Category Archives: Treatment

Warning: Do Not Discontinue Antidepressants Without Consultation

Understandably, learning that the benefits of antidepressants are largely due to the placebo effect, some depressed patients may be tempted to stop taking their medication. With this in mind, I have asked the publishers to highlight the following warning in bold typeface. It is akin to the black-box warning about the increased risk of suicide… Read More »

Electroconvulsive Therapy

No chapter on biological treatments for psychiatric disorders would be complete without a discussion of electroconvulsive therapy (electroconvulsive therapy). Electroconvulsive therapy is an effective treatment for acute episodes of severe depression and may also provide prevention against its recurrence. Electroconvulsive therapy yields a quicker therapeutic response and may have fewer adverse effects than treatment with… Read More »

Narcotic Therapy for Patients with Chronic Non-Cancer Pain

The use of narcotics in the management of chronic non-cancer pain (CNCP) is an important but extremely controversial subject. In 1991, Hardy noted that “there is no place for opiates in the treatment of chronic benign pain”. A year later, an American Pain Society survey of its physician members indicated that opioids are probably underutilized… Read More »

Using Narcotics Appropriately

State and federal clinical practice guidelines do indicate that it is appropriate to ameliorate pain and that the use of pain medications to do so is not illegal. A set of so-called frequently asked questions (FAQ) was released by the Federal Drug Enforcement Agency (DEA) along with pain specialists from the University of Wisconsin, in… Read More »

Chronic Opioid Use in Patients with Chronic Non-Cancer Pain

Two interesting studies from Canada noted important facts, which would most likely be replicated if done in the United States. A report in 2001 by Moulin et al. found that 340 Canadian pain patients with an average pain intensity of 6.3 (on a 1-10 scale) were taking medication for pain. Eighty percent complained of moderate… Read More »

Tolerance and Opioid-induced Pain

Over time, continued opiate usage will induce “tolerance,” a known effect, to the opioid analgesic effect (see above). It has been felt that most commonly, dose escalation is secondary to increasing pain, as a result of increasing nociception from ongoing disease processes. However, studies and additional clinical activity indicate that tolerance to different opioid effects… Read More »

Mood Stabilizing Medications in the Treatment of Psychotic Disorders

Mood Stabilizing Medications in the Treatment of Psychotic Disorders of Children and Adolescents, Other Treatments, and Alternative Treatments For a variety of reasons, other medications are added frequently to the psychopharmacological treatment of chronic psychotic conditions in children and adolescents. Among these, mood stabilizers (valproate, lithium, lamotrigene, and others) play a significant role in the… Read More »


Lithium has a double-blind, placebo-controlled, prospective study. In this study lithium demonstrated therapeutic superiority over placebo in the treatment of bipolar disorders. First introduced into psychiatry by Cade in Australia in 1949, lithium received FDA approval for the treatment of mania in 1970, and for prophylaxis of bipolar disorder in 1974. Lithium has stood the… Read More »


There are no published double-blind, placebo-controlled studies of the use of valproic acid in children and adolescents for the treatment of bipolar disorders. Valproate was the first alternative mood stabilizer to be studied. First introduced as an antiepileptic in France in 1967, it was first introduced into the United States in 1978, and received approval… Read More »


There are no published double-blind, placebo-controlled studies on the use of carbamazepine in children and adolescents for the treatment of bipolar disorders. carbamazepine increases limbic gamma amino butyric acid (GABA) type B receptors, decrease GABA and dopamine turnover, inhibits inositol transport, and weakly inhibits calcium influx by a NMDA mediated effects in preclinical trials. Chronic… Read More »