The Serotonin Hypothesis: Controversies and Nuance with Awais Aftab, MD

Catatonia in children and teens is underdiagnosed, frequently misunderstood, and potentially fatal if left untreated. In this episode, Dr. David Puder and Dr. Annabel Kuhn interview Dr. Joshua Ryan Smith—child and adolescent psychiatrist and division director at Vanderbilt University—to explore the essential clinical skills and medical knowledge needed to identify and treat pediatric catatonia. You’ll learn how to differentiate catatonia from other neuropsychiatric conditions in both neurodivergent and neurotypical children, how to apply tools like the Bush-Francis and Pediatric Catatonia Rating Scales. This episode also unpacks common misdiagnoses in cases involving autism spectrum disorder, schizophrenia, and autoimmune or metabolic conditions. Finally, it offers practical, evidence-based guidance for both inpatient stabilization and outpatient follow-up care. Whether you’re a psychiatrist, pediatrician, therapist, or student, this episode offers life-saving insights into one of the most overlooked syndromes in child psychiatry. By listening to this episode, you can earn 1.0 Psychiatry CME Credits. Link to blog. Link to YouTube video.

In this episode, Dr. David Puder is joined by psychiatrist Dr. Eric Bender to explore the psychological depth of the Emmy Award-winning show, The Bear (FX). Through a psychodynamic lens, they examine Carmy’s character—his trauma, complex PTSD, obsessive-compulsive personality traits, and avoidant attachment style. They also break down the borderline dynamics in his family, especially his mother’s primitive defenses, identity diffusion, and projective identification. The discussion covers dissociation, personality styles, sibling roles, and emotional neglect, drawing connections to clinical work and real-life therapy. This episode gives both clinicians and fans of the show a nuanced understanding of how early attachment, trauma, and family dynamics shape adult behavior. Whether you're a therapist, student, or simply a fan of the show, you'll gain insight into how The Bear reflects complex inner worlds. Link to blog. Link to YouTube video.

Dr. David Puder and psychologist Dr. Jonathan Shedler explore depressive personality style—how it differs from clinical depression and why it often goes unrecognized. Through a detailed role play, they demonstrate how self-criticism, unconscious guilt, emotional deprivation, and suppressed anger emerge in therapy. They discuss: How depressive personalities form in childhood The role of introjection, self-blame, and gentle idealization Why therapists may miss key dynamics if therapy feels “too good” How to help patients access their real needs and frustrations This episode is ideal for clinicians and anyone interested in deep psychodynamic work. Shedler draws from the work of Nancy McWilliams and Otto Kernberg while offering his own insights on personality, countertransference, and therapeutic technique.   Link to blog. Link to YouTube video. By listening to this episode, you can earn 2 Psychiatry CME Credits.

Dive deep into the connection between cannabis (THC) and psychosis in this enlightening episode with Dr. David Puder. Explore cutting-edge research on how cannabis impacts neurodevelopment, particularly during adolescence, and discover genetic and environmental factors that can amplify psychosis risk. This episode provides valuable insights into recognizing cannabis-induced psychotic symptoms, understanding the importance of early intervention, and implementing effective strategies for treatment and prevention. Essential listening for mental health professionals, educators, parents, and anyone interested in the nuanced relationship between cannabis use and mental health.   By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video.

In this episode, Dr. Otto Kernberg, a pioneer of Transference-Focused Psychotherapy (TFP), discusses personality disorders through a psychoanalytic lens. Explore key insights into Borderline Personality Disorder (BPD), identity diffusion, primitive defense mechanisms such as splitting and projective identification, and the complexities of narcissistic, paranoid, schizoid, and histrionic personalities. Dr. Kernberg also shares reflections on sexuality, aggression, reflective functioning, and why therapists choose to help others. By listening to this episode, you can earn 1.5 Psychiatry CME Credits. Link to blog. Link to YouTube video.

In this episode of Psychiatry & Psychotherapy, Dr. David Puder hosts a deep dive with experts Nicholas Fabiano, MD, Brandon Luu, MD, Joshua Mangunsong, MS3, and Liam Browning, MS4 into the exciting potential of creatine supplementation for mental health and cognitive enhancement. They explore cutting-edge research on how creatine can improve mood disorders, including depression and anxiety, enhance cognitive functions such as memory, attention, and reasoning, and support brain metabolism through its role in ATP regeneration. The episode also reviews clinical trials demonstrating creatine’s effectiveness in psychiatric disorders, optimal dosing strategies, and its safety profile. Listen to learn how creatine may revolutionize treatment options in psychiatry. By listening to this episode, you can earn 1.5 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Explore the transformative potential of the ketogenic diet for mental health with expert Dr. Matt Bernstein, a pioneer in metabolic psychiatry. Learn how targeting metabolic dysfunction can profoundly improve psychiatric outcomes in bipolar disorder, schizophrenia, depression, and epilepsy, with fewer side effects than traditional treatments. Discover actionable insights on diet, metabolism, and brain health backed by the latest scientific research. Tune in to revolutionize your understanding of nutrition's role in mental wellness! By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Join Dr. David Puder and expert psychopharmacologist Dr. Michael Cummings in a detailed discussion on Clozapine, the gold standard medication for treatment-resistant schizophrenia. They explore recent significant updates, including the removal of the Clozapine REMS program, which simplifies patient care and medication management. This episode covers optimal dosing practices, managing side effects, crucial drug interactions, and approaches to related conditions such as catatonia. An essential resource for psychiatrists and mental health professionals seeking updated clinical insights. By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Is depression really caused by low serotonin? Dr. Awais Aftab joins Dr. David Puder to explore the serotonin hypothesis, antidepressant efficacy, and the controversies surrounding SSRIs. They dive into the history of the serotonin deficiency theory, key research on antidepressants vs. placebo, and how neuroplasticity, psychotherapy, and lifestyle changes factor into depression treatment. The episode also examines differences between major treatment guidelines, including RANZCP and NICE, and what the latest evidence suggests about the future of mental health care. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video. Links for Dr. Awais Aftab: Substack World Psychiatry Conversations in Critical Psychiatry

In this episode, Dr. David Puder interviews Dr. Frank Yeomans, a leading expert in Transference-Focused Psychotherapy (TFP) and personality disorders, to explore the treatment of Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD). They discuss object relations theory, identity diffusion, splitting, and the therapeutic relationship in TFP. Dr. Yeomans shares clinical insights on working with paranoid, devaluing, and omnipotent transferences, highlighting how therapists can navigate idealization, devaluation, and therapeutic neutrality. They also compare TFP with other psychodynamic approaches and discuss the role of aggression in mentalization and personality integration. Learn how TFP helps patients develop a stable identity Understand the differences between BPD and NPD treatment Explore the role of transference in psychotherapy Tune in for a deep dive into psychodynamic therapy with one of the field’s top experts! By listening to this episode, you can earn 2.0 Psychiatry CME Credits. Link to blog Link to YouTube video