The Journal of Clinical Psychiatry Podcast

The JCP Podcast
  • 5.0 (11)
  • 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. 2d ago

    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

  2. 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

  3. 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

  4. 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

  5. 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

  6. Jul 28

    Turning Stigma Into Stories of Hope with Aderonke Pederson, MD

    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

    Turning Stigma Into Stories of Hope with Aderonke Pederson, MD

  7. Jul 14

    Bipolar Disorder in Pregnancy and Postpartum, with Crystal T. Clark, MD, MSc

    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

    Bipolar Disorder in Pregnancy and Postpartum, with Crystal T. Clark, MD, MSc

  8. Jun 16

    The Art of Deprescribing: A Framework for Ending Medication

    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

    The Art of Deprescribing: A Framework for Ending Medication
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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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