Brain Trust: Conversations in Psychopharmacology

Episoder

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  15: The Power of the Placebo Effect: A Conversation With Walter A. Brown, MD 24.07.2026 48min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sat down with Walter Brown, MD, to discuss the placebo effect in clinical psychopharmacology, including its mechanisms, the nocebo effect, ethical considerations, and practical strategies for harnessing placebo responses in everyday psychiatric practice.Brown traced his interest in the placebo effect to his involvement in early SSRI clinical trials in the 1980s, in which approximately 58–60% of patients responded to active drug versus 40–45% to placebo—a gap he found surprisingly narrow. He spent the next 30 years reviewing the literature and studying placebo responders, synthesizing his findings in a 2013 book, The Placebo Effect in Clinical Practice.Brown identified expectation as the most widely studied mechanistic driver of the placebo effect. He also cited a 3-arm study of St John's wort, sertraline, and placebo in approximately 100 patients, in which outcome correlated more strongly with what patients believed they had received than with what they actually received—proposing that "the belief in what treatment you're getting has a more powerful effect than its actual pharmacologic activities."Brown and Goldberg also discussed the nocebo effect, noting that informing patients about potential side effects increased their likelihood of experiencing them, which was illustrated by some COVID-19 vaccine trials. Mitigation strategies included positive framing (highlighting the 90% who do not experience a side effect rather than the 10% who do) and "authorized concealment," in which patients consent to receiving only selected side effect information.Brown urged clinicians to regard the placebo response "not a nuisance, which is what has been thought of for a long time, but as an important part of all healing, and it should be enhanced"—noting it accounted for roughly a third of treatment benefit. Goldberg agreed that maximizing placebo effects through optimistic framing, therapeutic alliance, and mobilization of hope can be an element of expert psychopharmacologic practice.
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  14: Managing Co-Occurring Mood and Substance Use Disorders With Michael J. Ostacher, MD, MPH 17.07.2026 46min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sat down with Michael Ostacher, MD, MPH, to discuss managing co-occurring mood and substance use disorders (SUDs), including patient engagement, the "self-medication" narrative, and underuse of evidence-based addiction pharmacotherapy.Ostacher traced his approach to mentor Ken Minkoff, who argued against a separate addiction specialty because all clinicians treat patients with addictions. Ostacher said a directive stance with patients who use substances rarely helped, since most already recognized the problem, as opposed to something like sleep hygiene counseling, where direct instruction worked well.On whether mood symptoms or substance use came first, Ostacher said the distinction mattered less than commonly assumed, since most patients presented with continuing symptoms of both. Patients who invoked self-medication were often "precontemplative" about change, he said. Counterintuitively, in studies including STEP-BD, "the people who have substance use disorders are much more likely to get better and to get better more quickly than the people who don't have a substance use disorder and bipolar disorder," likely because motivated patients reduced use upon seeking treatment.Ostacher did not recommend avoiding addiction pharmacotherapy for bipolar patients pending disorder-specific trials. He supported varenicline and nicotine replacement for smoking cessation, methadone or buprenorphine (including long-acting injectables) for opioid use disorder, and naltrexone or acamprosate for alcohol use disorder, noting these worked regardless of psychiatric comorbidity. He cited a Stanford study in which only about 2% of patients with alcohol use disorder were discharged on an indicated medication, and a STEP-BD finding that only 4.4% of eligible bipolar patients received SUD pharmacotherapy. Ostacher said, "if you have a patient who has an alcohol use disorder diagnosis, you should offer them medications for treatment. They're welcome to not take them, but you should offer them for treatment." He added that GLP-1 agonists are being studied for alcohol use disorder.Goldberg closed by underscoring that, rather than waiting to start treatment for one condition pending resolution of the other, clinicians must address both simultaneously.
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  13: How AI Can Help in Everyday Psychiatry: A Conversation With Roy Perlis, MD 10.07.2026 55min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Roy Perlis, MD, to discuss the role of artificial intelligence (AI) in clinical psychopharmacology, including its applications in treatment-resistant depression (TRD), suicide risk stratification, digital phenotyping, and the challenges of integrating AI tools into everyday psychiatric practice.Perlis reflected on 25 years of experience in this domain, noting that early neural network models used for psychiatry, like those applied to fluoxetine trial data, yielded little predictive signal. He observed that despite dramatic growth in dataset size—from hundreds of patients in early studies to hundreds of thousands in contemporary electronic health record (EHR) analyses—AI models have not consistently outperformed the well-trained clinician. He argued that one of AI's most practical near-term contributions is not superior prediction but rather democratization: giving the average practitioner access to the same structured clinical reasoning that expert clinicians apply intuitively.Perlis raised important concerns about the quality of the data from which AI models learn. He noted that EHR notes serve multiple purposes—clinical communication, billing, and medical-legal documentation—and that this dilutes the clinical signal in modeling cases. He warned that models can only find what clinicians document, and that key predictors of outcomes such as TRD may simply not be captured in structured or narrative data. Perlis cited his collaborative work with EHR data across institutions, noting that TRD prediction models trained at one site often fail to generalize to another, suggesting the limiting factor is data quality rather than sample size.On digital phenotyping, Perlis identified some potential, emphasizing that passively collected smartphone data (like changes in usage patterns, timing, and movement) are most informative when interpreted as deviations from an individual's own baseline rather than as population-level classifiers. He identified integration into clinical workflows as a primary barrier, not data availability or analytic methods.Perlis urged caution regarding premature deployment of AI tools, particularly suicide risk models, noting that current models still yield incorrect answers approximately 10% of the time. He also addressed large language model confabulation, clarifying that these systems are trained to complete sentences, not to acknowledge uncertainty, and that grounding models in constrained, citable data sources remains an active area of development.
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  12: Deprescribing: Insights From an ASCP Panel of Psychiatric Experts 03.07.2026 51min

  Joseph F. Goldberg, MD, in this special installment of "Brain Trust: Conversations in Psychopharmacology," sat down with a panel of experts from the American Society of Clinical Psychopharmacology Annual Meeting (ASCP) Deprescribing Task Force while in attendance at the 2026 ASCP Annual Meeting in Miami, FL. In the wake of the MAHA Institute summit on mental health on May 4, 2026, and the plans to curb “psychiatric overprescribing,” the ASCP released deprescribing recommendations for psychiatrists and practicing mental health clinicians.Goldberg has been very passionate in speaking about proper and appropriate deprescribing, as evidenced by his May 2025 cover for Psychiatric Times: “Deprescribing: Does the Term Belong in the Psychiatric Lexicon?”In this discussion, the panel explained the importance of deprescribing in the national dialogue and debate, and emphasized the need for judicious, thoughtful, supervised, purposeful, intentional, clinically-indicated decision making by clinicians.David W. Goodman, MD, highlighted the lack of understanding among a broad range of prescribers with varying degrees of training and background, leading to inaccurate diagnoses and inappropriate prescriptions. Roger S. McIntyre, MD, FRCPC, emphasized the supply and demand mismatch in mental health services, noting the explosion in demand and the lack of quality healthcare supply. Rajnish Mago, MD, added that the difficulty in deprescribing is due to the complexity of managing multiple medications and the reluctance of patients, families, and doctors to change treatments.Anita Clayton, MD, pointed out that most psychiatric medications are prescribed by primary care providers who lack the opportunity to follow patients closely and adjust medications as needed.Leslie L. Citrome, MD, MPH, discussed the challenges of deprescribing in primary care settings, where time limitations and lack of measurement-based care hinder effective treatment.Holly A. Swartz, MD, emphasized the importance of patient-clinician communication and the need for alternatives to medications, such as psychotherapy and lifestyle changes.Mauricio Tohen, MD, suggested that the FDA should require tapering studies for new drugs to ensure appropriate deprescribing practices.Swartz and Citrome highlighted the importance of screening tools and systematic reassessment in deprescribing.Collectively, the group discussed practical approaches to deprescribing, including starting discussions with patients and prioritizing medications based on their impact.
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  11: Practical Insights Into the Evolving Treatment of Bipolar Disorder With David Dunner, MD, FACPsych 26.06.2026 57min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with David Dunner, MD, FACPsych, to discuss practical insights into the evolving treatment of bipolar disorder and treatment-resistant depression.Dunner described the origins of the rapid cycling concept, which emerged from his chart review of lithium nonresponders at the Columbia University lithium clinic in the early 1970s. He explained that patients with 4 or more mood episodes per year were consistently poor lithium responders, a finding later replicated and incorporated into DSM-IV. He also recounted his earlier work at the National Institute of Mental Health, where review of inpatient records led to the first characterization of bipolar II disorder: patients with hypomania and depression who did not meet criteria for full mania but demonstrated high rates of suicidality and family history of suicide.Dunner cautioned against conflating ultra-rapid cycling—which he attributed to neurological causes such as multiple sclerosis or substance use—with true bipolar rapid cycling. He also addressed the differential diagnosis of mood variability, distinguishing episodic bipolar cycling from the briefer, interpersonally triggered reactivity seen in borderline personality disorder, noting that the 2 conditions could coexist but that lithium addressed only some features of the latter.On pharmacotherapy, Dunner pointed out the commercial displacement of lithium by promoted anticonvulsants, observing that many lacked robust maintenance trial data. Regarding second-generation antipsychotics, Dunner acknowledged their efficacy as augmentation agents but noted unresolved questions about sequencing and duration of use. He emphasized neuromodulatory interventions—transcranial magnetic stimulation, vagus nerve stimulation, esketamine, and deep brain stimulation—for treatment-resistant depression. He expressed caution about psilocybin, noting that "the safety issue is more concerning to me unless they show that this is a long-term safe compound to use."On the broader state of the field, Dunner observed that mania phenotypes had shifted markedly toward mixed and dysphoric presentations. He reflected that while outcomes have improved substantially over his career, fundamental uncertainties in antidepressant selection persist: "It's clear that we lack a lot of insight into what's the absolute best drug for this patient. We're making an educated guess," he concluded.
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  10: The Challenge of Medication Adherence With Martha Sajatovic, MD 19.06.2026 45min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Martha Sajatovic, MD, to discuss the multifaceted challenge of medication adherence in psychiatric practice.Sajatovic opened by framing adherence as behavioral and attitude alignment with a prescribed treatment plan, noting that nonadherence was far more common than most clinicians recognized. Evidence suggests that roughly half of patients prescribed psychotropic medications had difficulty maintaining recommended regimens. Sajatovic emphasized that this gap had real consequences, including relapse, hospitalization, and misattributed treatment failure—situations in which clinicians might incorrectly escalate dosing or change medications without recognizing poor adherence as the underlying cause.The discussion turned to practical strategies for initiating nonjudgmental dialogue. Sajatovic advocated normalizing adherence difficulties before asking patients whether they applied personally: “the evidence suggests that it's hard for people to stay on track with medications, and it's really common." Both Goldberg and Sajatovic agreed that the term "compliance" carried adversarial connotations and had been beneficially supplanted by "adherence," which invited shared decision-making rather than punitive evaluation.Sajatovic identified self-efficacy as an emerging correlate of better adherence, drawing on National Institutes of Health-funded research showing that patients who felt empowered to influence their own health outcomes were more likely to remain on track. Additional barriers our experts addressed included fluctuating insight in bipolar disorder, stigma, polypharmacy burden, concurrent substance use, and negative family attitudes; Sajatovic noted that in one sample group of patients with bipolar disorder, up to 40% of family members did not believe medication was indicated.Sajatovic described Customized Adherence Enhancement, a brief modular behavioral intervention she developed with colleague Jennifer Levin, MD, that targeted individualized barriers through psychoeducation, provider communication, substance-use counseling, and medication-routine strategies. The conversation concluded with a discussion of long-acting injectable antipsychotics, periodic medication reviews, and deprescribing—including a forthcoming paper by Goldberg and Sajatovic in JAMA Network Open reporting that over 90% of a Delphi expert panel endorsed regular, structured regimen reviews as standard practice.
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  9: How to Prescribe Off-Label With Henry Nasrallah, MD 12.06.2026 49min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Henry Nasrallah, MD, to discuss off-label prescribing and polypharmacy.Nasrallah bases the discussion off his landmark analysis that demonstrated 88% of DSM psychiatric diagnoses have no US Food and Drug Administration (FDA)-approved pharmacotherapy, leaving clinicians with no choice but to prescribe off-label for many of the patients they encounter. He argues that the FDA's diagnosis-centric approval framework, rather than a symptom- or circuit-based model, is a primary driver of this gap, noting that a shift toward symptom-level indications could render irrelevant much of current off-label practice.Both clinicians emphasize that off-label prescribing, when rationale-based and neuroscientifically informed, constitutes responsible clinical care rather than reckless deviation. Nasrallah describes examples like using valproate for impulsive aggression in traumatic brain injury, clozapine augmentation for treatment-resistant suicidality, and high-dose modafinil for refractory depression—each grounded in mechanistic reasoning. Goldberg observes that "off-label practices are legitimate…good for patients and save a lot of lives," while cautioning that prescribers must understand what a drug does in the brain, not merely follow or ignore labeling.The conversation also addresses the transdiagnostic model, polypharmacy, insurance barriers to off-label coverage, and the underutilization of clozapine. Nasrallah concludes by characterizing off-label discovery as "a creative process, the cutting edge of scientific advances," urging clinicians to publish case reports and share serendipitous findings to catalyze future trials.
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  8: Early Intervention & Psychopharmacology in Bipolar Disorder With Robert M. Post, MD 05.06.2026 48min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Robert M. Post, MD, to discuss evolving perspectives on bipolar disorder and treatment, emphasizing early intervention and the underutilization of lithium.There is a high prevalence of childhood-onset bipolar disorder in the United States, noted Post, with approximately a quarter of cases beginning before age 13. Earlier onset and longer delays to first treatment independently predict poorer adult outcomes. Post posited, “untreated illness is the greatest threat to our children,” arguing that concerns about overprescription have overshadowed the risks of delayed or absent care.Goldberg and Post then discuss the duration of untreated illness as a prognostic factor analogous to other areas of medicine. Delayed initiation of effective therapy diminished treatment responsiveness. According to emerging data, lithium was the most effective when introduced after a first episode, potentially preserving cognitive function and preventing neuroprogression. He reiterated that lithium’s benefits extended beyond mood stabilization, describing it as neuroprotective and potentially disease modifying. As Post explained, “The earlier you use it, the better it is, and that it avoids neurological and bone abnormalities and disease progression.”Despite this, lithium remains markedly underused, with far more patients receiving antidepressants despite bipolar diagnoses. Post attributed this pattern to overemphasis on lithium’s adverse effects and underrecognition of its broader benefits, including antisuicidal effects, neurogenesis, preservation of hippocampal volume, reduced all-cause mortality, and possible protection against bone fractures. Both Goldberg and Post suggested that delayed lithium initiation may create a self-fulfilling prophecy in which diminished responsiveness reinforces hesitancy to prescribe it. The discussion called for earlier, evidence-based intervention to improve long-term outcomes in bipolar disorder.
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  7: The Role of Psychopharmacology in Pediatric Care: Discussing Strategies With Melissa DelBello, MD 29.05.2026 49min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with child and adolescent psychiatrist Melissa DelBello, MD, to discuss the role of psychopharmacology in pediatric mental health treatment. Their conversation emphasized early identification and intervention for mood and related disorders in young patients.DelBello addressed common concerns regarding medication safety in children, noting that when prescribed by clinicians with appropriate expertise, psychotropic medications “can be life-saving” and used in ways that minimized adverse effects while maximizing efficacy. She cautioned against excessive polypharmacy and inadequate duration of therapeutic trials, which could undermine optimal outcomes.DelBello also underscored the developmental consequences of untreated psychiatric illness. She explained that childhood and adolescence represent critical periods for achieving social, academic, and interpersonal milestones. The onset of major depression, bipolar disorder, psychosis, anxiety, or attention disorders during these years could disrupt developmental trajectories, with enduring functional sequelae. She drew parallels to untreated medical conditions affecting growth, arguing that failure to address early psychiatric symptoms could similarly alter long-term outcomes.Goldberg raised the question of whether earlier intervention might mitigate chronicity and comorbidity, echoing the sentiment of many practitioners wishing they could have seen a patient just in time to prevent a disorder worsening. DelBello supported a positive view on early intervention, suggesting that timely treatment could prevent abnormal neurodevelopment and reduce downstream complications. She emphasized that early-phase intervention was often more effective than treatment initiated after recurrent episodes and accumulated morbidity.The discussion also highlighted substance use risk in youth with bipolar disorder, particularly in the context of family history. DelBello described proactive psychoeducation targeting adolescents before college transition. She advised candid discussions about biological vulnerability, for example, letting particular patients know that vulnerability is part of their “genetics and neurochemistry, and if you start using substances, you’re more likely to get addicted faster.” Framing risk in neurobiological terms appeared to enhance insight and facilitate harm-reduction strategies.Goldberg and DelBello advocated for developmentally informed, longitudinal care models that prioritized early recognition, individualized risk assessment, and judicious pharmacotherapy to improve long-term psychiatric and functional outcomes.
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  6: The Complex Psychopharmacology of Personality Disorders: Prioritizing Symptom Management With Michael Gitlin, MD 22.05.2026 46min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Michael Gitlin, MD, to discuss psychopharmacologic options for personality disorders.They highlighted the dimensional nature of personality disorders, contrasting them with the categorical DSM model.“The relationship between treating personality disorders and the use of medicines is not as natural as it would be for classic symptom-based disorders, such as mood disorders, anxiety disorder, and psychotic disorders. Because, when we describe symptom-based disorders, we have symptoms, we have time frames, and it fits the medical model. The DSM is categorical, meaning there are allegedly boundaries around all of the disorders. The problem is all of psychopathology, but most of all personality pathology, is dimensional, not categorical,” said Gitlin.Gitlin emphasized the importance of treating specific symptom complexes like impulsive aggression and affective liability rather than the entire disorder. He suggested using anticonvulsants, low-dose antipsychotics, and serotonergic drugs for different symptom profiles.“Instead of saying, do I know how to treat borderline personality disorder with medicine, what we should do is take a step back say, what are the symptom complexes that dominate the features of that personality disorder? And then say, do I know how to treat that?” said Gitlin.They also discussed the role of therapeutic alliance and placebo effects in enhancing treatment outcomes. A collaborative approach, where the patient is an active participant in the treatment plan, can enhance adherence and treatment outcomes.Overall, the conversation underscores the need for personalized, goal-oriented approaches in managing personality disorders.
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  5: Pharmacogenetic Testing in Psychiatry: Exploring Personalized Medicine With John J. Miller, MD 15.05.2026 54min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Psychiatric Times' very own editor in chief, John J. Miller, MD, to discuss the current state and future directions of pharmacogenetic testing.According to Goldberg, pharmacogenetics is almost like a Rorschach test in the eyes of many practitioners and patients: “It is thought to be a projective that you sort of identify in various ways. It is going to tell me things about myself. It is going to make predictions. It is going to help me guide treatment. It is going to override clinical factors, patient specific features that influence outcome, and really get to the heart of things.”Miller also shared his initial reactions to the introduction of this testing: "When pharmacogenetic testing first became available about 12 to 14 years ago, I was excited. And then, as I learned more about it, read the literature, and became aware of the institutions that exist to vet genes and whether or not they are clinically actionable, I became very frustrated by how overly adoptive pharmacogenomics has become when really the evidence base is not there. In fact, as we have learned more, it has become less evidence based in terms of clinical applications."Recently, the International Society of Psychiatric Genetics published a review article on genetics and psychiatry, and they concluded that there are 4 genes that are evidence based and actionable: CYP2D6, CYP2C19, HLA-B*1502, and HLA-A*3101."I think there is a mythology that all you have to do is do the gene testing, and you can choose a drug based on the results," shared Miller.When it comes to testing, Miller believes we need to alter the thinking around testing in psychiatry: "We are very selective, and we do it for a reason, because we have a hypothesis. Maybe there is atrophy. Maybe we have some neurological sign. It really should spark the curiosity of the clinician to think, would a test—any test, for that matter—be informative to answer a question. That is how I always think about any test in medicine."Together, Goldberg and Miller stress the importance of therapeutic drug monitoring and personalized medicine, while acknowledging the limitations and ongoing evolution of pharmacogenetic testing."We have a common goal. We want to do a test that is scientifically informative for you. If there is a test out there that I think will help us answer a question, I promise you, I will order it, but not everything comes down to a particular test, right? There are certain clinical impressions we have in medicine. How do you diagnose migraine headaches? There is no test for that. How do you diagnose your bowel syndrome or tinnitus? There is no test for that. So we look for tests to someday enhance or augment what we think is an observation that we would like some corroboration for," said Goldberg of speaking to patients about testing.Miller agreed, concluding that, "We do not want to put the car before the horse, and so let's stick to the what the experts who really know this stuff are guiding us, and then incrementally use what becomes clinically actionable or evidence based."
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  4: Psychedelics for Depression and Other Mental Health Conditions: The Way Forward With Guy Goodwin, MD 08.05.2026 44min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Guy Goodwin, MD, to discuss the potential of psychedelics in treating depression and other mental health conditions. Goodwin, who is the chief medical officer at Compass Pathways, highlights psilocybin's ability to induce profound experiences that can lead to long-term improvements in mood and anxiety. "I got the opportunity to go full time into a new position with Compass Pathways to develop psilocybin. I'd been interested already, I'd advised a little bit on how to design the phase 2 clinical trial. At the time that I did that, I was a little pessimistic about whether there was really a future in this, because it looked quite hard to raise money and quite difficult to do the studies. There were a lot of things that seemed to me potentially difficult, but many of these obstacles have become overcome by the people at Compass. That was the beginning of a new life," Goodwin said of his research evolution in psilocybin.LSD, the first psychedelic, discovered in 1943 by Albert Hofmann,1 "was the stimulus to understanding serotonin metabolism and function, both in the brain and to a lesser extent, in the peripheral nervous system," shared Goodwin. Together, Goldberg and Goodwin evaluate the challenges of developing psilocybin, including regulatory hurdles and the need for careful clinical settings. Goodwin notes that psilocybin's effects are immediate and can be more effective than traditional treatments for some patients. They also touch on the potential for psilocybin to treat posttraumatic stress disorder (PTSD) and substance abuse, and the importance of understanding its pharmacodynamic properties and potential combinations with other drugs.For example, in an open-label, small study of 22 patients with PTSD, Goodwin and investigators saw an approximate 80% remission rate in symptoms.2 In the follow up interviews with patients, Goodwin found a few details very striking: "One is that patients can have the trauma recur—the actual index trauma can be something that recurs in the experience under the influence of psilocybin—and it seems to be something that is tolerated by the patient. They kind of find an indirect route to feeling better about the trauma."As to future directions, Goodwin believes we should start carefully: "We're advocating for very careful use. We're advocating reimbursement so that access is fair and equitable. Our objective is not to get this widest possible use of the drugs; Our objective is to get the proper use of the drugs in the right patient population."
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  3: The Intersection of Psychotherapy and Psychopharmacology for Mood Disorders: Optimizing Patient Outcomes With Holly A. Swartz, MD 01.05.2026 28min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Holly A. Swartz, MD, to discuss evidence-based psychotherapies for mood disorders, emphasizing a nuanced approach to treating depression. If a patient prefers to start with psychotherapy, they should be given 6 to 12 weeks to see if it works before considering augmentation or switching to another modality, shared Swartz. The approach is similar to starting pharmacotherapy and considering augmentation or switching if there is no response.For less severe depression, Swartz recommends utilizing psychotherapies like cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), as they are comparable to pharmacotherapy. For patients with severe depression, Swartz finds combining psychotherapy with antidepressants to be more effective; however, patients with severe depression alongside cognitive rigidity and melancholia may benefit more from pharmacotherapy, whereas patients with moderate depression and interpersonal or cognitive issues may benefit more from CBT or IPT."The way that I think about it is you have got to have stuff to work with in order for the treatments to be effective. We have seen that differential response to IPT and CPT," said Swartz.Additionally, patient preference significantly impacts treatment success, with those receiving their preferred treatment being 4 times more likely to respond."Getting what you think is going to help you feel better, get better actually matters a lot," said Swartz. The conversation also explores the integration of psychodynamic principles in pharmacotherapy, the role of psychotherapy in neuroplasticity, and the concept of deprescribing in psychotherapy."We always want to tailor our treatments for the individual. Some people might feel that they need a little bit less because they really get it, and they are able to use other coping strategies, whereas there may be others who struggle a bit more and need more frequent help. Our modal frequency would be monthly, with the capacity to flex that based on on patient needs and tailored treatments," concluded Swartz. 
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  2: The Role of GLP-1s in Psychiatry: Learning More With Roger S. McIntyre, MD, FRCPC 24.04.2026 33min

  Joseph F. Goldberg, MD, in this installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Roger S. McIntyre, MD, FRCPC, to discuss glucagon-like peptide-1 (GLP-1) agonists and their role in psychiatry. McIntyre highlights the transformative impact of GLP-1 agonists on weight and glucose management. GLP-1s are "truly transformative," McIntyre says, as they affect the brain in a way that suggests they are psychiatric drugs. There are currently 5 indications approved by the US Food and Drug Administration for obesity, diabetes, sleep apnea, cardiovascular disease, and kidney disease.1 While their use in psychiatry is off-label—for example, managing weight gain from antipsychotics—effects on brain plasticity, reward systems, and inflammation, suggest they have a broad range of uses in the space and mental health prescribers should be familiar with these drugs.2"There is in fact a relationship or association between obesity and type II diabetes, or impaired glucose tolerance, and its effect on the brain," said McIntyre. "When the brain is exposed to the milieu created by obesity or impaired glucose tolerance, that jeopardizes brain health that manifests in different types of neurologic and psychiatric disorders."Goldberg and McIntyre also discuss the importance of collaboration with specialists for managing complex metabolic conditions, in order "to help the patient as part of the circle of care"The future is very exciting. I'd encourage colleagues to stay tuned. We have many difficult to treat conditions in psychiatry, not just weight gain from drugs, but also cognitive impairment in schizophrenia, bipolar depression, treating anhedonia, and treating aspects of the medical problems we talked about. GLP-1s have moved into late phase development in the prevention of cognitive impairment in Alzheimer disease, the prevention of episodes in bipolar depression and schizophrenia, and other things like alcohol use disorder, smoking, and the list keeps going. These are well along in terms of development," said McIntyre.You can read more on GLP-1s and their potential as game-changers in psychiatric treatment from McIntyre in the 2025 July cover story of Psychiatric Times. Read it here.
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  1: Depression, SSRIs, and Pregnancy: Getting to the Truth With Marlene P. Freeman, MD 17.04.2026 34min

  Joseph F. Goldberg, MD, in his first installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Marlene P. Freeman, MD, to discuss the treatment of depression, selective serotonin reuptake inhibitors (SSRIs), and pregnancy. On July 21, 2025, the US Food and Drug Administration led an expert panel on SSRIs and pregnancy, in which they questioned the validity of psychiatric medication use during pregnancy."There were a lot of issues that came out of that panel discussion about the potential risks vs safety of SSRIs in pregnancy," said Goldberg. In their discussion, Goldberg and Freeman evaluate what the panel got wrong. Freeman, a leading expert in women's mental health, specifically discussed the complexities of treating psychiatric disorders during pregnancy, emphasizing the high rate of unplanned pregnancies and the risks of untreated illnesses: "Any prescriber should keep in mind that for women of reproductive potential, the rate of unplanned pregnancies in this country is about 50%. So whenever we are writing prescriptions or deciding on treatment plans, we want to keep in mind that even if a woman is not planning on becoming pregnant at the time, she might become pregnant at some time."She highlighted the need for well-controlled studies to understand the effects of SSRIs on pregnancy outcomes. Notably, SSRI use does not increase the risk of autism.  It is important to note though that a mental health disorder is also a risk factor to pregnant patients: "We know that with with all the major psychiatric disorders that have been studied across pregnancy, the disorder itself carries risk for the individual, the pregnancy outcomes postpartum, and for the baby, and ultimately for child development."Freeman also addressed the misinformation around stopping SSRIs in the third trimester and the importance of patient-centered, evidence-based care.