A podcast detailing current topics in the Journal of Clinical Psychopharmacology.
In this podcast, Dr. Jonathan Leung discusses the article, “The Modernization of Clozapine: A Recapitulation of the Past in the United States and the View Forward,” published with several colleagues in the November-December 2022 issue of the Journal of Clinical Psychopharmacology (Volume 42, Issue 6). Dr. Leung, lead author of the review article, is a psychiatric pharmacist at the Mayo Clinic in Rochester, MN, and faculty member at the Mayo Clinic College of Medicine.
Clozapine is a unique life-saving drug for treatment-resistant schizophrenia and reduction in risk of recurrent suicidal behavior in schizophrenia or schizoaffective disorder, but it is underused in the United States despite its established efficacy. Clozapine’s benefits for reduction of suicidality may extend to other uses as well, although more rigorous studies are needed. The article and podcast discuss the history of FDA approval for clozapine, hematologic monitoring requirements that have been viewed as cumbersome, as well as other barriers related to clozapine use.
In small-scale studies, 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for posttraumatic stress disorder has shown some promise, but exploratory analyses have suggested that recent use of selective serotonin reuptake inhibitors (SSRIs) can dampen the efficacy of this novel therapy. In this podcast, Dr. Collin M. Price, a psychiatric resident at UCLA, and Dr. Allison Feduccia, a neuropharmacologist and CEO of a company that curates CME courses on psychedelics, discuss their new article
in the Journal of Clinical Psychopharmacology that provides a selective review of the literature in the basic and clinical neurosciences relevant to the interaction of SSRIs and MDMA. They suggest that there is an urgent need for future work dedicated to addressing this important clinical topic. Their article is published in the September-October 2022 issue of the journal.
In this podcast, Dr. Melvin McInnis discusses lithium toxicity in individuals with bipolar disorder who were infected by the SARS-CoV-2 virus. Lithium is an effective long-term management strategy for treating bipolar disorder, but because acute kidney damage can be a complication of COVID-19, the body’s ability to process lithium may be affected. Based on his case report study
, coauthored by Dr. Anastasia Yocum and published in the September-October 2022 issue of the Journal of Clinical Psychopharmacology
, Dr. McInnis urges proactive monitoring for signs of diminished kidney functions to avoid levels of toxicity, especially during the pandemic.
Panic disorder is a common psychiatric disorder, with generally effective pharmacologic treatments for most patients. However, a subset of patients do not respond, and roughly 25% of patients have adverse effects. In this podcast, based on his guest editorial published in the September-October 2022 issue of the Journal of Clinical Psychopharmacology, Dr. Antonio Nardi makes the case that the next era of treatments may be inhibitor specific. Because of the amygdala’s essential role in the control of anxiety responses, Dr. Nardi suggests that it may be the key to developing such therapies. While acknowledging that his editorial focuses on selective molecules for α2/3-GABAAR, Nardi expresses hope that the two classes of GABAkines in clinical development, studied in conjunction with models of carbon dioxide inhalation in healthy volunteers, might represent the beginning of a new era in treatment for panic disorder.
A recently published book provides sharp criticism of the modern era of clinical psychopharmacology, questioning the validity of psychiatric diagnoses and the effectiveness of psychopharmacologic treatments. In this podcast, Dr. Anthony J. Rothschild, Editor-in-Chief of the Journal of Clinical Psychopharmacology, offers his perspective on the book, The Rise and Fall of the Age of Psychopharmacology. The book “ignores the fact that many people with serious psychiatric disorders have had their lives dramatically improved by psychotropic medications,” Dr. Rothschild says, noting that he vehemently disagrees with how the book’s author characterizes the profession. The podcast accompanies Dr. Rothschild’s editorial in the July-August 2022 issue of the journal.
Clozapine is often prescribed for patients with treatment-resistant schizophrenia, but its use is sometimes discontinued if it is suspected of inducing neutropenia. In this podcast, author Laurent Béchard discusses a consecutive case series published in the July-August 2022 issue of the Journal of Clinical Psychopharmacology assessing the continuation or reintroduction of this drug despite a neutropenia episode. In addition to suggesting further research to better define severe vs. moderate cases, Dr. Béchard proposes the use of pharmacovigilance tools to assess possible causes of neutropenia so clinicians can better determine if this highly effective antipsychotic should remain part of a patient’s treatment plan.
In this podcast, Editor-in-Chief Anthony Rothschild discusses his editorial in the May-June 2022 issue about the use of antipsychotic medications for treatment of nonpsychotic patients. With four drugs approved by the FDA for use as augmentation for the treatment of nonpsychotic depression, and possibly a fifth soon, he advocates for more longitudinal studies to better understand the potential risks vs. benefits to this practice. While citing previous similar treatment approaches in the history of psychopharmacology, Dr. Rothschild advocates that until potentially serious adverse effects can be ruled out, the prescription of antipsychotic medications to nonpsychotic patients should be limited to those who are resistant to all other treatments.
The use of the combination of stimulants and antipsychotic medications is increasing in pediatric patients who suffer from Attention Hyperactivity Disorder (ADHD). In this podcast, Dr. Mohamed Mohamoud discusses how this combination may result in acute hyperkinetic movement disorder in children. Using the FDA Adverse Event Reporting System database, Dr. Mohamoud and his colleagues conducted a case series analysis and identified 36 instances where a pharmacodynamic drug-drug interaction may have resulted in the disorder. Their report is published in the May/June 2022 issue of the Journal of Clinical Psychopharmacology. Prescribing information has recently been updated and this podcast discusses the data upon which that information was changed. Dr. Mohamoud is being interviewed by FDA press officer Charlie Kohler.
Drs. Steve Dubovsky and Dori Marshall discuss their article reviewing the potential of calcium channel blockers for the treatment of mood disorders, an area of research that the authors assert has received too little attention. Their article, titled Calcium Channel Antagonists for Mood Disorders, appears in the March-April 2022 issue of the Journal of Clinical Psychopharmacology.
“Polypharmacy,” the simultaneous use of multiple medications, has been linked to an increased risk of treatment complications. An article in the March-April 2022 issue of the Journal of Clinical Psychopharmacology takes a systematic look at research studies that have tested interventions to optimize polypharmacy in psychiatric treatment and nursing homes. Improvement of drug-related outcomes can be achieved by interventions such as individualized medication review and educational approaches. Changes in clinical outcomes, however, are often not substantial. Drs. Philip Stötzner and Eva Brandl, two of the authors of the systematic review, discuss their findings and avenues for future research.
How can we improve psychopharmacology practice? This podcast features a lively discussion among the authors of two articles in the January-February 2022 issue of the Journal of Clinical Psychopharmacology in which they address that important topic. The participants discuss some weaknesses in current models of psychopharmacology training as well as the challenges clinicians face in keeping up with medication advances.
A large observational study from researchers at Washington University in St. Louis found an elevated risk of breast cancer in women who take some types of antipsychotic drugs – specifically, drugs that raise levels of the hormone prolactin. In this podcast, Dr. Tahir Rahman, lead author of the study, discusses the findings and their implications for patient care.
In the effort to prevent relapse in patients who have experienced depressive episodes, it has been common practice to have them continue long-term on antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs). In this author podcast, Giovanni A. Fava discusses his guest editorial that challenges that custom and suggests alternative approaches for preventing relapse. Dr. Fava’s Guest Editorial is published in the November-December 2021 issue of the Journal of Clinical Psychopharmacology.
The link between substance abuse, impulsivity,
and violence in psychotic patients remains unclear. In this author podcast, Gabriella Gobbi, MD, PhD, and Stefano Comai, PhD, discuss their study, which was designed to assess whether cannabis use disorder is associated with violent and/or psychotic behavior in patients who are hospitalized in a high-security hospital.
The findings show that cannabis and alcohol
are often abused (by themselves or together) by psychotic patients with a propensity for violence, but only alcohol is associated with impulsive and violent behavior. The article is published in the November-December 2021 issue of the Journal of Clinical Psychopharmacology.
Individuals with major depressive disorder and suicidal ideation are particularly vulnerable and may not respond as well to standard treatment as patients without suicidal ideation. In this author podcast, Dr. Dong-Jing Fu and Dr. Carla Canuso discuss the results of a pooled analysis of data from the ASPIRE studies, randomized placebo-controlled trials of esketamine, plus comprehensive standard-of-care treatment. The results, published in the September-October 2021 issue of the Journal of Clinical Psychopharmacology, suggest that esketamine can provide rapid relief of depressive symptoms in patients with MDD and acute suicidal ideation or behavior, especially in those with a history of prior suicide attempt.
Dr. Julia Ann Koretski reflects on the critical role of the placenta in drug metabolism and potential near- and long-term effects on postanatal life. The placenta was once viewed as a passive, almost mechanical barrier, but we are continuing to learn of the important ways it influences drug metabolism and development of conditions such as postnatal adaptation syndrome and schizophrenia. Dr. Koretski’s commentary is inspired by a Guest Editorial in the journal authored by Dr. Richard Shader, Founding Editor-in-Chief Emeritus of the Journal of Clinical Psychopharmacology. Dr. Koretski is Digital Editor of the journal.
Obsessive compulsive disorder (OCD) can often be effectively treated with cognitive behavioral therapy or serotonin reuptake inhibitors. About one-third of patients, however, do not receive adequate symptom relief. Jon E. Grant discusses the potential of monoamine oxidase inhibitors (MAOIs) in treatment-resistant OCD. In an article in the journal, Dr. Grant and his coauthors present new data from a case series of nine patients; three had marked improvement on phenelzine and three had some improvement. Large-scale trials are needed to fully assess the benefits and risks of the therapy in this population group.
Journal of Clinical Psychopharmacology
Mass shootings have become a common occurrence in the United States and elsewhere. In this podcast, author Ira D. Glick discusses the research he and his colleagues conducted to analyze whether certain mass shooters had psychiatric illnesses and had received appropriate medication before they committed the violence. While the authors acknowledge the limitations in their research, their data suggest that many persons who commit domestic mass murders may have experienced compromising and untreated psychiatric illnesses.
Journal of Clinical Psychopharmacology
Psychotic depression is a severely disabling illness and is more common than is generally realized. Unfortunately, there is no FDA-approved medication for its treatment. In this podcast, the Editor-in-Chief of the Journal of Clinical Psychopharmacology, Anthony J. Rothschild, discusses his opinions as to how this came about and encourages further research and development of a suitable medication with an eye toward FDA approval.
Authors Nicholas A. Mischel and Richard Balon discuss their commentary, “Esketamine: A Drug to Treat Resistant Depression That Brings More Questions Than Answers.” Their commentary asks: How does this treatment fit into the broader repertoire in treating resistant depression and suicidal ideation or behavior, with both concepts ill-defined?
Editor-in-Chief Anthony Rothschild discusses his editorial, “The Pitfalls of Psychotropic Polypharmacy.” For psychiatric disorders, it is common for patients to be prescribed more than one medication. While there may be benefits, it is essential that clinicians also be mindful of potential problems, such as pharmacokinetic interactions (affecting drug absorption, distribution, metabolism, and elimination), pharmacodynamic interactions (for example, serotonin syndrome, QT-interval prolongation, and lowering of seizure threshold), drug-induced liver injury, and falls in older patients. There are times when “treatment-resistant symptoms” are actually adverse effects of the many medications being taken.