The Journal of Clinical Psychiatry Podcast

Dr. A. John Rush, renowned for leading the famous STAR*D depression study, addresses a critical challenge in modern psychiatry: while physicians often rely on their clinical intuition to treat complex depression, new data proves this approach has a significant blind spot. Experience alone can miss the full extent of a patient's suffering, leaving crucial progress untracked.
Dr. Rush reveals a system to fix this clinical blind spot using the psychology of clinical measurement. He explains how doctors can implement simple assessment tools to gather objective data, leading to more precise treatment adjustments. This straightforward method gives physicians the power to see what is truly working and can significantly boost patient remission rates.
🎯 BIGGEST LESSON [12:17]:
"By bringing measurement to the bedside, we bring precision and science. The evidence is very clear right now. We make better decisions about what to do with patients."
🎯 OTHER KEY TAKEAWAYS:
⚠️ THE HIDDEN GAP IN PSYCHIATRIC CARE [8:10]:
"We don't know anything about in what order, in what combination, and by what methodology we implement that 'what'."
Dr. Rush explains why knowing a treatment can work is only half the battle. This is the crucial gap between research and real-world results that most clinicians overlook.
✨ WHY 'PROVEN' TREATMENTS FAIL YOUR PATIENTS [20:45]:
"Does this apply to everybody with depression, no matter how they show up? Absolutely not. That's where it really gets very, very interesting because now we're going from efficacy research to effectiveness research."
Learn the critical difference between a treatment working in a controlled trial versus in your complex, real-world patient population.
⚡ THE LAW OF DIMINISHING RETURNS IN DEPRESSION [34:57]:
"The more steps you take, the problem is, the less likely you are to get into remission. So remission rates were like 35% in the first step, 28% in the second step, 15% in the third step, 15% in the fourth step."
Dr. Rush reveals the stark data from the STAR*D study. Use this critical insight to set realistic expectations with patients about the challenges of treatment-resistant depression.
CHAPTERS:
00:00 - Introducing Dr. A. John Rush
02:20 - Why Dr. Rush Chose Psychiatry & a Career in Clinical Research
05:45 - How Cognitive Therapy Shaped Evidence-Based Psychiatry
07:10 - Strategies, Tactics, and the Research Gap
10:59 - Using AI & Clinical Data to Guide Treatment Decisions
18:39 - Why Clinical Trial Results Don't Match Real-World Patients
22:54 - Pragmatic Trials That Reflect Everyday Psychiatric Practice
30:48 - The STAR*D Trial: Sequencing Treatments for Depression
36:32 - Dose Optimization & Long-Term Depression Recovery
39:56 - Building a Learning Healthcare System in Psychiatry
43:48 - Dr. Rush’s Advice for Researchers and Clinicians
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep12-bridging-research-reality-mental-health-care-a-john-rush
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
Dr. A. John Rush: https://www.linkedin.com/in/a-john-rush-8aa46042/
American Psychiatric Association (APA) Website: https://www.psychiatry.org/psychiatrists/research/registry
#Psychiatry #ClinicalResearch #Depression

Families expect cognitive decline as a normal part of getting older. We watch relatives lose their memories and accept the loss. Past medical trials regarding Alzheimer's disease failed 99 percent of the time, early signs of brain changes were missed, and precious years for early screening and treatment were lost.
But new science changes this reality. Doctors now use blood tests and brain imaging for accurate diagnosis. They prescribe immunotherapy treatments that clear toxic brain plaques and slow cognitive decline by 30 percent. Dr. Marc Agronin shares his exact methods for geriatric psychiatry and dementia care. Learn how early medical intervention stops memory loss as he reveals his new research.
🎯 PRIMARY DISCOVERY[19:51]:
"Someone goes from thinking, ‘I have a terminal disease,’ to ‘I have a manageable disease and I am going to continue to live and do things.’ Their whole mindset changes."
Dr. Agronin reveals the exact medical advancements that give patients their lives back.
🩺 PRACTICE UPGRADE [30:56]:
"We have all sorts of vital signs we check by routine. We need to have a cognitive vital sign that we check, and something like a Mini-Mental, Montreal Cognitive Assessment, something like that is practical to be done in primary care."
Discover how doctors catch memory loss early with simple annual tests.
✨ MEDICAL MILESTONE [46:29]:
"We see over the 18 months of the studies that the rate of decline in terms of both cognition and function is on average about 30 percent slower. And then we know that after 18 months, it is a very slow rate of reaccumulation."
Hear how new monoclonal antibodies melt away brain plaques and stop memory loss.
CHAPTERS:
00:00 - Meet Alzheimer’s Research Leader Dr. Marc Agronin
01:45 - Why a Career in Geriatric Psychiatry and Dementia Care?
06:17 - Why Alzheimer’s Research Is Entering a Breakthrough Era
08:07 - Why Alzheimer’s Disease Is Rising Worldwide
11:04 - How to Explain Alzheimer’s Diagnosis to Patients and Families
16:11 - The Biggest Scientific Breakthroughs in Alzheimer’s Disease
24:30 - How New Biomarker Guidelines Are Changing Alzheimer’s Diagnosis
29:57 - Why Early Screening for Cognitive Decline Matters
36:13 - Brain Health Habits That May Reduce Alzheimer’s Risk
42:50 - Current Alzheimer’s Medications and How They Help Cognition
45:45 - New Anti-Amyloid Treatments That Slow Alzheimer’s Progression
50:01 - Understanding ARIA Side Effects in Alzheimer’s Immunotherapy
54:09 - Emerging Alzheimer’s Treatments and Future Research Directions
01:02:09 - The Role of Empathy and Person-Centered Dementia Care
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep11-what-clinicians-should-know-about-alzheimers-treatment-marc-agronin/
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
Dr. Marc Agronin: https://www.marcagronin.com/
Figure referenced at 53:35 comes from Figure 1 in the paper “Alzheimer’s Disease Drug Development Pipeline: 2025.”: https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/trc2.70098
#AlzheimersResearch #BrainHealth #GeriatricPsychiatry

Psychiatric hospitals admit patients for severe mental illness and high suicide risk every day. While mental health professionals treat acute suicidality during these intense crises, standard depression medications can take weeks to work. Traditional clinical psychiatry often leaves vulnerable patients in danger after hospital discharge. Medical teams need rapid suicide prevention treatments to help stabilize psychiatric inpatients quickly.
Learn about potential improvements to inpatient suicide care as Dr. Brett Jones, Medical Head of the Bipolar Disorder Clinic at Toronto’s Center for Addiction and Mental Health, reveals the results of his research review into the best evidence-based medical interventions.
🎯 KEY EPISODE HIGHLIGHTS:
🛑 RESEARCH BLINDSPOT [10:25]:
"I think there are a lot of studies out there. I was reading, I was seeing the evidence, but the consensus as to what would be the most effective treatment and for whom really wasn't there."
Hear Dr. Jones explain the massive missing piece in psychiatric care.
🧠 CLINICAL BREAKTHROUGH [23:45]:
"Some of the chronotherapy was something I actually didn't know about. That certainly is a low cost intervention. So that's quite promising if it turns out to be effective."
See how simple sleep treatments change inpatient psychiatry.
🛠️ STRATEGIC ACTION [34:50]:
"We showed a good effect with a digital version of DBT… So we're going to look at trying to replicate that in a multicenter study."
Get the exact details on digital therapy for hospital units.
CHAPTERS:
00:00 - Honoring Dr. Nolan Williams
03:07 - Career Path into Psychiatry and Suicide Research
07:59 - Why Inpatient Suicide Treatment Needs Better Evidence
12:59 - Key Limitations in Suicide Intervention Research
14:57 - Ketamine and Rapid Acting Treatments for Suicidality
19:48 - Emerging Treatments Beyond Traditional Depression Care
25:47 - Translating Research into Real World Inpatient Practice
30:38 - Major Research Gaps and Need for Better Clinical Trials
33:04 - Hospitalization as a Critical Window to Prevent Suicide
37:41 - Up Next: Dr. Marc Agronin
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep10-inpatient-treatment-suicidality-brett-jones/
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
Inpatient Treatment of Suicidality: A Systematic Review of Clinical Trials:
https://pubmed.ncbi.nlm.nih.gov/39832343/
Dr. Brett Jones: https://www.linkedin.com/in/brett-jones-1b308260/?originalSubdomain=ca
Center for Addiction and Mental Health: https://www.camh.ca
University of Toronto Psychiatry: https://psychiatry.utoronto.ca
#AcuteSuicidality #InpatientPsychiatry #ClinicalResearch

Feeling tired despite a full night's sleep? The problem may not be the hours you get, but the quality of your breathing. According to sleep medicine expert and founding physician of SLIIIP, Dr. Avinesh Bhar, many people dismiss fatigue, snoring, or frequent waking, using caffeine and over-the-counter aids to cope.
This masks a deeper problem. Undiagnosed sleep-disordered breathing, like sleep apnea, is a silent driver of serious health issues, from heart disease to mental health conditions. Ignoring the root cause makes other medical treatments less effective, creating a cycle of declining health. 90% of people with mental health conditions also struggle with sleep issues. Getting help is easy at SLIIIP.com. No travel required. Insurance accepted.
🎯 KEY EPISODE TAKEAWAYS:
⚠️ THE SURVIVAL MODE TRAP [08:49]:
"If you don't sleep well, your whole day changes in perspective. You are in survival mode, and you can't be your best self. You can't perform."
Are you just surviving instead of thriving? Watch this segment to understand the biological cost of poor sleep and why feeling "just okay" is a major red flag for your health.
✨ THE MENTAL HEALTH BREAKTHROUGH [29:24]:
"If you're a therapist or psychiatrist managing mental health, you should also make sure the sleep is evaluated…otherwise, your improvements in mental health aren't going to reach the level that actually makes the patient feel like they've actually turned the corner.”
Unlock better patient outcomes. See how integrating a sleep evaluation can be the missing piece in treating depression, anxiety, and PTSD effectively.
⚡️ THE 2-QUESTION DIAGNOSTIC [59:40]:
"'Are you sleeping well? Are you waking up refreshed?' If you have a 'no' to either one of those questions, the patient needs an evaluation."
This is the simple, powerful framework you need. Listen to this section to learn the exact questions that tell you if it's time to refer a patient (or yourself) to a sleep specialist and how easy it is via www.sliiip.com. SLIIIP is making advanced sleep care fast & convenient, offering patients same week appointments with board-certified sleep medicine physicians instead of the months‑long wait typical of traditional sleep labs.
CHAPTERS:
00:00 - Introducing Dr. Avi Bhar
03:48 - From ICU to Sleep Medicine and What Clinicians Miss
06:52 - What Sleep Does Biologically and Why Quality Beats Hours
13:23 - Sleep Myths That Keep You Sick and Tired
16:24 - Sleep Hygiene That Works
19:54 - When to Suspect a Real Sleep Disorder Beyond Stress
23:00 - How Sleep Apnea Drives Heart, Metabolic, and Inflammatory Disease
27:51 - Sleep and Psychiatry
30:35 - Solving Access With Home Sleep Tests and Step-Based Care
39:33 - The Ideal Telemedicine Sleep Care Pathway
48:28 - Stop Masking Sleep Problems With OTC Aids and Melatonin
52:33 - When to Retest and How Treatment Lowers Long-Term Healthcare Costs
1:01:03 - Up Next: Dr. Brett Jones
Key Takeaways:
"Sleep is a reparative opportunity. It heals and repairs the trauma of the day. It's essential, not optional."
"Quality and quantity of sleep matter. Sleeping 7-8 hours is good, but waking refreshed is key."
"Sleep disturbances don't just coexist with illnesses; they can drive medical and psychiatric morbidity."
"Evaluate sleep in patients with mental health issues. It's both a driver and symptom of psychiatric illness."
"Speed and efficiency in sleep evaluation are crucial. It reflects the urgency and importance of the issue."
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep9-sleep-issues-psychiatric-practice-avinesh-bhar/
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
SLIIIP: https://sliiip.com/
#SleepApnea #MentalHealth #SleepDisorders

Ben welcomes psychiatrist Dr. Mike Halassa back to the podcast to discuss the shifting landscape of inpatient schizophrenia treatment. An early adopter of Cobenfy, Dr. Halassa shares real-world insights from his research published in Nature Mental Health in this conversation that bridges technical neuroscience with the high-stakes reality of managing acute psychiatric crises.
The discussion focuses on Cobenfy’s muscarinic mechanism, the first novel approach to psychosis in seventy years. Dr. Halassa details his "dose-sparing" strategy, reducing reliance on traditional D2 blockers and their metabolic burdens, and he shares case studies of treatment-resistant patients who succeeded on this agent after clozapine failed. Finally, Ben and Dr. Halassa explore functional recovery, precision psychiatry, and the empathic connection required to treat society's most vulnerable individuals.
Episode Highlights:
00:00 - Welcoming Back Dr. Mike Halassa
01:46 - ‘Spending a Day in Someone Else’s Brain’
04:21 - Empathy, Parenting, and Staying Grounded in Psychiatry
06:37 - Why Inpatient Psychiatry Works: Acuity, Speed, and Team-Based Care
09:31 - Evaluating Acute Psychosis: Intake, Chronicity, and Treatment Decisions
12:46 - Discovering XT as the First Novel Schizophrenia Mechanism in Decades
16:19 - A Remarkable XT Case Study
23:26 - XT Dosing Tolerability and Early Clinical Results
30:15 - From Observation to Evidence: Identifying XT Response Patterns
35:12 - Testing Negative Symptoms in Real Time on the Inpatient Unit
40:33 - XT vs D2 Blockers for Positive and Negative Symptom Control
50:28 - Redefining Success in Schizophrenia Through Functional Recovery
54:15 - The Future of Precision Psychiatry and Treating the Whole Person
56:42 - Up Next: Dr. Avi Bhar
Key Takeaways:
"Inpatient psychiatry demands quick thinking and rapid decisions. It's a critical care type environment."
"I find my kids keep me grounded and empathetic. They're my window into empathy."
"XT offers a fundamentally different way of engaging the system. It's not just another antipsychotic."
"Seeing patients become more socially connected on XT is remarkable. It's a new light in their eyes."
"Negative symptoms have been intractable. XT offers hope for functional recovery."
"The multidisciplinary team is crucial in schizophrenia care. It requires coordination and dedication."
"XT allows for dose sparing of traditional antipsychotics, potentially reducing side effects."
"We must aspire to help patients engage with life fully, beyond just managing symptoms."
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep8-early-use-xanomeline-trospium-michael-halassa/
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
Dr. Halassa’s Substack: michaelhalassa.substack.com
The Halassa Lab: https://halassalab.tufts.edu/
Preliminary real-world predictors of response to muscarinic targeting in psychosis: https://www.nature.com/articles/s44220-025-00529-w
Real-World Implementation of Xanomeline-Trospium in Schizophrenia: A Consensus Panel Report: https://pubmed.ncbi.nlm.nih.gov/41201439/