||PsychopharmaStahlogy Show: Treatment-Resistant Depression and Suicide Prevention
The PsychopharmaStahlogy Show is a special podcast series released on the NEI Podcast. In the second three part series, Dr. Andrew Cutler asks Drs. Stephen Stahl, Roger McIntyre, and Christine Moutier important questions relating to treatment-resistant depression and suicide prevention.
Episodes released under this theme include:
||Part I - Episode 104
Hot Off the Press Ketamine Guidelines with Dr. Roger McIntyre
What do clinicians need to know about the pharmacokinetics of ketamine, especially when it comes to drug-drug interactions? What is the abuse potential for ketamine and for esketamine? What are some ways that clinicians can mitigate the risk of abuse? At this time, what is the consensus, in comparing the efficacy of ketamine and esketamine for treatment resistant depression? In this episode, Dr. Andrew Cutler interviews Dr. Roger McIntyre and Dr. Stephen Stahl on their recent publication in the American Journal of Psychiatry.
||Part II - Episode 107
Mental Health Consequences and Suicide Prevention During the COVID-19 Pandemic
What unique risk factors surround the COVID-19 pandemic and potential heightened risk of suicide? What populations have been most vulnerable to mental health consequences, substance use disorders, suicidal ideation, and self-harm during the pandemic and why? In this episode, Dr. Andrew Cutler interviews Dr. Roger McIntyre and Dr. Stephen Stahl on the suicide risk and prevalence during this challenging time.
||Part III - Episode 110
An Update on Suicide Prevention and The Suicide Prevention Handbook with Dr. Christine Moutier
What do we know about the world suicide rate and the national suicide rate? What are the differences and how might they be explained? How does the role of medications help or hinder suicide prevention? In this episode, Dr. Andrew Cutler interviews Dr. Christine Moutier and Dr. Stephen Stahl on their Suicide Prevention Handbook, where they address timely questions like these and so much more.
Transcript from Part III - Episode 110
DR CUTLER: Tell me a little more about what are some of the evidence based interventions for suicide?
DR MOUTIER: Sure, one of the most powerful ones that we've actually known about for sometime is the aggressive identification of suicide risk. The aggressive identification of depression and other mental health conditions, it's not just only about depression. Depression, of course, is the most common and probably one of the more potent among psychiatric conditions. So for example, when you trained primary care doctors how to do that, identify suicide risk, identify depression, and give them some tools to manage it in a chronic illness management sort of manner. Just like they know how to do for hypertension or diabetes, you actually it can show that they drive down that populations risk of suicide. That has been demonstrated now in several countries, including in the U.S., it’s very powerful stuff. It's actually how the zero suicide movement got going here in the United States.
DR STAHL: One of the questions I have is how are we going to get clinicians, who are the majority listening to this, to pivot from treating individuals to treating populations. Because I treat one patient at a time here, so I don't treat in public health model. I individualized treatments down to the single person. So, I need to prevent or predict, god forbid suicide, in this patient now. Not the fact that I am treating patients in a population in my practice or over career that if I apply these principles generally will have good effects, but not necessarily to the specific patient at this specific time. It’s a whole way of practicing medicine.
DR MOUTIER: It's true, it's true. I don't want to be discouraging of clinicians because we all do have an incredibly important role to play because guess where people are sent when their suicide risk is detected, whether it's in their school or their workplace or their family. They come to us, and actually they come to primary care even more than they come to us. They also come to emergency departments. If we learn how to do a systematic suicide risk assessment and not let our anxiety get the best of us, but dive right in. Be compassionate, caring, lead them through a safety planning exercise that you come back and you revisit overtime. You pay attention to lethal means in their home environment. You get the family involved, when you can, when it's possible. That is life saving for those patients. That has been demonstrated at the clinical intervention level. And by the way, there are also treatments that were newly designed with suicide risk reduction in mind. So we can talk about those later as well, because those are more specialty referrals. But Steve, I think what you're talking about is a system wide approach that if you're a clinician that also happens to be a health system leader in any shape or form you do have a role to play in this public health model, because what you can do is set up your health system in the way that I mentioned. Zero Suicide framework is one example, but doesn't have to be that particular flavor or brand. But there are ways for the system to understand that suicide is it preventable clinical target to go after. Just like they have other clinical targets in the system. You set it up in the exact same way. It becomes part of the electronic health record there's a dashboard, you do training and education, just wrong side surgery or hand washing, All of those initiatives through that safety and quality framework. Suicide prevention can be approached the same way in health systems.
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