CLINICAL SITUATION: Your patient is not tolerating or is not responding adequately to an SSRI or SNRI and the dose and duration have been adequate. Symptoms of anxiety or depression persist in spite of optimized psychosocial interventions and therapy and you believe that further psychopharmacologic intervention is required. What to do? There are four strategies […]

How Should We Treat Grief and How to Distinguish it from Depression? 1/16/2020

Grief as a response to significant loss is normal. However, the mourning that occurs during periods of grief has features that overlap with depression and anxiety. This makes it occasionally confusing to distinguish one from the other and to know how to help patients heal appropriately. In previous DSM versions, mental health professionals were to […]

The Role of Antidepressants in Managing Chronic Pain 1/9/2020

This week’s article summarizes the potential benefits and the limitations of using antidepressant medications as co-analgesic agents along with other pain medication interventions from findings drawn from a recent article of Drs. Leo and Khalid from Current Psychiatry1.   They note the finding that pain syndromes are often associated with significant depressive symptomatology and they further […]

Melatonin 12/19/2019

Melatonin is being increasingly used on an over-the-counter basis by patients, both adult and pediatric, for sleep disturbance, both for difficulty initiating sleep and maintaining sleep. When suggested or prescribed, it is also advisable to incorporate guidance about sleep hygiene habits and to encourage patients to get ample exposure to bright sunlight and appropriate levels […]

Off-Label Prescribing of Psychotropic Medications in Pediatric Populations 12/5/19

The optimal approach in medicine is to aim for evidence-based treatments that provide reasonable assurance of efficacy and effectiveness along with meaningful evidence of limited potential for serious side effect risk.   With both adult populations but more especially with children and adolescents, there are clinical situations where use of medications that are not FDA approved […]

Issues of Anxiety in Primary Care Patients 11/21/2019

Anxiety is a normal and adaptive aspect of life for everyone. A little bit helps keep us safe, but excessive anxiety can be harmful. It can be a sign of a psychiatric disorder and/or it can be a trigger for (or a symptom of) an organic illness. Many medications can trigger anxiety symptoms. Understanding how […]

Adverse Childhood Experience Screening in the Primary Care Setting Part II: The Importance of Resilience 11/14/2019

In previous SmartCare Weekly editions, we reviewed the role resiliency-based interventions may play in a comprehensive pediatric Adverse Childhood Experiences (ACEs) screening campaign. According to Masten and Barnes, “Resilience is defined as the capacity of a system to adapt successfully to challenges that threaten the function, survival, or future development of the system.” (2018). Subsequently, […]

Adverse Childhood Experience Screening in the Primary Care Setting: The Importance of Resilience 11/7/19

Ever since Dr. Vincent Felitti led the 1998 study of adverse childhood experiences (ACEs), the impact of trauma on health outcomes has been more closely studied and more widely appreciated. Of course, in the realm of behavioral health, trauma has long been seen as a factor shaping more often than not a damaged sense of self and provoking deleterious symptoms. Yet, it was not until the lifelong […]

4 Traits That Put Kids at Risk for Addiction 10/31/2019

The looming question of “What can we do to curb the addiction crisis facing our youth?” has remained unanswered because there is no single way to reduce the drug and alcohol epidemic in our society. Traditional anti-drug education in schools that focuses on scare tactics and the message “Just Say No”, has been found to […]