The Journal of Clinical Psychiatry Podcast

The JCP Podcast
  • 4.9 (13)
  • Mental Health

The Journal of Clinical Psychiatry Podcast explores the science, practice, and human side of mental health care. Hosted by Dr. Ben Everett, Senior Scientific Director at Physicians Postgraduate Press, the series brings together leading voices in psychiatry, neuroscience, and behavioral medicine to discuss the evidence shaping clinical care today. Each episode features thoughtful conversations with JCP authors, academic experts, and frontline clinicians exploring disorders across the mental health continuum, from schizophrenia and mood disorders to anxiety, depression, and sleep-related conditions. By bridging research and real-world practice, the podcast delivers insights that empower psychiatrists, nurse practitioners, physician associates, and primary care clinicians to deliver better care for patients with mental illness. Insightful. Evidence-based. Human-centered.

  1. 11h ago ·  Bonus

    Bonus Episode: Psychedelic Research Inside an Academic Medical Center with Scott Thompson, PhD

    In this bonus episode, Dr. Ben Everett speaks with Scott Thompson, PhD, professor of psychiatry at the University of Colorado School of Medicine, where he directs the Novel Therapeutics in the Brain and Behavior Innovation Center and leads the Psychedelic Public Policy Partnership. Drawing on more than 40 years of synaptic research, Dr. Thompson describes how an unexpected finding on SSRI action led his lab to show in mice that psilocybin's antidepressant-like effects persisted even when the 5-HT2A receptor was blocked, and what that finding means for the question of whether the psychedelic experience itself is the medicine. As psychedelic compounds advance through late-stage development, clinicians face open questions about mechanism, trial design, safety, and access. This conversation covers functional unblinding and the search for objective endpoints such as anhedonia, what it takes to run Schedule I research inside an academic medical center, and real-world outcome and safety data from more than 2,300 people who received regulated psilocybin services in Colorado and Oregon. Dr. Thompson also discusses the role of psychotherapy, the evidence on microdosing, and phase III programs including Definium's DT120 LSD formulation and Beckley Atai's intranasal 5-MeO-DMT. KEY EPISODE HIGHLIGHTS: A SUPERCHARGED SSRI [45:30] “psychedelics do what SSRIs do. They just do it more potently and more quickly.” Dr. Thompson's working hypothesis frames psychedelics as faster, stronger versions of a mechanism clinicians already use every day, which shapes how his lab tests whether the trip is required. A DOSE CEILING IN REAL-WORLD DATA [27:31] “people who got doses of psilocybin less than thirty milligrams displayed the same improvement in symptoms as people who got doses more than thirty-five” Outcome data from more than 2,300 regulated psilocybin clients suggest a threshold rather than a linear dose-response, challenging the assumption that higher doses yield greater benefit. MICRODOSING AND EXPECTANCY [31:00] “There's strong evidence now that microdosing is primarily a placebo effect.” Placebo-controlled studies show benefit tracks what participants believed they received rather than what they actually took, useful context when patients ask about microdosing. CHAPTERS: 00:00 – Introduction: Is the Experience the Medicine? 02:00 – From Basel and Zurich to Psilocybin and Synaptic Plasticity 07:30 – Psychedelic Research and Policy at CU Anschutz 10:30 – Functional Unblinding and the Search for Objective Endpoints 15:00 – Facilitator Support, Placebo Response, and Predictive Biomarkers 20:00 – Building Safety Into Colorado's Regulated Psilocybin Services 24:30 – Real-World Outcomes From Colorado and Oregon Psilocybin Clients 28:00 – Dose Thresholds, MEQ-30 Scores, and the Evidence on Microdosing 32:00 – Running Schedule I Research: Regulation, Funding, and INDs 36:30 – Safety Signals: Psychosis, Suicidality, and Adverse Event Follow-Up 43:00 – Blocking the 5-HT2A Receptor: Is the Trip Necessary? 47:30 – Cost, Access, and Shorter-Acting Psychedelics 50:30 – Receptor Promiscuity and Non-Hallucinogenic Compounds 53:30 – The Role of Psychotherapy in Psychedelic Treatment 59:30 – Definium's DT120: Phase III Data, Payer Realities, and Dose Selection 01:07:00 – Beckley Atai's 5-MeO-DMT and Other Short-Acting Compounds 01:09:30 – Clinical Takeaways LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep27-psychedelic-research-academic-medical-center-scott-thompson/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. Dr. Scott Thompson – LinkedIn https://www.linkedin.com/in/scott-thompson-241a1a15/ Harnessing Psilocybin (Hesselgrave et al., PNAS, 2021) https://doi.org/10.1073/pnas.2022489118 Dr. Thompson's mouse study showing psilocybin's antidepressant-like effects persisted despite 5-HT2A receptor blockade. Colorado Natural Medicine Program https://dpo.colorado.gov/NaturalMedicine State program for regulated psilocybin services discussed in this episode. Definium Therapeutics https://definiumtx.com Developer of DT120, the LSD formulation with phase III results in MDD and GAD. #Psilocybin #PsychedelicMedicine #LSD #Neuroplasticity #FunctionalUnblinding

    Bonus Episode: Psychedelic Research Inside an Academic Medical Center with Scott Thompson, PhD

  2. Oct 20

    Thirty Years of the DCPR with Jenny Guidi, PsyD, PhD

    Jenny Guidi, PsyD, PhD, associate professor of clinical psychology at the University of Bologna and director of psychometric and clinimetric studies at Massachusetts General Hospital, joins host Ben Everett, PhD, to discuss her new systematic review in The Journal of Clinical Psychiatry. The review examines more than 30 years of research on the Diagnostic Criteria for Psychosomatic Research (DCPR), covering all 14 DCPR syndromes across 96 studies. Traditional psychiatric diagnosis can overlook psychosocial factors that shape the course and outcome of medical illness. Dr. Guidi explains why DCPR syndromes were found more often than formal psychiatric diagnoses in many clinical settings, how demoralization differs from major depressive disorder and why that distinction changes treatment, and how allostatic overload links a patient's lived experience to measurable biological change. The conversation closes with practical considerations for bringing the semi-structured DCPR interview into routine clinical care. 🎯 KEY EPISODE HIGHLIGHTS: 🔍 WHAT STANDARD PSYCHIATRIC ASSESSMENT CAN MISS [09:39] “Our results suggested that the DCPR captured distinct clinical phenomena rather than merely symptomatic manifestations or attenuated forms of psychiatric disorders.” Many medically ill patients with meaningful psychological distress meet no psychiatric diagnostic category, yet DCPR syndromes can identify them and inform prognosis and treatment. 💊 WHEN AN ANTIDEPRESSANT IS THE WRONG TOOL [20:30] “On the other hand, if you misdiagnose demoralization as major depression, you are likely to prescribe unnecessary pharmacological treatment for what is essentially a psychological problem.” Recognizing demoralization redirects care toward psychotherapeutic approaches such as well-being therapy rather than medication with no evidence of benefit. 🧬 BIOGRAPHY WRITTEN INTO BIOLOGY [24:06] “The concept of allostatic overload provides a theoretical bridge between biography and biology.” Allostatic overload gives clinicians a measurable way to connect chronic stress and life events to changes across multiple biological systems. CHAPTERS: 00:00 – Introduction and Dr. Guidi's Path to the DCPR Review 05:00 – What the DCPR Detect Beyond DSM and the 2017 Revision 09:16 – DCPR Syndromes Across Cardiology, CL Psychiatry, and Primary Care 14:32 – Distinguishing Demoralization From Major Depression 18:08 – Recognizing and Treating Demoralization 23:03 – Allostatic Overload: Where Biography Meets Biology 29:02 – Bringing the DCPR Into Routine Clinical Practice LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep26-thirty-years-dcpr-psychosomatic-research-jenny-guidi/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. Thirty Years of the Diagnostic Criteria for Psychosomatic Research (DCPR): A Systematic Review and Discussion of Clinical Implications https://www.psychiatrist.com/jcp/Thirty-years-Diagnostic-Criteria-Psychosomatic-Research-systematic-review Dr. Guidi's systematic review of all 14 DCPR syndromes across 96 studies, the focus of this episode. The Demoralization Construct in Clinical Practice and Research (de Figueiredo) https://www.psychiatrist.com/jcp/demoralization-construct-clinical-practice-research/ Companion commentary on distinguishing demoralization from depression, discussed in the episode. Biography Inscribed in Biology (Horwitz) https://www.psychiatrist.com/jcp/biography-biology-diagnostic-criteria-psychosomatic-research-embodiment-lived-experience/ Companion commentary on allostatic overload and the embodiment of lived experience. Dr. Jenny Guidi - LinkedIn https://www.linkedin.com/in/jenny-guidi-psyd-phd/ #DCPR #Demoralization #AllostaticOverload #PsychosomaticMedicine #Clinimetrics

    Thirty Years of the DCPR with Jenny Guidi, PsyD, PhD

  3. Oct 13 ·  Bonus

    Bonus Episode: Lessons from Early Adopters of XT in Schizophrenia with Ilan Melnick, MD

    In this bonus episode, host Ben Everett, PhD, reconnects with Ilan Melnick, MD, chief medical officer of Passageway, a South Florida forensic community control program, who also maintains a private concierge practice. Dr. Melnick chaired a JCP consensus panel of early adopters of xanomeline-trospium chloride (XT), and nearly two years after approval, he shares what clinicians have learned putting this first-in-class muscarinic agent into everyday practice. Unlike dopamine D2 blockers, XT activates M1 and M4 muscarinic receptors to lower presynaptic dopamine, while trospium limits peripheral cholinergic effects. The conversation covers EMERGENT trial findings on positive, negative, and general psychopathology symptoms; early use in first-episode psychosis; titration to maintenance doses; prophylactic ondansetron and empty-stomach dosing; distinguishing cholinergic from anticholinergic adverse events; class-specific cross-titration; and antipsychotic dose sparing. Dr. Melnick also reviews two new Psych Congress posters: a real-world prescriber survey and a post hoc analysis of EMERGENT-5 examining GI side effects and treatment retention. 🎯 KEY EPISODE HIGHLIGHTS: 💊 ONDANSETRON BEFORE NAUSEA STARTS [31:00] “One of the things we know about ondansetron is that it's a better preventer than it is a fixer.” Prophylactic ondansetron at initiation is a simple step that can prevent early GI-related discontinuation. ⚖️ CHOLINERGIC OR ANTICHOLINERGIC? [36:00] “If they're cholinergic in nature, go up to the one twenty-five. But if they're anticholinergic in nature then we have to see what other medicines are causing that extra anticholinergic effect.” Identifying the type of adverse event determines whether to titrate up or review concomitant medications such as OTC sleep aids. 📈 STALLING AT 100 MG AND DROPOUT [49:41] “So those that stay there and don't move up to the 125 milligram dose ended up usually dropping out due to higher GI issues.” A post hoc EMERGENT-5 analysis suggests that titrating to the higher dose may support retention rather than threaten it. CHAPTERS: 00:00 – Introduction: Revisiting the XT Consensus Panel 02:04 – Forensic Community Care and a Concierge Practice 05:26 – From Postsynaptic Blockade to Presynaptic Modulation 08:34 – M1/M4 Agonism and the Role of Trospium Chloride 13:03 – EMERGENT Trial Results and Early Cognitive Benefits 18:17 – Inside the Panel: Early Adopters and Experiential Evidence 22:35 – Early Use in First-Episode Psychosis and Dose Titration 28:28 – Patient Selection and Prophylactic Ondansetron 31:47 – Empty-Stomach Dosing and Cholinergic vs Anticholinergic Effects 37:15 – Cross-Titrating From Dones, Pines, and Partial Agonists 40:33 – Antipsychotic Dose Sparing, the ARISE Trial, and LAIs 44:17 – Psych Congress Poster: Real-World Prescriber Survey 49:07 – EMERGENT-5 Retention Data and the Future of Muscarinics LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep25-lessons-early-adopters-xt-schizophrenia-ilan-melnick/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. Real-World Implementation of Xanomeline-Trospium in Schizophrenia: A Consensus Panel Report https://www.psychiatrist.com/jcp/real-world-implementation-xanomeline-trospium-schizophrenia-consensus-report/ The JCP consensus panel report chaired by Dr. Melnick and discussed throughout this episode. Dr. Ilan Melnick - LinkedIn https://www.linkedin.com/in/ilan-melnick-516b4468/ #Schizophrenia #XanomelineTrospium #MuscarinicAgonist #FirstEpisodePsychosis #Psychopharmacology

    Bonus Episode: Lessons from Early Adopters of XT in Schizophrenia with Ilan Melnick, MD

  4. Oct 6

    A Trauma Expert's View on Psychedelic Medicine with Steven Berkowitz, MD

    In this episode of the JCP Podcast, host Dr. Ben Everett speaks with Dr. Steven Berkowitz, Professor of Psychiatry at the University of Colorado School of Medicine and Director of the Stress, Trauma, and Adversity Research and Treatment (START) Center at CU Anschutz. Drawing on a career spanning the Yale Child Study Center, Penn, and CU, Dr. Berkowitz discusses how childhood trauma shapes psychiatric illness across the lifespan and what that means for early intervention, assessment, and treatment. The conversation covers the neurobiology of early maltreatment, the development and outcomes of the CFTSI early intervention model, the debate over developmental trauma disorder and complex PTSD, and how trauma presents differently in autistic youth. Dr. Berkowitz also addresses treatment sequencing for comorbid substance use and ADHD, the central role of sleep in trauma care, sensory processing deficits in children in the child welfare system, and the scientific and ethical questions that would need to be answered before psychedelic research could be extended to children and adolescents with PTSD. 🎯 KEY EPISODE HIGHLIGHTS: 🌱 WE CAN'T TREAT OUR WAY OUT OF THIS CRISIS [07:00] “I really believe in prevention, and I think unfortunately, given our current set of circumstances, we're never gonna treat our way out of what is a mental health crisis in this country.” Dr. Berkowitz frames pediatric trauma work as prevention, noting that most adults in outpatient psychiatric care carry a history of childhood trauma. 😴 TRAUMA PSYCHIATRY IS SLEEP PSYCHIATRY [25:42] “Trauma psychiatry in many ways is about sleep psychiatry. The goal is to get people sleeping.” Targeting nightmares and nighttime intrusive symptoms first may make it possible for patients to engage meaningfully in trauma therapy. 🧠 PSYCHOTHERAPY IS ESSENTIAL IN YOUTH PSYCHEDELIC RESEARCH [35:32] “With kids, feeling is it's not even a question. We should absolutely be doing psychotherapy in these sessions as well as before and after.” Any future psychedelic trials in children and adolescents will require extensive family preparation and integrated psychotherapy, raising design questions the field has yet to answer. CHAPTERS: 00:00 – Introducing Dr. Steven Berkowitz 01:30 – Forensic Expert Work and Delayed-Onset PTSD 05:00 – Prevention and the Neurobiology of Childhood Trauma 11:00 – Developing the CFTSI Early Intervention Model 16:00 – Developmental Trauma, Complex PTSD, and the Limits of the DSM 19:30 – How Trauma Presents in Autistic Youth 23:30 – Sequencing Treatment for Substance Use, Comorbidities, and Sleep 26:30 – The START Center, Sensory Processing, and the “Trauma-Informed” Debate 32:00 – PTSD Pharmacotherapy and Psychedelic Research in Youth LINKS: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep24-trauma-expert-view-psychedelic-medicine-steven-berkowitz/ Journal of Clinical Psychiatry https://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode. Dr. Steven Berkowitz – LinkedIn https://www.linkedin.com/in/stevenberkowitz/ CU Anschutz START Center https://www.cuanschutz.edu/home Dr. Berkowitz's family-centered, lifespan trauma research and treatment center. Child and Family Traumatic Stress Intervention (CFTSI) https://www.nctsn.org/interventions/child-and-family-traumatic-stress-intervention Brief early intervention model for children and caregivers discussed in this episode. #ChildTrauma #PTSD #CFTSI #TraumaPsychiatry #PsychedelicResearch

    A Trauma Expert's View on Psychedelic Medicine with Steven Berkowitz, MD

  5. Sep 22

    Six Decades of Schizophrenia Care with Nina Schooler

    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

    Six Decades of Schizophrenia Care with Nina Schooler

  6. Sep 8

    The Regulatory Maze of Ketamine and Psychedelics with Benjamin Brody, MD

    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

    The Regulatory Maze of Ketamine and Psychedelics with Benjamin Brody, MD

  7. Aug 25

    From Screening to Treatment: Rethinking Suicide Risk with Elizabeth Ballard, PhD

    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

    From Screening to Treatment: Rethinking Suicide Risk with Elizabeth Ballard, PhD

  8. Aug 11

    Feeding the Mind: Metabolism in Psychiatry with David T. Liebers, MD, MPhil, MPP

    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

    Feeding the Mind: Metabolism in Psychiatry with David T. Liebers, MD, MPhil, MPP
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The Journal of Clinical Psychiatry Podcast explores the science, practice, and human side of mental health care. Hosted by Dr. Ben Everett, Senior Scientific Director at Physicians Postgraduate Press, the series brings together leading voices in psychiatry, neuroscience, and behavioral medicine to discuss the evidence shaping clinical care today. Each episode features thoughtful conversations with JCP authors, academic experts, and frontline clinicians exploring disorders across the mental health continuum, from schizophrenia and mood disorders to anxiety, depression, and sleep-related conditions. By bridging research and real-world practice, the podcast delivers insights that empower psychiatrists, nurse practitioners, physician associates, and primary care clinicians to deliver better care for patients with mental illness. Insightful. Evidence-based. Human-centered.

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