Probiotics, Depression, and the Role of Inflammation

Probiotics, Depression, and the Role of Inflammation

Researchers examined evidence suggesting that probiotics may exert antidepressant effects via anti-inflammatory mechanisms.

Analyzing differences in illness and outcomes for anxious depression

Analyzing differences in illness and outcomes for anxious depression

Ranging definitions of anxiety associated with depression have caused variations in findings.

Modest changes in level of exercise may prevent new cases of depression

Modest changes in level of exercise may prevent new cases of depression

Relatively modest changes in population levels of exercise may have important public mental health benefits and prevent a substantial number of new cases of depression.

Preventing suicide in US veterans

Preventing suicide in US veterans

Greater awareness and enhancing communication between patients and primary care providers can help lower the risk of suicide among US veterans.

Limited evidence available for augmentation therapy in treatment-resistant depression

Limited evidence available for augmentation therapy in treatment-resistant depression

Clinicians prescribing antidepressants may need to consider augmenting monotherapy with another agent.

Successful addiction recovery

Successful addiction recovery

Suboxone can curb drug addiction if it is used correctly.

Suboxone and methadone—our readers weigh in on the pros and cons

Suboxone and methadone—our readers weigh in on the pros and cons

Research has shown that use of suboxone and methadone, in conjunction with counseling, can be effective addiction treatment.

Healthcare issues of the LGBT community: What the primary care clinician should know

Healthcare issues of the LGBT community: What the primary care clinician should know

A greater understanding of the healthcare issues specific to the lesbian, gay, bisexual, and transgender community may improve the quality of care.

Suboxone: the methadone of the decade

Suboxone: the methadone of the decade

One clinician feels that suboxone is not the answer to the opioid crisis.

Clozapine use and neutropenia

Clozapine use and neutropenia

Low dose lithium can bring return absolute neutrophil count (ANC) to normal levels.

Passing on full-practice authority

Passing on full-practice authority

A reader weighs in on suboxone prescribing practices.

Diagnosing anxiety 
disorders in primary care

Diagnosing anxiety 
disorders in primary care

The challenge associated with assessing for anxiety disorders is that the clinical features of one disorder can closely resemble those of another.

Effective management of opioid addiction in pregnancy

Effective management of opioid addiction in pregnancy

Caring for a woman who is pregnant and dependent on opioids is an opportunity to make life-changing interventions for the sake of her health and the health of her unborn child.

Stat Consult: Opioid abuse 
or dependence

Stat Consult: Opioid abuse 
or dependence

Learn how to identify and treat opioid abuse, withdrawal, and dependence.

Sexual assault—Intervention in primary care

Sexual assault—Intervention in primary care

Recognizing red flag symptoms, such as anxiety, depression, and increased substance use, is important in helping victims who are reluctant to report the assault.

Electronic cigarettes—The primary care provider's response

Electronic cigarettes—The primary care provider's response

Although e-cigarettes may not be considered healthy, they may be the lesser of two evils when compared with traditional tobacco cigarettes.

Referral misses 
drug-seeking 
behavior

Referral misses 
drug-seeking 
behavior

A patient overdoses when communication breaks down between clinicians.

Major depressive disorder: a guide for primary-care clinicians

Major depressive disorder: a guide for primary-care clinicians

Ruling out a physiological reason for symptoms is a good starting point for NPs and PAs caring for patients with a new psychiatric disorder.

Consider alternatives to drug therapy for geriatric depression

Consider alternatives to drug therapy for geriatric depression


Geriatric patients who are not responding well to antidepressants may benefit from a combination of pharmacotherapy and psychotherapy.

Neuropsychiatric woes in Parkinson disease

Neuropsychiatric woes in Parkinson disease

Approximately two-thirds of patients with Parkinson disease and depression were not taking an antidepressant at any visit.

N-acetylcysteine supplements boost overall health

N-acetylcysteine supplements boost overall health

The WHO indicates NAC is essential for pulmonary and renal protection, antimicrobial uses, and psychiatry.

Keep an eye out for depression

Keep an eye out for depression

Females are more likely to have suicide attempts; males are more likely to have completed suicides.

Antidepressants and suicide risk

Antidepressants and suicide risk


Over the last two decades, the prescribing of tricyclic antidepressants (TCAs) has decreased due to their unfavorable side-effect profile.

Improving outcomes for infants with NAS

Improving outcomes for infants with NAS

Newborns who were exposed to certain substances in utero face unique challenges during their first months of life.

The safe use of opioids in the treatment of pain

The safe use of opioids in the treatment of pain

To minimize the risk of abuse and addiction, evidence-based prescribing practices must be used when treating acute and chronic pain with opioids.

An understanding of 
substance use disorder

An understanding of 
substance use disorder


Effective treatment requires the recognition of addiction as a brain disease and an understanding of its underlying physiology and pathophysiology.

A schizophrenic patient with poorly controlled diabetes

A schizophrenic patient with poorly controlled diabetes

Dietary supervision may have driven the patient out of his facility.

The challenges of identifying 
Prader-Willi syndrome

The challenges of identifying 
Prader-Willi syndrome

Children with this condition develop an insatiable appetite that leads to obesity, diabetes, hypertension, and behavioral problems when not treated.

Remembering side effects of antipsychotic medications

Remembering side effects of antipsychotic medications

An easy way to remember which antipsychotic medications cause weight loss and which cause weight gain.

Critics question DSM-5 methodology, transparency

Critics question DSM-5 methodology, transparency

Widespread over-diagnosis of certain conditions with new criteria among top concerns.

Understanding the 
changes in DSM-5

Understanding the 
changes in DSM-5

The latest revision of the diagnostic manual does away with the complex 
multiaxial organization in favor of a simpler chapter order of disorders.

Addressing decreased libido in smokers

Addressing decreased libido in smokers

What can be used to treat vaginal dryness and decreased libido in women who smoke?

Depression complicates wound treatment in a diabetes patient

Depression complicates wound treatment in a diabetes patient

An off-label treatment gives a patient in pain a second chance.

Self harm on the surgical ward

Self harm on the surgical ward

A nurse misses a doctor's written order not to remove a patient's hand restraints.

Be specific when screening teens

Be specific when screening teens

Teenagers often give vague answers when asked about sensitive topics like substance abuse or suicide.

Do antipsychotics increase the risk of pulmonary embolism?

Do antipsychotics increase the risk of pulmonary embolism?

Is there any evidence that psychiatric medications contribute to a greater risk of pulmonary emboli?

Diagnosing fatigue

Diagnosing fatigue


What is the most appropriate method for working up a diagnosis of fatigue?

Providing appropriate mental health care for low-income patients

Providing appropriate mental health care for low-income patients

How do I do what is best for the patient if the patient cannot afford a higher level of treatment?

Treating a paranoiac for dementia

Treating a paranoiac for dementia

What is the recommended treatment for patients diagnosed with dementia who are suffering with paranoia and/or hallucinations?

Case Report: High-Dose Methylphenidate for Adult ADHD

Case Report: High-Dose Methylphenidate for Adult ADHD

Long-acting ADHD medications improve adherence and demonstrate efficacy similar to that of immediate-release dose formulations.

Postpartum depression in a primary-care setting

Postpartum depression in a primary-care setting

Experienced by up to one in five mothers, postpartum depression often goes untreated. Learn what risk factors to be alert for.

Treating psychiatric illness during pregnancy

Treating psychiatric illness during pregnancy

What considerations exist regarding the safety of using aripiprazole during pregnancy?

ADHD & antisocial personality disorder: Minimizing the risks

ADHD & antisocial personality disorder: Minimizing the risks

Around 20% of pediatric patients with ADHD will develop antisocial personality disorder in adulthood.

Sources of comfort for those with dementia

Sources of comfort for those with dementia

A clinician shares gender-specific advice for comforting patients with dementia in moments of confusion.

Show—don't tell—when it comes to weight loss

Show—don't tell—when it comes to weight loss

Conversations about weight loss can contribute tremendously to behavioral changes, but tangible examples may be even more effective.

Drug-testing a teenager without permission

Advice for dealing with parent requests to drug test their teen without the child's knowledge or consent.

Options for treating an anxious and depressed alcoholic

What is the best treatment option for a 50-year-old woman with major depression, alcoholism and general anxiety disorder.

Antioxidants in saffron fight depression, dementia and PMS

Antioxidants in saffron fight depression, dementia and PMS

Saffron contains more than 50% of the USDA's recommended daily allowance of vitamin C, iron and magnesium, and more than 30 % of the recommended daily phosphorus and potassium.

Choosing an SSRI

What are the differences in side effects and responses to the available SSRIs?

Implementing new pain-management terminology

The term "contract" when used in regard to agreements with patients who have chronic pain is dated, perceived negatively and not preferred.

Hypnosis for pain management, anxiety and behavioral disorders

Hypnosis for pain management, anxiety and behavioral disorders

Medical hypnotherapy today is most commonly used for pain management, treatment of anxiety or psychosomatic illness, and treatment of behavioral disorders.

Counseling parents with colicky babies

Counseling parents with colicky babies

Colic can agonize parents and upheave family life. Two pediatric health-care providers offer tips for how best to treat colicky babies and their caregivers.

Alleviating treatment-resistant depression

Alleviating treatment-resistant depression

Anywhere from 10% to 30% of individuals taking a single antidepressant face obstacles to successful treatment, including undiagnosed illness.

Depression treatment in an overweight recent ex-smoker

Which antidepressant would you recommend for a woman aged 47 years who presents with depressed mood, low energy, decreased motivation and hypersomnia?

Confirming suspicions of hepatic encephalopathy

A patient is suspected of having hepatic encephalopathy (HE) attributable to liver failure from alcoholism.

Screening for functional deficits in older adults

Screening for functional deficits in older adults

Assessment of functional impairments in an aging population is one of the most daunting challenges facing primary-care clinicians.

Moving beyond "Just say no"

Moving beyond "Just say no"

Discourage teenagers from engaging in risky behaviors such as drug, tobacco and alcohol use in a meaningful way.

Antibiotics have no effect on oral contraceptives

While it is true that lower serum ethinyl estradiol and progestin levels have been found in women using combination OCs and antibiotics, these women remain well within the therapeutic window.

Serotonin syndrome in depressed patients with migraine

How concerned should clinicians be about serotonin syndrome when prescribing a triptan with a selective serotonin reuptake inhibitor (SSRI)?

New strategies against obesity comorbidities

New strategies against obesity comorbidities

Obese adults are at risk for many serious health conditions, including diabetes, coronary heart disease, hypertension, stroke, obstructive sleep apnea (OSA), depression and liver disease.

The effects of two boat trips linger even after coming ashore

The effects of two boat trips linger even after coming ashore

After vacationing on a houseboat, a woman could not stop feeling like she was rocking, especially when walking.

Advice for managing insomnia in patients with dementia

Experts are not certain why reversed sleep-wake cycles occur in patients with dementia, but it may be related to late-day confusion, end-of-day exhaustion and reduced lighting, among other factors.

Taking back control: the fight against obesity

Taking back control: the fight against obesity

As obesity rates continue to rise, primary-care clinicians remain integral in assessing, diagnosing, and treating this worldwide epidemic.

Salvia: A treatment option for depression and mental illness?

Salvia: A treatment option for depression and mental illness?

Despite salvia's growing notoriety as a hallucinogenic drug abused by teenagers, the herb has medicinal properties and has been used to treat various ailments including diarrhea, headache, rheumatism and mental illnesses.

Therapy for major depressive disorder

Therapy for major depressive disorder

Depression can be dealt with in the clinical setting if the practitioner is familiar with the latest drug treatments and psychotherapeutic options.

Advice for switching selective serotonin reuptake inhibitors

When switching selective serotonin reuptake inhibitors (SSRIs), what is the best way to wean off of one before starting a new prescription?

Treatment guidelines for Alzheimer-type dementia

Treatment guidelines for Alzheimer-type dementia

The most common dementia in the elderly, Alzheimer disease places tremendous physical and emotional strain on patient and caregiver alike.

Shortness of breath and chest pain worsened by fruits and vegetables

Shortness of breath and chest pain worsened by fruits and vegetables

What first appeared to be infectious esophagitis ended up being a lifelong diagnosis for a young woman.

Is a patient in pain or seeking drugs?

How should a clinician treat a patient with recurring migraines, that also has a history of drug seeking behavior?

Can acetylcholinesterase inhibitors help students cram?

The acetylcholinesterase inhibitors have produced excellent results in patients with Alzheimer's disease or dementia, but are they also beneficial for students preparing for exams?

Postpartum depression risk

Postpartum depression occurs in 8%-20% of all new mothers. If a woman with no history of depression develops postpartum depression, is there a greater likelihood of developing recurrent mood disorders later?

Silence surrounding a difficult birth adds insult to injury

Silence surrounding a difficult birth adds insult to injury

Respiratory problems lead to neurologic damage for the child and financial ruin for the family.

Crisis management of a personality disorder

Crisis management of a personality disorder

Resolving the immediate problem is the primary concern when treating an individual with borderline personality disorder in the midst of a crisis.

Psychostimulants effective for ADHD

Psychostimulants effective for ADHD

Primary-care based psychopharmacologic and psychosocial interventions can be used to manage this common childhood disorder.

Flipping the covers off female sexual dysfunction

Women are increasingly asking health care providers for help with their sex life.

Methamphetamine withdrawal symptoms

How long do symptoms of methamphetamine withdrawal typically last?

A delusional patient looks for help

A delusional patient looks for help

Are family practitioners to blame when a clinically depressed patient succeeds in ending his life?

Are vaginas troublesome for girls with body image issues?

Women's health care providers should encourage self-awareness, appreciation and acceptance among adolescent patients.

Alzheimer's disease affects clinicians as well

Caregivers often experience burnout and compassion fatigue.

Examining victims of sexual abuse

Given the high incidence of sexual abuse, what is the best way to perform a physical examination without inducing anxiety?

Medical supply shortage in Haiti leads to creative care

Medical supply shortage in Haiti leads to creative care

Physician assistant solves patient's problem with nontraditional treatment.

Nurse helps prevent schizophrenic patient's suicide

Psychiatric ward crafts wedding gifts in occupational therapy.

Treatment successfully clears Darier's Disease

A fourteen-year-old girl that presents with thick scaling skin becomes less introverted after skin condition improves.

Cognitive behavioral therapy may improve adult ADHD symptoms

Medications are often used for treatment of adults with attention-deficit hyperactivity disorder (ADHD), but many patients remain symptomatic despite treatment with stimulants or other drugs.

Was a patient using methamphetamine to self medicate?

Depression, drug addiction subsides after receiving thyroid treatment.

Dietary changes transform a depressed teen

Dietary changes transform a depressed teen

Hopeless parents seek a nurse's help after years of treatment failure.

Akathisia and visual hallucintions in an elderly woman

Akathisia and visual hallucintions in an elderly woman

First diagnosed with Alzheimer's and Parkinson's, the patient could not tolerate antipsychotic meds.

Patient overcomes homelessness, obesity and mental health issues

Patient overcomes homelessness, obesity and mental health issues

Guidance and support from a nurse practitioner made all the difference for a hard-working, humble man.

Psychotropic drugs in children and teens

Psychotropic drugs in children and teens

Most children with psychiatric disorders do not receive appropriate evaluation and treatment. A practice parameter offers guidance.

Transcranial magnetic stimulation an alternative to antidepressants?

Major depression is commonly treated with a combination of antidepressants and psychotherapy, but many patients experience little or no improvement with treatment.

Lipid panel frequency in children and adolescents

Do I need to obtain baseline labs before starting an antipsychotic?

The right thing takes a wrong turn

The right thing takes a wrong turn

Should the clinician have kept silent when asked about the treatment a patient was receiving?

An antipsychotic's side effects derail a patient's symptom management

An antipsychotic's side effects derail a patient's symptom management

After five years of treatment without side effects, his glucose level took off.

New data guide update on panic disorder

New data guide update on panic disorder

This disabling condition interferes with daily functioning and can cause significant distress. Pharmacotherapy is not the only treatment option.

Strategies for patients suffering insomnia

Strategies for patients suffering insomnia

Evaluation and management of chronic insomnia, the most prevalent sleep disorder, may require behavioral as well as pharmacologic therapies.

When SSRIs are not enough for depression

Consider buspirone or mirtazapine as an additive agent.

Nonpharmacologic approach to depression

Exercise and psychotherapy are effective in preventing relapse and recurrence of depression.

Diagnosing bipolar disorder in an alcoholic

What can be done for a mood disorder secondary to alcohol abuse when the patient has failed all treatments?

Links between obesity and mental health

Links between obesity and mental health

When treating obesity, psychological issues must not be overlooked. Learning why patients eat can help clinicians improve what patients eat.

Adult depression: Treating by subtype for success

Adult depression: Treating by subtype for success

Instead of attempting to treat the broad categories, primary-care clinicians should focus on symptoms or features that identify a specific subtype.

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