Diet Drug Interactions: Achieving and Maintaining Ketosis As Adjunct to Psychotropic Polypharmacotherapy
As interest grows in the therapeutic potential of ketogenic diets for bipolar disorder, careful attention must be given to drug-diet interactions. Overlapping mechanisms between therapeutic ketosis and mood-stabilizing agents may offer opportunities for synergistic effects, but may also introduce risks related to altered pharmacokinetics, pharmacodynamics, and additive toxicities. In this podcast, Dina N. Ali, MD, and Jonathan Leung, PharmD, discuss the complex picture of trying to optimize treatment outcomes while many research questions are yet to be answered. Ali and Leung are authors of the commentary, "Diet Drug Interactions: Achieving and Maintaining Ketosis As Adjunct to Psychotropic Polypharmacotherapy," which is published in the November-December 2025 issue of the Journal of Clinical Psychopharmacology. The other contributing authors are Mark A. Frye, MD; Iain H. Campbell, PhD; Matej Markota, MD; Mikaela M. Hofer, PharmD, and Heather Standorf, PharmD. doi: 10.1097/JCP.0000000000002074
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Anticholinergic Equivalence in Psychotropic Medications: A Guide for Psychiatrists
In this podcast, Nicolas Badre, MD, and Eric Geier, MD, PhD, discuss their article, "Anticholinergic Equivalence in Psychotropic Medications: A Guide for Psychiatrists," which is published in the November-December 2025 issue of the Journal of Clinical Psychopharmacology. Anticholinergic side effects from psychotropic medications are common and can lead to significant adverse events, including cognitive impairment and falls, particularly in vulnerable populations like the elderly. The cumulative anticholinergic burden from multiple medications is a critical concern associated with poorer clinical outcomes. Quantifying this burden is essential for safer prescribing. For their article, they developed a table to provide a practical tool for psychiatrists to quantify and compare the anticholinergic potential of psychotropic medications. doi: 10.1097/JCP.0000000000002073
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Fact Versus Fear: Antidepressants in Children and Adolescents
A presidential executive order early this year directed federal departments and agencies to address the issue of chronic disease in the United States, including "the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors (SSRIs)," with a particular focus on youth. In this podcast, Dr. Jeffrey R. Strawn discusses his editorial, "Fact Versus Fear: Antidepressants in Children and Adolescents," which is published in the September-October 2025 issue of the Journal of Clinical Psychopharmacology. In the editorial, Dr. Strawn and his coauthor, Dr. John T. Walkup, write that the framing of the issue in the executive order risks reinforcing stigma and diminishing trust in evidence-based pediatric mental health care. The editorial summarizes the evidence supporting the efficacy, safety, and tolerability of SSRIs in youth and contextualizes these findings within a discussion of the risk of withholding potentially effective treatments due to stigma and misinformation. The editorial is published in the September-October 2025 issue of the Journal of Clinical Psychopharmacology. doi: 10.1097/JCP.0000000000002054
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How Does Positive Mental Health Affect Next-Step Treatment Outcomes in Treatment-Resistant Depression?
Many patients view the return of "positive mental health" (PMH) to be their most important goal of treatment for major depressive disorder (MDD). However, few studies have systematically measured PMH or prospectively examined the added value of considering PMH as a treatment predictor of outcomes. In this podcast, Dr. Somaia Mohamed discusses her article, "How Does Positive Mental Health Affect Next-Step Treatment Outcomes in Treatment-Resistant Depression? A VAST-D Report." Dr. Mohamed and her coauthors found that high PMH scores at baseline were associated with a greater chance of remission. The article is published in the September-October 2025 issue of the Journal of Clinical Psychopharmacology. In addition to Dr. Mohamed, the other authors are Sidney Zisook, Gary R. Johnson, and Beata Planeta. doi: 10.1097/JCP.0000000000002051
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Variability in Response to Antidepressants
Antidepressants are in widespread use, but there is considerable variability in how patients respond, with some seeing substantial improvement while others respond only partially or not at all. In this podcast, Dr. Antonio E. Nardi discusses the many factors that underlie response rates, including psychological factors, personality traits, and medication adherence. There are also some mood conditions such as demoralization that may seem to resemble depression but do not meet all the clinical criteria. Recognizing these different emotional states is crucial for both individuals and clinicians in the treatment of low mood disorders. Dr. Nardi, along with Drs. Richard I. Shader, Richard Balon, Anthony J. Rothschild, and Larissa Junkes, are the authors of an editorial titled, " 'I am depressed': The many meanings that may underlie variability in response to antidepressants." The editorial is published in the September-October 2025 issue of the Journal of Clinical Psychopharmacology. doi: 10.1097/JCP.0000000000002053
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