Psychofarm Podcast

Episode

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  Sleep Medications Treatment Tier List: Best Insomnia Medications Ranked 11.08.2026 1j 9mnt

  In this episode, the hosts rank the behavioral and medication strategies they use for sleep problems in psychiatric practice, starting with strict wake times, CBT-I, sleep hygiene, exercise, and treating the underlying disorder. They compare doxepin, trazodone, mirtazapine, hydroxyzine, melatonin, gabapentin, benzodiazepines, Z-drugs, antipsychotics, and other options, with attention to sleep onset, sleep maintenance, side effects, dependence, sleep architecture, and comorbid conditions. The conversation also covers caffeine and stimulant timing, alcohol and cannabis, primary sleep disorders, and why diagnosis should guide insomnia treatment before medication choice. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Mood Stabilizers for Bipolar Disorder: Lithium, Lamotrigine, Depakote & More 28.07.2026 1j 1mnt

  Mood stabilizers for bipolar disorder can be confusing because lithium, lamotrigine, Depakote, carbamazepine, and oxcarbazepine have very different strengths, risks, and clinical roles. In this episode, two psychiatrists break down how they think about maintenance treatment, lithium dosing and monitoring, common side effects, lab levels, toxicity counseling, and medication interactions. They also compare Depakote for mania, lamotrigine for bipolar depression, carbamazepine’s interaction burden, and the potential role of oxcarbazepine. Along the way, they discuss combination treatment, diagnostic uncertainty, pregnancy and fertility considerations, rash counseling, and why effective bipolar care requires focusing on long-term episode prevention rather than the symptom of the day. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Dr. Jim Phelps’ Bipolar Treatment Tier List: Lessons from 30+ Years in Psychiatry 23.07.2026 1j 12mnt

  Bipolar disorder treatment is put to the test in this clinically grounded tier list with psychiatrist Jim Phelps. He and Dr. Malzberg rank low-dose lithium, lamotrigine, social rhythm therapy, dark therapy, dawn simulators, antidepressants, carbamazepine, supplements, ketogenic diet, mood tracking, and group psychoeducation. Along the way, they discuss why sleep and circadian rhythm belong in the mood stabilizer conversation, how antidepressants may worsen cycling or mixed states, and why the long-term goal is not simply treating the mood of the day. The episode also explores practical adherence, bipolar comorbidity, passive sleep tracking, and underused nonmedication approaches.Dr. Phelps’ YouTube: https://www.youtube.com/@psycheducation This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Anxiety Medications Tier List: The Best and Worst Treatments for GAD 14.07.2026 1j 3mnt

  Anxiety medications tier list: two psychiatrists rank the treatments they actually use for generalized anxiety disorder… and the ones they avoid. The discussion covers first-line SSRIs, why buspirone may be underrated, when benzodiazepines can help or harm, and how to think about mirtazapine, hydroxyzine, propranolol, gabapentin, pregabalin, quetiapine, and bupropion. Just as important, the episode argues that “anxiety” is not a diagnosis: re-diagnosis, mindfulness, CBT and ACT principles, exercise, reducing caffeine or stimulants, and understanding avoidance may matter more than adding another prescription. The result is a practical, opinionated guide to anxiety treatment that combines evidence, clinical experience, side effects, dependence risk, and long-term recovery. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, Interpretation 30.06.2026 40mnt

  Psychodynamic therapy interventions are the focus of this episode, organized through a practical levels framework for clinicians. Dr. Fu and Dr. Greg break down empathic mirroring as a way to keep the patient’s narrative moving, clarification as a tool for deepening detail, confrontation as a gentle way to point out patterns or discrepancies, and interpretation as the rare intervention that should come only after enough groundwork. Along the way, they connect these skills to diagnostic interviewing, medication management, forensic psychiatry, therapeutic alliance, and the difference between helping a patient talk more and pushing too quickly toward insight. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  ECT Treatment: When to Refer, Who It Helps, and What Actually Happens with Dr. MaryEllen Eller 17.06.2026 54mnt

  Unfortunately no Dr. Fu today, but Dr. Malzberg speaks with the wonderful psychiatrist Dr. Mary Ellen Eller, who walks through what modern electroconvulsive therapy actually looks like and when clinicians should consider it. The episode covers ECT history, stigma, seizure monitoring, memory concerns, side effects, and the real-world logistics patients face during a treatment course. It also explores where ECT fits in the algorithm for severe depression, depression with psychosis, catatonia, bipolar mania. The result is a grounded, clinician-friendly guide to a misunderstood treatment. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Suicide Risk Assessment: Acute vs Chronic Risk, Formulation, and Suicidal Ideation Types 02.06.2026 1j 3mnt

  Suicide risk assessment is often taught like a checklist, but this episode argues that the real work is formulation. We talk about why history is only the starting point, how acute and chronic risk differ, and why suicidal ideation can mean very different things depending on context. We cover stress-related suicidality, intoxication, baseline recurrent thoughts, mood and psychotic disorders, OCD intrusive thoughts, hospitalization decisions, red flags, countertransference, and documentation. The result is a practical psychiatry conversation for clinicians and trainees who want to think more clearly about suicide risk without pretending they can predict the future. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDD 19.05.2026 1j 14mnt

  Psychiatrists rank antidepressants for major depressive disorder, including SSRIs like sertraline, escitalopram, fluoxetine, and paroxetine; SNRIs like venlafaxine and duloxetine; and atypical options like bupropion and mirtazapine. They also cover lithium, low-dose aripiprazole, trazodone, esketamine, stimulants, benzodiazepines, TCAs, and MAOIs, with emphasis on diagnosis, side effects, withdrawal, weight gain, sexual dysfunction, anxiety, insomnia, and why “which antidepressant is best” depends on the patient. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment Skill 05.05.2026 52mnt

  Mindfulness in psychiatry is the focus of this episode, with Doctors Malzberg and Fu treating it as a practical clinical skill rather than vague wellness advice. They define mindfulness as deliberate attention to the present moment without judgment, then connect it to DBT, MBCT, ACT, anxiety, depression, PTSD, substance use, and trauma-informed care. The conversation also covers when mindfulness should be modified, why it is not always a standalone treatment, and how clinicians can teach it through short, scheduled practice, DBT “what skills,” grounding techniques, and careful follow-up. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Psychiatric Technique for Diagnostic Interviewing and Therapy: 6 Mantras Every Clinician Should Know 21.04.2026 46mnt

  Psychotherapeutic techniques are the subject of this episode, as the conversation lays out six memorable therapy mantras for better diagnosis, formulation, and treatment. Rather than focusing on abstract theory, the discussion shows how clinicians can stay close to patient material, clarify vague symptom language, notice countertransference, rewind key moments, and make links that improve both psychotherapy and medication management. It’s a practical lesson in interviewing: ask simpler questions, tolerate not knowing too quickly, observe contradictions, and avoid getting lost in content when the process is where the diagnostic data actually lives. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Psychodynamic Technique and Therapeutic Intervention: Containment 08.04.2026 58mnt

  Psychodynamic technique is the throughline of this episode, which argues that the core skills of therapy belong at the center of psychiatry, not at the margins. The conversation maps five levels of intervention, from level zero through interpretation, while stressing that the most important work usually happens earlier: frame, alliance, follow the affect, and technical containment. Rather than glamorizing clever interpretations, the episode shows why reflective listening, emotionally accurate language, and careful therapeutic interventions help patients think, regulate, and elaborate on their experience. It’s a practical discussion for clinicians who want to improve interviewing, formulation, and treatment across everyday psychiatric practice.Lots of material from this lecture is from here: https://www.appi.org/Products/Psychotherapy/Clinician-Technique-in-Personalized-Psychotherapy This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Tips to Avoid Burnout in Psychiatry (Outpatient, mostly) 24.03.2026 55mnt

  In this episode, Dr. Fu and Dr. Malzberg share practical systems for time protection: start on time, end on time, finish documentation inside the visit, and use tools like AI scribes and quiet typing gear. They also lay out clear messaging rules so emails, texts, and forms do not become off-the-clock clinical care, plus the value of emergency slots. The deeper work is emotional: process the job with mentors or supervision, know your limits, and build a real life outside medicine so you can stay effective for the long game. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  CPTSD vs BPD: How to Think About the Difference and What to Do About It 10.03.2026 56mnt

  In this episode, Dr. Malzberg and Dr. Fu tackle one of psychiatry’s hottest diagnostic debates: complex PTSD versus borderline personality disorder. They walk through the DSM-5 and ICD-11 definitional differences, the historical roots of the C-PTSD concept in Judith Herman’s work, and the real clinical distinctions clinicians can use to differentiate the two. More than a theoretical argument, the conversation zeroes in on how to communicate these diagnoses to patients, why BPD stigma drives some of the debate, and what therapies fit each presentation… from DBT and mentalization-based therapy to EMDR and trauma-focused approaches. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Detecting Subtle Signs of Psychosis: Assessment of Voices, Delusions, and Psychosis 24.02.2026 35mnt

  Subtle psychosis can be missed when you rely on checklists or slip into an interrogator stance. We break down a clinician-friendly approach to detecting psychosis early: use countertransference as a signal, mirror emotion without agreeing with delusions, and clarify the patient’s narrative without derailing it. You’ll also get an OLDCARTS-style framework for taking a voice-hearing history (onset, location, duration, character, and more), plus practical alliance moves for paranoia. We close with how to bridge the treatment gap once you’re seeing the pattern clearly. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening Questions 10.02.2026 54mnt

  Bipolar diagnosis is tricky without labs, so this episode lays out a practical, semi-structured interview you can use in real clinics. We start with what many clinicians skip: a medication and substance timeline, plus medical causes, before jumping into mood symptoms. Then we map major depressive episodes, screen for hypomania with narrative follow-ups, and compare behavior to baseline instead of trusting yes/no answers. Along the way we cover classic pitfalls and mimics, including PTSD insomnia, borderline traits, psychosis-related agitation, and ADHD mislabeling. Finally, we talk about when tools like the MDQ or Rapid Mood Screener help, and why collateral history can change the case. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  What Makes a Belief a Delusion? Delusions, Thought Disorder, the TALD Scale 27.01.2026 45mnt

  How do you actually evaluate a “delusion” in the room, especially when the belief could be plausible, culturally reinforced, or tied to mood or substances? In this episode, we break down a practical approach to psychosis language, why “fixed false belief” is often insufficient, and the interview questions that help clarify origin, certainty, flexibility, and function. We also use the TALD framework to expand beyond the usual linear vs circumstantial vs tangential model of thought disorder, then apply everything to a case vignette where a single supplement becomes the explanation for an entire life collapse. Educational and clinically focused.TALD: https://ars.els-cdn.com/content/image/1-s2.0-S0920996414005933-mmc1.docxUnderstanding Delusions Paper: https://journals.lww.com/inpj/fulltext/2009/18010/understanding_delusions.2.aspx This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  What is Psychosis? Look at the DSM, Common Mimics, and a Framework for the Differential 13.01.2026 1j

  What does “psychosis” actually mean, and how do clinicians recognize it in practice? In this episode, we define psychosis as a syndrome (not a single diagnosis) and walk through the core symptom domains: delusions, hallucinations, disorganized thinking/speech, disorganized behavior, and negative symptoms. We focus on the differential diagnosis, including how to distinguish schizophrenia-spectrum and schizoaffective disorders from mood disorders with psychotic features, trauma-related phenomena, borderline personality disorder, neurodevelopmental presentations (including autism spectrum traits), and substance-induced psychosis. We share red flags that can be easy to miss, like new-onset suspiciousness, functional decline, social withdrawal, and subtle thought disorganization, and we emphasize the value of collateral history and longitudinal follow-up. We close with treatment implications: when antipsychotics are helpful, why risks and benefits need to be individualized, and when psychotherapy and supportive interventions are the better first move. Educational disclaimer: This episode is for educational purposes only and is not medical advice. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Top 10 Things to Know About Clozapine 29.12.2025 45mnt

  In this episode, we outline the top 10 things clinicians need to know before prescribing clozapine. Aimed at psychiatrists and trainees, we cover when to use Clozaril. for treatment-resistant schizophrenia and highlight unique benefits like reducing suicidal behavior and aggression. We also discuss why this gold-standard treatment remains underused and review the monitoring protocols. Crucial safety considerations are addressed, including how to watch for neutropenia and constipation. Tune in for practical tips on clozapine titration, side effect management, and best practices to ensure safe and effective use of this life-changing medication. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  Disability Claims 101 for Psychiatrists: Programs, Pitfalls, and Practical Steps 09.12.2025 1j 8mnt

  Today we tackle a nerve-wracking topic for many clinicians: psychiatric disability assessments and paperwork. We break down everything from FMLA leave and short-term disability to Social Security benefits, explaining how to evaluate mental health impairments and fill out disability forms ethically. They discuss how to handle patient requests for time off work, balance treatment with recovery, and even touch on ADA accommodations like emotional support animals. Without the jargon, they share tips to avoid pitfalls and personal biases, helping you feel more confident in this tricky area. It’s a practical guide to navigating the gray areas of disability claims in mental health care. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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  How to Decide When ADHD Is Actually ADHD 25.11.2025 56mnt

  Many adults who struggle with concentration, disorganization, or procrastination wonder if they have ADHD. But when is it ADHD, and how can you suss this out? In this episode, two psychiatrists explore a nuanced case of possible ADHD to demonstrate why diagnosis isn’t always straightforward. They discuss how personal history, childhood environment, mood swings, and even personality traits can all cloud the clinical picture. Listeners will learn how a comprehensive evaluation is done, what other conditions can mimic ADHD, and which practical strategies (like structured routines or therapy) can help improve focus. We emphasize careful assessment and a holistic approach to treating attention difficulties. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com