The Carlat Psychiatry Report

07/29/2026

𝗬𝗼𝘂𝗿 𝗽𝗮𝘁𝗶𝗲𝗻𝘁 𝗶𝘀 𝗵𝗼𝗽𝗲𝗹𝗲𝘀𝘀, 𝗵𝗲𝗹𝗽𝗹𝗲𝘀𝘀, 𝗮𝗻𝗱 𝘀𝗮𝘆𝘀 𝗹𝗶𝗳𝗲 𝗳𝗲𝗲𝗹𝘀 𝗳𝘂𝘁𝗶𝗹𝗲. 𝗜𝘀 𝘁𝗵𝗮𝘁 𝗱𝗲𝗽𝗿𝗲𝘀𝘀𝗶𝗼𝗻 — 𝗼𝗿 𝗱𝗲𝗺𝗼𝗿𝗮𝗹𝗶𝘇𝗮𝘁𝗶𝗼𝗻?

Daniel Shalev, MD trained in consultation-liaison psychiatry and then did something unusual: a hospice and palliative medicine fellowship, where he was the only psychiatrist in his class. He calls it the most intensive year of psychiatric training he's had.

In our new Expert Q&A, he shares the clinical anchor he uses to tell these apart: "Someone who is demoralized can still laugh at something funny; someone who is anhedonic can't."

He also covers what to do when a patient doesn't have four to eight weeks to wait for an antidepressant to work, why deprescribing needs to start before the crisis, and one widely held assumption about dissolvable antipsychotics that turns out to be wrong.

Read the full interview 👇 https://www.thecarlatreport.com/articles/6352-the-role-of-psychiatry-in-palliative-care

Palliative care psychiatry often requires a shift in how we think about symptoms, medications, and time. Dr. Shalev discusses distinguishing demoralization from depression and grief, choosing treatments when patients may not have weeks to wait, deprescribing thoughtfully, and supporting patients and...

07/28/2026

Adult ADHD 1: The Child Grows Up
DSM-5 loosened the criteria for adult ADHD, but did it get too loose? We look at what recent prosecutions of telehealth companies mean for those on the front lines trying to diagnose this disorder.
https://www.thecarlatreport.com/blogs/2-the-carlat-psychiatry-podcast/post/6367-adult-adhd-1-the-child-grows-up

DSM-5 loosened the criteria for adult ADHD, but did it get too lose? We look at what recent prosecutions of telehealth companies mean for those trying to diagnose this disorder on the front-lines.

06/30/2026

New Podcast Episode!
14 Reasons Why Psychopharmacology Differs in Women, Part 2

Premenstrual hormones can destabilize mood, worsen ADHD, trigger psychosis, and drive binge eating. This episode walks through the tools to manage hormonal fluctuations in female patients, from SSRIs to overlooked supplements to the lamotrigine-contraceptive drug interaction.

https://www.thecarlatreport.com/blogs/2-the-carlat-psychiatry-podcast/post/6340-14-reasons-why-psychopharmacology-differs-in-women-part-2

Listen to Part 1 here:
https://www.thecarlatreport.com/blogs/2-the-carlat-psychiatry-podcast/post/6338-14-reasons-why-psychopharmacology-differs-in-women-part-1

06/26/2026

'𝐄𝐯𝐞𝐫𝐲𝐭𝐡𝐢𝐧𝐠 𝐘𝐨𝐮 𝐖𝐚𝐧𝐭𝐞𝐝 𝐓𝐨 𝐊𝐧𝐨𝐰 𝐀𝐛𝐨𝐮𝐭 𝐋𝐢𝐭𝐡𝐢𝐮𝐦 𝐁𝐮𝐭 𝐇𝐚𝐝𝐧'𝐭 𝐇𝐞𝐚𝐫𝐝 𝐎𝐧 𝐓𝐡𝐞 𝐏𝐨𝐝𝐜𝐚𝐬𝐭 𝐘𝐞𝐭
Dr. Chris Aiken and Kellie Newsome, PMHNP have covered lithium quite a bit on The Carlat Psychiatry Podcast. Are you up to date on this cornerstone of psychiatry? Here's a clearinghouse of lithium episodes to catch you up.

See the episodes here:
• Lithium Goes Mainstream
• Lithium: From 7UP to Table Salt
• TIMING: When Lithium Comes First
• For patients: Living Well with Lithium

More: https://www.thecarlatreport.com/blogs/1-the-carlat-psychiatry-blog/post/6339-everything-you-wanted-to-know-about-lithium-but-hadnt-heard-on-the-podcast-yet

06/26/2026

A patient says, “I don’t do religion.”

And the conversation about 12-step programs usually ends there.

That moment comes up more often than we admit.

Not because patients don’t want help, but because we don’t always explain what these programs actually are.

More: https://www.thecarlatreport.com/blogs/1-the-carlat-psychiatry-blog/post/6336-rethinking-12-step-referrals

06/25/2026

𝐂𝐡𝐨𝐨𝐬𝐢𝐧𝐠 𝐭𝐡𝐞 𝐑𝐢𝐠𝐡𝐭 𝐀𝐩𝐩𝐫𝐨𝐚𝐜𝐡 𝐟𝐨𝐫 𝐀𝐝𝐮𝐥𝐭𝐬 𝐅𝐫𝐞𝐞 𝐐𝐮𝐢𝐜𝐤 𝐑𝐞𝐟𝐞𝐫𝐞𝐧𝐜𝐞 𝐆𝐮𝐢𝐝𝐞
Treatment Overview, Key Medication Classes, Choosing Between Classes, and More: https://www.thecarlatreport.com/blogs/1-the-carlat-psychiatry-blog/post/6320-stimulant-medications-for-adhd-choosing-the-right-approach-for-adults-free-quick-reference-guide

A treament overview of Methylphenidate and Amphetamine medicatoins for ADHD.

06/24/2026

𝐅𝐫𝐞𝐞 𝐏𝐨𝐝𝐜𝐚𝐬𝐭 𝐒𝐞𝐫𝐢𝐞𝐬: 𝐆𝐞𝐧𝐝𝐞𝐫 𝐀𝐟𝐟𝐢𝐫𝐦𝐢𝐧𝐠 𝐂𝐚𝐫𝐞 𝐢𝐧 𝐄𝐱𝐢𝐥𝐞
Chris and Kellie Newsome, PMHNP, cover the legal battles, clinical evidence, political pressures, and historical origins shaping gender-affirming care.
https://www.thecarlatreport.com/blogs/1-the-carlat-psychiatry-blog/post/6324-free-podcast-series-gender-affirming-care-in-exile

Two malpractice cases — one worth $2 million — are reshaping the standards of gender-affirming care. This episode traces what went wrong, what held up in court, and what every clinician needs to know when referring patients for gender affirming procedures.

06/22/2026

𝐓𝐡𝐞 𝐁𝐞𝐧𝐞𝐟𝐢𝐭𝐬 𝐨𝐟 𝐄𝐱𝐞𝐫𝐜𝐢𝐬𝐞 𝐢𝐧 𝐎𝐥𝐝𝐞𝐫 𝐀𝐝𝐮𝐥𝐭𝐬
We tell patients to exercise. We're usually vague about the dose.

A 2025 UK Biobank study put real numbers on it — using accelerometers, not self-report.
What 150–300 min/week of Moderate to Vigorous Physical Activity was associated with:
▸ 29% lower risk of depression
▸ 20% lower risk of anxiety

More:
https://www.thecarlatreport.com/blogs/1-the-carlat-psychiatry-blog/post/6309-the-benefits-of-exercise-in-older-adults

06/21/2026

𝐅𝐫𝐞𝐞 𝟒-𝐏𝐚𝐫𝐭 𝐏𝐨𝐝𝐜𝐚𝐬𝐭 𝐒𝐞𝐫𝐢𝐞𝐬:
𝐉𝐞𝐟𝐟𝐫𝐞𝐲 𝐄𝐩𝐬𝐭𝐞𝐢𝐧 𝐨𝐧 𝐭𝐡𝐞 𝐂𝐨𝐮𝐜𝐡
Chris Aiken, MD, and Kellie Newsome, PMHNP, have been digging through the Epstein files. This four-part podcast series brings you updates that shed light on his psychiatric diagnosis — examining the clinical terms invoked to explain him, and determining which ones actually fit.
https://www.thecarlatreport.com/blogs/1-the-carlat-psychiatry-blog/post/6325-free-4-part-podcast-series-jeffrey-epstein-on-the-couch

Chris Aiken, MD, and Kellie Newsome, PMHNP, have been digging through the Epstein files, and this podcast series brings you updates that shed light on his psychiatric diagnosis.

06/20/2026

𝐖𝐡𝐞𝐧 𝐒𝐨𝐜𝐢𝐚𝐥 𝐖𝐢𝐭𝐡𝐝𝐫𝐚𝐰𝐚𝐥 𝐁𝐞𝐜𝐨𝐦𝐞𝐬 𝐈𝐧𝐯𝐢𝐬𝐢𝐛𝐥𝐞 𝐏𝐚𝐭𝐡𝐨𝐥𝐨𝐠𝐲

Have you ever heard of hikikomori?

I bet not. But do you have patients with it?

Almost certainly.

I only just learned about it myself, while browsing the literature for fresh LinkedIn posting material. I almost scrolled right by a new meta-analysis — but then flashed on a trip I'd just taken to Japan.

https://www.thecarlatreport.com/blogs/1-the-carlat-psychiatry-blog/post/6291-when-social-withdrawal-becomes-invisible-pathology