Category Archives: Psychiatry

Onset of action of antidepressants

For twenty-five years I’ve accepted without question the standard teaching that SSRIs take 2 – 3 weeks to kick in and often longer. Then, due to a family situation, I actually went and looked it up, and discovered that the … Continue reading

Posted in Credits 2019, Medication, Psychiatry | Leave a comment

Management of an acutely disturbed person in the community

This BMJ article dealt with the management of someone presenting in an acutely disturbed/psychotic state: Above all, try to de-escalate the situation, and call for help quickly using, if possible, a silent messaging system. Be calm and sympathetic. Use non-threatening … Continue reading

Posted in Credits 2019, Psychiatry | Leave a comment

Mirtazapine + SSRIs

I’ve occasionally seen Mirtazapine used as an add-on to SSRIs in resistant depression. An RCT recently showed that adding Mirtazapine to an SSRI or SNRI in resistant depression works no better than adding placebo. That said, the definition of ‘resistant’ … Continue reading

Posted in Credits 2019, Medication, Psychiatry | Leave a comment

Dementia: NICE guidance update

I was pleased to see a summary of the new NICE guidance on dementia in the BMJ, since dementia accounts for a significant proportion of my work at the local care home. However, it turned out to be a mixture … Continue reading

Posted in Credits 2018, Dementia | Leave a comment

Management of psychotropic drugs during pregnancy

Good news – it seems that many of the problems initially thought to be related to taking antidepressants during pregnancy (cardiac problems, autism) are, in fact, probably due to risk factors related to the underlying illness. Since psychiatric illness is … Continue reading

Posted in Credits 2016, Medication, Medication in pregnancy, Pregnancy and Childbirth, Psychiatry | Leave a comment

Random prescribing points

Statins: Fluvastatin, simvastatin and atorvastatin are predominantly lipid-soluble, whereas pravastatin and rosuvastatin are predominantly water-soluble. Therefore, if a patient gets SEs on a lipid-soluble statin, it’s worth trying water-soluble.   Remember that the cut-offs for stopping are liver enzymes >3x … Continue reading

Posted in BMJ, Cardiovascular, Credits 2013, Gastroenterology, Medication, Prescriber, Psychiatry | Leave a comment

Assessment of pain in dementia

There are now scales for assessing pain in patients too demented to communicate. They rely on observation of behaviour over at least 5 minutes. PAINAD (Pain Assessment in Advanced Dementia) OPBAI (Observational Pain Behaviour Assessment Instrument) PADE (Pain Assessment in … Continue reading

Posted in Credits 2012, Elderly Medicine, Pain control, Psychiatry | Leave a comment


It may be worth starting metformin immediately on diagnosis of DM, without waiting to see whether dietary treatment works. One study found that starting metformin within three months of diagnosis was associated wtih a reduced rate of monotherapy failure a … Continue reading

Posted in Alternative medicine, BMJ, Cardiovascular, Credits 2012, Dementia, Diabetes, HRT, Migraine, Paediatrics | Leave a comment


I’ve been hitting the backlog of old journals over the holiday season (sad, I know), and I seem to have come up with an assortment of points that I want to remember but that don’t seem to be enough for … Continue reading

Posted in Anaemia, Credits 2012, Elderly Medicine, Haematology, Natural Remedies, Neurology, Psychiatry | Leave a comment

Antidepressants and sexual dysfunction

This comes from an article I found while clearing out: Kennedy SH & Rizvi S., Sexual Dysfunction, Depression, and the Impact of Antidepressants.  Journal of Clinical Psychopharmacology 2009; 29: 157 – 163.  Since we tend to think of N&V as … Continue reading

Posted in Medication, Psychiatry | Leave a comment