100 episodes

From the editors of The Carlat Psychiatry Report, this weekly podcast brings clear, engaging, and practical updates on clinical psychiatry. Through expert interviews and authoritative reviews, we cover all things psychiatric with an independent eye. Episodes covering child and adolescent psychiatry are hosted by Joshua D. Feder, MD, and Mara Goverman, lICW. The Carlat Report has operated free of pharmaceutical support since its inception in 2003. Hosted by Chris Aiken, MD, and Kellie Newsome, PMHNP.

The Carlat Psychiatry Podcast The Carlat Psychiatry Report

    • Mental Health
    • 4.8, 78 Ratings

From the editors of The Carlat Psychiatry Report, this weekly podcast brings clear, engaging, and practical updates on clinical psychiatry. Through expert interviews and authoritative reviews, we cover all things psychiatric with an independent eye. Episodes covering child and adolescent psychiatry are hosted by Joshua D. Feder, MD, and Mara Goverman, lICW. The Carlat Report has operated free of pharmaceutical support since its inception in 2003. Hosted by Chris Aiken, MD, and Kellie Newsome, PMHNP.

    Unexpected Results on Lithium and the Kidneys

    Unexpected Results on Lithium and the Kidneys

    This week we’re podcasting from the International Society for Bipolar Disorders 2020 conference, where we’ve been scouring the virtual halls for all that is practical and newsworthy. The yield is high so tune in for a new episode every day. Today, a poster presentation from the Mayo Clinic challenges conventional wisdom about whether to stop lithium in the face of renal decline.
    Published On: 7/3/2020
    Duration: 5 minutes, 42 seconds
    Got feedback? Take the podcast survey (http://www.thecarlatreport.com/podcastsurvey).

    • 5 min
    Can therapy work on its own in bipolar II?

    Can therapy work on its own in bipolar II?

    This week we’re podcasting from the International Society for Bipolar Disorders 2020 conference, where we’ve been scouring the virtual halls for all that is practical and newsworthy. The yield is high so tune in for a new episode every day. Today, unpublished findings on the first solo psychotherapy study in bipolar II.
    Published On: 7/2/2019
    Duration: 4 minutes, 15 seconds
    Got feedback? Take the podcast survey. (http://www.thecarlatreport.com/podcastsurvey)

    • 4 min
    Celebrex for Bipolar Depression

    Celebrex for Bipolar Depression

    This week we’re podcasting from the International Society for Bipolar Disorders 2020 conference, where we’ve been scouring the virtual halls for all that is practical and newsworthy. The yield is high so tune in for a new episode every day. Today, new results on an anti-inflammatory medication in bipolar depression.
    Published On: 7/1/2020
    Duration: 3 minutes, 36 seconds
    Got feedback? Take our podcast survey (http://www.thecarlatreport.com/podcastsurvey).
     

    • 3 min
    A Diet for Bipolar Disorder

    A Diet for Bipolar Disorder

    The first clinical trial of a modified diet for bipolar disorder in this daily dispatch from the International Society for Bipolar Disorders 2020 conference.
    Published On: 6/30/2020
    Duration: 7 minutes, 50 seconds
    Got feedback? Take the podcast survey (http://www.thecarlatreport.com/podcastsurvey).

    • 7 min
    Will the Best Atypical Stand Up?

    Will the Best Atypical Stand Up?

    Daily dispatches from the International Bipolar Disorders Conference. There are four atypical antipsychotics that treat bipolar depression, but which have the best balance of efficacy and tolerability?
    Published On: 6/29/2020
    Duration: 5 minutes, 15 seconds
    Transcript:
    Will the Best Atypical Stand Up?
    This week we’re podcasting from the International Society for Bipolar Disorders 2020 conference, and there’s so much here that we’re trying out a new format. We’ll bring you a new episode each day. If you like the daily format, leave us a review in your podcast store and we’ll keep up the pace if we get enough shouts.
    Today, an unpublished paper from Leslie Citrome and colleagues on how the atypical antipsychotics measure up in bipolar depression.
    Welcome to the Carlat Psychiatry Podcast, keeping psychiatry honest since 2003. I’m Chris Aiken, the editor in chief of the Carlat Report. And I’m Kellie Newsome, a psychiatric NP and a dedicated reader of every issue.
    We have four atypicals that work in bipolar depression: cariprazine, lurasidone, olanzapine-fluoxetine combination (or OFC), and quetiapine. Among them, only OFC is supposed to be used with an antidepressant ─ that’s the only way they got olanzapine to work in the clinical trials ─ the other 3 work on their own.
    Now if you’re thinking that the other atypicals probably work because these four do, you’re betting on hope. Two of them ─ aripiprazole and ziprasidone ─ were tested in bipolar depression and failed. The others are untested. If we have to rest our hope on one, maybe it’s asenapine (Saphris). Asenapine has never been studied for acute bipolar depression but it does have good evidence to prevent depressive episodes in bipolar disorder, while the other atypicals ─ outside of the FDA-approved four ─ do not.
    So that’s what works, but how well do they work? Leslie Citrome and colleagues looked into that question with the Likelihood to be Helped or Harmed ratio – which tells us which med has the best ratio of efficacy and tolerability. It’s based on the more familiar Numbers Needed to Treat or Harm. Here’s what they found:
    Lurasidone (Latuda) rose to the top in nearly every category.
    The “categories” were based on the side effect. When we’re talking about efficacy, we’re talking about one thing: treating depression. But side effects are many, so they measured the Likelihood to be Helped or Harmed in several categories of side effects:
    Weight gain, EPS, fatigue, akathisia, nausea, and drop out due to any adverse effect.
    I should note the study was sponsored by Sunovion, the maker of lurasidone. But I have reviewed the data in other less biased sources and agree with the general consensus there. Lurasidone is one of the better tolerated antipsychotics, and with a number needed to treat of 5 it stands comfortably alongside OFC and quetiapene ─ those two are high on efficacy but lower on tolerability.
    OFC – olanzapine fluoxetine combination ─ was actually a close second to lurasidone in most category except weight gain. Quetiapine, on the other hand, sank to the bottom in most categories. Although Quetiapine ranks high for both short- and long-term efficacy in bipolar disorder mania and depression, it’s also the atypical that patients are most quit in the short term, and its side effects like fatigue and hypotension are the reason.
    What about cariprazine/Vraylar? It’s basically the less effective cousin of lurasidone.

    • 5 min
    The Stats on a Dayvigo: A New Hypnotic [60 Sec Psych]

    The Stats on a Dayvigo: A New Hypnotic [60 Sec Psych]

    Lemborexant/Dayvigo is the second in sleep med to join the orexin receptor antagonist family. It’s now on the pharmacy shelves, where it sits beside Suvorexant/Bellsomra, released in 2015. Landry I, Nakai K, Ferry J, et al. Pharmacokinetics, pharmacodynamics, and safety of the dual orexin receptor antagonist lemborexant: Findings from single-dose and multiple-ascending-dose phase 1 studies in healthy adults. Clin Pharmacol Drug Dev. 2020;10.1002/cpdd.817. [Link (https://pubmed.ncbi.nlm.nih.gov/32468649/)]
    Published Today: 6/27/20
    Duration: 1 minute, 49 seconds
    Transcript:
    Lemborexant/Dayvigo is the second in sleep med to join the orexin receptor antagonist family. It’s now on the pharmacy shelves, where it sits beside Suvorexant/Bellsomra, released in 2015. Today, we review its pharmacokinetics from a new industry-sponsored meta-analysis of 3 RCTs by Ishani Landry:
    Lemborexant reaches its peak in 1-3 hours. Tell patients to take it right before going to bed.
    Its half life is 17-19 hours, 30% of the drug is still in the bloodstream the next morning, but this didn’t seem to cause any next-day functional effects. Patients should allow at least 7 hours of sleep when they take lemborexant. One advantage of the orexin class is that they are better studied ─ and have better safety metrics ─ in the elderly than the z-hypnotics.
    Start lemborexant at 5 mg/night and titrated as needed to a max of 10 mg/night. Watch out for drug interactions with CYP3A inhibitors and inducers. Strong CYP3A inhibitors like nefazodone and HIV meds can increase it 4-fold, while moderate ones like the calcium channel blockers increase it about 1.5 fold.
    The analysis included a Japanese study, but race did not seem to effect lemborexant‘s pharmacokinetics
    Got Feedback? Take the podcast survey. (http://www.thecarlatreport.com/podcastsurvey)

    • 1 min

Customer Reviews

4.8 out of 5
78 Ratings

78 Ratings

Ajaib is All-Emporer ,

thank you!

Fantastic psychiatry podcast, useful for working clinicians. I really enjoy listening both to the NP and the MD: both have clear and pleasant speaking voices and the NP has a great Australian accent which adds interest. I am grateful for the back and forth between the two presenters, also keeps my mind from drifting. The clinical material is extremely useful, and is presented in a thoughtful and helpful way which makes it intelligible. The careful analysis of study quality is great!

Andymb2 ,

Fantastic

Fantastic psych podcast. Please keep up the daily episodes.
-psychiaty resident

robxblue ,

Great Podcast should be daily

Interesting to non-clinicians like myself. I like every episode and wish this was DAILY please. Whether you’re a clinician or patient you will find the information extremely helpful and thought provoking. Dr. Aiken has a wealth of insight to share as does his partner Kelly.

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