This month, we lost a true brother in the Carlot family. Michael Posternak was a frequent contributor to the

journal, and he passed unexpectedly on July 3, 2023. He worked up to the very end, turning in his

final piece on binge eating disorder a few days before he died. He leaves behind two children, a loving extended family, and a private

practice filled with patients whose lives were changed by his work. Mike began his career in

academics, working alongside Mark Zimmerman at Brown University School of Medicine. I knew of

his work back then, because even from that ivory tower, he was producing papers that were relevant to everyday practice.

He was the first to show that antidepressants begin to separate from placebo by week two, not after four weeks like the conventional wisdom said at the time.

Later, when the maker of Trintellix tried to use that feat

to claim they had the fastest onset, Mike brought them down a notch. One paper he published in 2005

was unforgettable. The title was Pure Posternak. Why isn't Puproprion the most frequently prescribed antidepressant?

Not the kind of title we're used to seeing in an academic tone like the Journal of Clinical Psychiatry,

but Michael had a passionate voice and a keen eye for where psychiatry was doing a disservice to their patients. In this case, by using

SSRI's first line, medications that caused apathy, sexual dysfunction, sleep problems, weight gain,

and a terrible withdrawal syndrome, instead of buproprion, which caused none of these.

Mike suspected that this was due to marketing, as well as to a myth,

that serotonin calmed anxiety while buproprion did the opposite.

This, as he showed us in that paper, was a misunderstanding, for buproprion is just as effective

at treating depression with anxious features as the SSRIs are.

Buproprion does not treat anxiety disorders, but despite that linguistic overlap,

there is little scientific rationale to say anxiety or phobic disorders are the same as anxious depression.

His paper changed by practice, but we didn't agree on everything. Mike was a contrarian, and we often debated things for the report late

into the night. After a while, I got to realize that he made me a better editor, and I started

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