How to Start a Psych Medication VI
The Carlat Psychiatry Podcast
Pocket Psychiatry: A Carlat Podcast
4.7 • 524 Ratings
🗓️ 22 September 2025
⏱️ 17 minutes
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Summary
Lithium, pramipexole, bupropion, carbamazepine, valproate, and trazodone. Meds that require special skill to start:
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Published On: 09/15/2025
Duration: 17 minutes, 27 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Transcript
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| 0:00.0 | Lithium, Primapexol, buproprione, carbamazapine, valproate, and tracidone. |
| 0:05.6 | These are our final meds that require special skill to start. |
| 0:12.4 | Welcome to the Carlyte Psychiatry Podcast, keeping psychiatry on us since 2003. |
| 0:17.9 | I'm Chris Aiken, the editor-in-chief of the Carlatte Psychiatry Report. |
| 0:21.6 | And I'm Kelly Newsom, a psych NP and a dedicated reader of every issue. |
| 0:29.5 | We started this series with some sound advice. |
| 0:32.4 | Ask the patient if they'd rather go fast or slow when titrating a medication. |
| 0:37.1 | The patients expect us to be the experts, |
| 0:39.0 | and you need to know where the lines are drawn. That is what the rest of this series has been |
| 0:44.8 | about. Like don't start above one milligrams with praisesin. Don't speed up on the titration of |
| 0:52.1 | chlozapine or lomotrogen and go extra slow when drug interactions are present. |
| 0:57.9 | I also lean toward the slow side in older and younger adults, those under age 18 or over age 65, who are medically frail. |
| 1:06.8 | And when I'm unsure of how the medication is going to affect them, like when the patient has brain injuries or they have a developmental disorder, you know, these are populations where meds are understudied and paradoxical reactions abound. Those are cases where I'll also go slow. |
| 1:24.1 | Then there are a few meds where we just know that the early side effects are likely going to be a problem. |
| 1:30.7 | And that's what this podcast episode is about, meds like lithium, prima pexol, and bupropriion. |
| 1:38.0 | At the end, we'll close with a research update on antidepressant withdrawal. |
| 1:50.0 | Music update on antidepressant withdrawal. First is bupropion, wellbutrin. |
| 1:53.0 | This antidepressant has a reputation for causing insomnia and anxiety, |
| 1:58.0 | and I used to get a lot of callbacks about panic on it, but 15 years |
| 2:03.4 | ago, I learned about a trick with buproprion at an APA course, and I've not had that problem since. |
| 2:11.6 | Though the PDR suggests starting buproprion at 150 to 200 milligrams a day, I often start lower 75 milligrams a day in anxious |
| 2:23.9 | patients, and I raise it very slowly by 75 milligrams every week. I also use this strategy when starting |
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