This will be my last Carlat Psychiatry Blog post for a while, as I have recently accepted a new job as the director of the Pew Prescription Project in Washington DC. My main job there will be to pull together a group of experts to review conflict of interest recommendations, and to work with various partner organizations (AMSA, Community Catalyst, and the National Physician's Alliance) to ..read more

The British Medical Journal's great blogger Richard Lehman has published the following Ten Commandments for excellent clinical practice. These are great rules of thumb for any savvy health care practitioner--but they do require that wee bit of extra work to truly understand the statistics behind the medical literature. (Hat tip to Steve Balt, MD, for sending me the link).  The New Therapeutics ..read more

The Carlat Report Newsletters are launching a bi-monthly email newsletter that will contain concise, practical advice for busy clinicians based on the work we are doing in The Carlat Report, The Carlat Child Report, and The Carlat Addiction Treatment Report. You don't have to be a paid subscriber to get it, simply fill out this quick webform and you'll start receiving each new issue, along ..read more

Antipsychotics are not perfect. No drugs are. They can cause weight gain and weird movement side effects and sleepiness. But they have their uses, such as quelling racing thoughts, inner turmoil, and psychosis. There’s nothing inherently good or bad about any class of drugs. It’s up to physicians to understand the data and to prescribe medications judiciously. With that introduction out of the ..read more

The fact that psychiatry lags far behind the rest of medicine scientifically is no great news flash. The leaders of our field have long acknowledged this problem (see, for example, this withering self-critique by then head of NIMH Thomas Insel).  None of this should be taken personally. Psychiatrists are just as smart as other doctors. It’s just that we have the misfortune of having chosen the ..read more

You may have heard that the Food and Drug Administration has given the drug ecstasy (MDMA) its "breakthrough designation" for the treatment of PTSD. See this very thoughtful article in the Washington Post for details.  I came out of blog-slumber to post about this because we're in the midst of planning an upcoming issue of TCPR (The Carlat Psychiatry Report) on PTSD, and because we've recently ..read more

In the early 1950s, opium was considered an effective treatment for depression, but gradually it fell out of favor as its addiction risk became clear. Nonetheless, there's no denying that opioids rapidly elevate the mood of just about anybody, even the very depressed. So that's a pretty tantalizing challenge: Is it possible to harness the elating effects of opiates while avoiding the addictive ..read more

A new article in the British Medical Journal (BMJ) by Alastair Matheson takes a fresh look at ghostwriting in medical research. Apparently, pharmaceutical companies are waging a campaign to convince us that they are now opposed to ghostwriting. But Matheson argues that the practice continues, only under a different name: "editorial assistance." It comes down to how we define ghostwriting. The ..read more

It would be fantastic to have a lab test to help us decide which drugs to prescribe in psychiatry. See Sunday's great Boston Globe article that picked up on our recent coverage of the GeneSight test.  It's a promising technology, but the marketing has leap-frogged ahead of the science.  This Wednesday afternoon I will be participating in a webcast with journalists and other doctors ..read more

In the pages of The Carlat Psychiatry Report, we’ve covered transcranial magnetic stimulation (TMS) numerous times—most recently in the current issue. For those who haven’t heard of these devices, they work by pulsing magnetic fields into the brain. The magnetic fields stimulate neurons—far more gently than electroconvulsive therapy. The theory is that this gentle brain stimulation, focused on ..read more