahead and approved another antidepressant. As a psychopharmacology writer and speaker, this should teach me not to turn my back for even one second.
Polypharmacy: Friend, Foe, or Both?
“Psychiatric patients are over-medicated.” I hear that a lot, particularly from people who learn that I write a Psychopharmacology blog. Part of me agrees, yet another part of me realizes that this is not a simple black-or-white issue; instead, it is nuanced and complex.
Mental Health Disorders and Psychopharmacology: The Year 2010 In Review
Here are the highlights that I’ve taken away from researching several well-respected pieces of scholarly work regarding mental health disorders and Psychopharmacology during 2010.
We’ve Come a Long Way – Or Have We?
Contemporary antidepressants promise greater effectiveness over their predecessors. But do they really deliver?
Temper Dysregulation with Dysphoria…The Best Laid Plans
“The road to hell is paved with good intentions,” remember this old saying? Sometimes we spot a serious problem, and with the best of intentions, discover that our solution wreaks as much havoc as the original problem itself.
Recent Psychotropic Medication Arrivals: Can We Really Call Them New Drugs?
So what’s really new about Intuniv and Trazodone Extended Release? Not much. The release technology certainly isn’t, and as far as the improved side effects profile goes, maybe. They’re certainly no more effective than the immediate release products.
4 Key Reasons For Medication Non Compliance and How You Can Help
The basic tenet of non compliance is the failure to take medication according to prescribed directions. But it’s more than non adherence to directions, non compliance is also indicative of the misuse of medication.
The Placebo Effect
The placebo effect is likely as old as the healing professions themselves. This article discusses what it is, possible mechanisms for it and using the placebo effect.
6 Tips for Improved Relationships with Physicians
Non-medical clinicians train and practice in a world that is considerably different from that of physicians. We’ll look at tips to improve these relationships.
Are All Drugs Created Equal? Brand-Name vs. Generic Medications
Are low-priced generic medications as safe and effective as their brand-name counterparts?
Tips for Assessing and Treating Clinical Depression
Think of depression not as a diagnosis, but instead as a cluster of symptoms with many possible causes.
Depression in the workplace is a serious, costly illness. Here’s how employers and employees alike can cope.
4 steps to dealing with a difficult supervisor
Stop Saying ‘Yes’ When You Really Mean ‘No’
5 tips to help you become more assertive
Walking the Work-Family Tightrope
These 8 tips can help you to balance the demands of work with the needs of those you love
Six Ways to Beat Job Burnout
The thrill is gone at the office? Try these tips to get your work groove going again.
The Essential Dad
Tips for fathering — from infancy to adolescence.
Helping Clients Overcome Resistance to Psychotropic Medication: Part II
This article discusses two common reasons for resistance: Family Interference and Fear.
Try These 7 reinvigoration techniques to bring out your masculine side.
For Better or Worse – But Mainly For Better
Newlyweds, adopting these five qualities can help your marriage last for many, many years.
10 Ways to Get Your 40 Winks
Stop losing out to insomnia. Here are 10 highly effective tips for falling asleep — and staying asleep — with greater ease.
Helping Clients Overcome Resistance to Psychotropic Medication: Part I
The answer to a widely asked question: “How do I professionally and ethically handle the client that continues to resist psychotropic medication in spite of continuing symptoms?”
Rediscover Your Bliss
Six simple steps to help you reconnect with yourself today
Keep the Home Fires Burning
Five ways to put the spark back in your marriage — and keep it lit!
Facing Down Fear
Fear is universal; everyone experiences it from time to time. But the way we react to fear is not always appropriate.
Beat the Procrastination Bug
Eight powerful ways to get important things done – starting now!
Pediatric Anxiety Disorders: Pharmacological vs. Behavioral Treatment
Anxiety disorders are among the most common mental, emotional and behavioral problems to occur during childhood and adolescence.
Seasonal Affective Disorder (SAD): More Than Just the Winter Blues
Many of us notice increasing tiredness and difficulty getting out of bed as autumn turns to winter. In fact, for centuries, writers have portrayed the shorter days of the calendar year as a time of sadness, loss and lethargy. But for some people, winter causes a noticeable exacerbation of these symptoms, and their depression and lack of energy can become immobilizing.
One Child in Every Classroom: ADHD Affects Two Million American Kids — is Yours One of Them? Contributing author, Chattanooga Parent, Jan/Feb 2010
Boost Your Mood – Naturally!
Contributing author, Woman’s World Magazine, 12/28/09
Beyond Talk Therapy and ‘Happy Pills’: The Risks and Rewards of Alternative Treatments
Contributing author, Anchor Magazine, Fall 2009
The Alternative Remedy Frenzy
To read the volumes of ever-increasing information on this subject, the latest “natural” miracle cure is either on the horizon or already here. There are many claims to fame in this regard, but most of them fall by the wayside when subjected to scientific research.
Medicating Children With Bipolar Disorder
When it comes to stabilizing and maintaining remission of the constellation of symptoms associated with bipolar disorder, clinicians often disagree over an appropriate course of action.
Medications for Bipolar Disorder
Published in the Sept/Oct 2009 issue of Social Work Today magazine
Ten Factors that Every Clinician Should Know – and Share With Their Clients – About Antidepressants
Depression is a real illness, not a character flaw or weakness. We’ll take a look at this fact and many others.
The Interaction Between Families and Psychotropic Medication
Family members can have a significant influence on a client’s initial decision to attempt psychotropic medication. They can also influence the client’s willingness to adhere to a treatment regimen once it has been started.
Getting Enough Zzzzzzzz’s
A survey of 2,500 people by the American Psychological Association found that 80% of respondents say the economy is a significant source of stress and that it’s taking a toll on their health. Are you getting enough sleep?
A Priceless Ally – Cultivating a Positive Attitude
Attitude is more than the way you communicate your mood to others; it serves as you mind’s eye – the way you see the world, so to speak.
Anger Energy – Managing Anger Before It Manages You
Is anger always a big, bad, ugly, potentially destructive emotion? Absolutely not. When used constructively and productively, anger can be a very positive motivating force in your life.
The Sometimes Rocky Road Toward a Psychotropic Medication Evaluation
Client ambivalence is a common occurrence, but when faced with this, clinicians should take the opportunity to continue strengthening the therapeutic relationship as the decision making process unfolds.
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.