E280 - PsychopharmaPearls: Managing Rebound Insomnia with Dr. Thomas Schwartz

In this episode, Dr. Andy Cutler speaks with Dr. Thomas Schwartz about insomnia related to antidepressant discontinuation, including how rebound and withdrawal symptoms can emerge when tapering or stopping treatment. They review the underlying mechanisms, clinical risk factors, and how to distinguish discontinuation-related insomnia from relapse of depression or primary sleep disorders. The discussion emphasizes practical, evidence-informed strategies for safely tapering antidepressants and managing sleep disturbance in psychiatric practice.   Thomas L. Schwartz, MD, is a Distinguished Teaching Professor at Norton College of Medicine, SUNY Upstate Medical University in Syracuse, New York. He is an award-winning educator deeply involved in medical student and resident training, as well as the development of continuing medical education in psychiatry.  Andrew J. Cutler, MD, is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and EMA Wellness. He is a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Save $100 on registration for 2026 NEI Spring Congress with code NEIPOD26  Register today at nei.global/spring  Never miss an episode!🎙SUBSCRIBE to the NEI Podcast– available on all your favorite platforms: https://nei.global/podcast  Interested in Psychopharmacology?  Learn about the NEI Master Psychopharmacology Program: https://nei.global/mpp   Stay updated with email alerts and join our conversations on social. Follow us on:  YouTube: https://nei.global/youtube  Instagram: https://nei.global/instagram  LinkedIn: https://nei.global/linkedin  Facebook: https://nei.global/facebook  X: https://nei.global/twitter 

In this episode, Dr. Andy Cutler speaks with Dr. Holly Swartz about the critical role of sleep and circadian rhythms in bipolar disorder, including how sleep disturbance can function as both a symptom and trigger of mood episodes. They discuss how clinicians can better assess sleep to identify early warning signs of relapse, along with practical strategies for intervention, including applying principles of Interpersonal and Social Rhythm Therapy (IPSRT), choosing between behavioral and pharmacologic treatments for insomnia, and avoiding sleep medications that may destabilize mood. The episode offers a clinically focused approach to improving relapse prevention through better sleep management.   Holly A. Swartz, MD, is Professor of Psychiatry at the University of Pittsburgh, Director of the Center for Advanced Psychotherapy, and Medical Director of the Depression and Manic Depression Prevention Program. An internationally recognized expert in bipolar disorder treatment, she is President of the International Society for Bipolar Disorders and known for advancing Interpersonal and Social Rhythm Therapy (IPSRT), an evidence-based approach targeting sleep, circadian rhythms, and mood stabilization to prevent relapse.  Andrew J. Cutler, MD, is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and EMA Wellness. He is a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Resources  The Social Rhythm Therapy Workbook for Bipolar Disorder  Bipolar II Disorder  Interpersonal and Social Rhythm Therapy – ipsrt.org  Depression and Bipolar Support Alliance – dbsalliance.org    Save $100 on registration for 2026 NEI Spring Congress with code NEIPOD26  Register today at nei.global/spring    Never miss an episode!🎙SUBSCRIBE to the NEI Podcast– available on all your favorite platforms: https://nei.global/podcast  Interested in Psychopharmacology?  Learn about the NEI Master Psychopharmacology Program: https://nei.global/mpp   Stay updated with email alerts and join our conversations on social. Follow us on:  YouTube: https://nei.global/youtube  Instagram: https://nei.global/instagram  LinkedIn: https://nei.global/linkedin  Facebook: https://nei.global/facebook  X: https://nei.global/twitter

In this revisited episode, Dr. Robyn Thom discusses autism spectrum disorder (ASD) and the psychiatric comorbidities that frequently accompany it. She reviews how ASD is diagnosed, the core domains of social communication differences and restricted or repetitive behaviors, and why treatment often focuses on co-occurring conditions such as anxiety, ADHD, sleep disorders, and agitation. Dr. Thom also shares practical strategies for evaluating agitation, distinguishing overlapping symptoms, and selecting behavioral and pharmacologic interventions to support patients with ASD across the lifespan.  Robyn Thom, MD, is an Assistant Professor of Psychiatry at Harvard Medical School and a staff psychiatrist at the Massachusetts General Hospital Lurie Center for Autism. She specializes in treating children and adults with autism spectrum disorder and other neurodevelopmental conditions, with clinical and research interests in psychiatric comorbidities, anxiety, and mood disorders. Save $100 on registration for 2026 NEI Spring Congress with code NEIPOD26  Register today at nei.global/spring  Never miss an episode!🎙SUBSCRIBE to the NEI Podcast– available on all your favorite platforms: https://nei.global/podcast  Interested in Psychopharmacology?  Learn about the NEI Master Psychopharmacology Program: https://nei.global/mpp   Stay updated with email alerts and join our conversations on social. Follow us on:  YouTube: https://nei.global/youtube  Instagram: https://nei.global/instagram  LinkedIn: https://nei.global/linkedin  Facebook: https://nei.global/facebook  X: https://nei.global/twitter 

In this episode, Dr. Andy Cutler talks with Dr. Robert Cotes about optimizing outcomes in early psychosis and why the first episode is a critical window for intervention. They discuss the impact of duration of untreated psychosis, recovery trajectories after a first episode, and what to measure beyond symptom reduction—including functional outcomes, cognition, and relapse risk. The conversation also highlights strategies for engaging young adults and families in coordinated specialty care, early identification of clinical high risk for psychosis, and innovations aimed at improving long-term recovery.  Robert O. Cotes, MD, is Professor of Psychiatry and Behavioral Sciences at Emory University School of Medicine and Chief of Psychiatry at Grady Health System in Atlanta. He directs the Clinical and Research Program for Psychosis at Grady, which includes Project ARROW, a coordinated specialty care program for young people with early psychosis, and a specialized clozapine clinic for treatment-resistant schizophrenia.    Andrew J. Cutler, MD, is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and EMA Wellness. He is a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Save $100 on registration for 2026 NEI Spring Congress with code NEIPOD26  Register today at nei.global/spring  Never miss an episode!🎙SUBSCRIBE to the NEI Podcast– available on all your favorite platforms: https://nei.global/podcast  Interested in Psychopharmacology?  Learn about the NEI Master Psychopharmacology Program: https://nei.global/mpp   Stay updated with email alerts and join our conversations on social. Follow us on:  YouTube: https://nei.global/youtube  Instagram: https://nei.global/instagram  LinkedIn: https://nei.global/linkedin  Facebook: https://nei.global/facebook  X: https://nei.global/twitter 

PsychopharmaPearls is NEI's focused podcast series highlighting the clinical insights that can sharpen your prescribing decisions. In this episode, Dr. Andy Cutler talks with Dr. Lisa Harding about how to choose between IV ketamine and intranasal esketamine for patients with difficult-to-treat depression. They unpack the differences that truly matter in practice—from patient selection and monitoring to access, cost, and common missteps. Tune in for practical pearls you can immediately apply to select the right treatment for the right patient.  Lisa Harding, MD is a board-certified psychiatrist and nationally recognized depression specialist with deep expertise in interventional psychiatry. She has performed more than 4,000 procedures, including electroconvulsive therapy (ECT), intravenous ketamine, intranasal esketamine, and transcranial magnetic stimulation (TMS). Dr. Harding is known for her thoughtful approach to complex, treatment-resistant depression, integrating advanced somatic therapies, psychopharmacology, and psychotherapy. She serves as an Assistant Clinical Professor of Psychiatry at Yale University in New Haven, Connecticut.  Andrew J. Cutler, MD is a leading psychiatrist, psychopharmacology expert, and clinical researcher with decades of experience in CNS drug development. As Chief Medical Officer of Neuroscience Education Institute and EMA Wellness, he brings frontline clinical insight together with deep knowledge of the evidence base. Dr. Cutler is widely recognized for translating research into practical guidance for everyday practice and serves as a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Resources  Sanacora G et al. A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders. JAMA Psychiatry 2017;74(4):399-405. doi:10.1001/jamapsychiatry.2017.0080  McIntyre RS et al. Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. Am J Psychiatry 2021;178(5):383-399. doi:10.1176/appi.ajp.2020.20081251    Save $100 on registration for 2026 NEI Spring Congress with code NEIPOD26  Register today at nei.global/spring    Never miss an episode!🎙SUBSCRIBE to the NEI Podcast– available on all your favorite platforms: https://nei.global/podcast  Interested in Psychopharmacology?  Learn about the NEI Master Psychopharmacology Program: https://nei.global/mpp   Stay updated with email alerts and join our conversations on social. Follow us on:  YouTube: https://nei.global/youtube  Instagram: https://nei.global/instagram  LinkedIn: https://nei.global/linkedin  Facebook: https://nei.global/facebook  X: https://nei.global/twitter

In this episode, Dr. Andy Cutler talks with Dr. Tim Wilens about enduring myths surrounding ADHD diagnosis and treatment, beginning with why misconceptions about overdiagnosis and misuse continue to shape clinical hesitation. They explore common misunderstandings about ADHD medications—including stimulants versus non-stimulants, concerns about diversion, personality changes, and long-term safety—and contrast stigma-driven narratives with the clinical evidence. The conversation equips clinicians with practical, evidence-based strategies to address patient fears, counter misinformation, and make thoughtful, individualized treatment decisions.  Timothy Wilens, MD, is chief of the Division of Child and Adolescent Psychiatry and is co-director of the Center for Addiction Medicine at Massachusetts General Hospital. He is the MGH Trustees Chair in Addiction Medicine and a professor of psychiatry at Harvard Medical School. Dr. Wilens' research interests include the relationship among attention deficit/hyperactivity disorder (ADHD), bipolar disorder, and substance use disorders, embedded health care models, and the pharmacotherapy of ADHD across the lifespan.   Andrew J. Cutler, MD, is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and EMA Wellness. He is a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Save $100 on registration for 2026 NEI Spring Congress with code NEIPOD26  Register today at nei.global/spring  Never miss an episode!🎙SUBSCRIBE to the NEI Podcast– available on all your favorite platforms: https://nei.global/podcast  Interested in Psychopharmacology?  Learn about the NEI Master Psychopharmacology Program: https://nei.global/mpp   Stay updated with email alerts and join our conversations on social. Follow us on:  YouTube: https://nei.global/youtube  Instagram: https://nei.global/instagram  LinkedIn: https://nei.global/linkedin  Facebook: https://nei.global/facebook  X: https://nei.global/twitter

In this episode, Dr. Andy Cutler speaks with Dr. Jonathan Meyer to dispel common myths about antipsychotic treatment, from concerns about sedation, personality change, and brain effects to misunderstandings about safety, long-acting injectables, and clozapine. The discussion focuses on what the evidence actually shows about efficacy, risk, and recovery, and how clinicians can communicate more clearly and confidently with patients and families.  Jonathan Meyer, MD, DLFAPA, is a Voluntary Clinical Professor of Psychiatry at the University of California, San Diego. He serves as a Senior Academic Advisor to the California Department of State Hospitals, is a psychopharmacology consultant to the first episode psychosis program at Balboa Naval Medical Center, and has published extensively on psychopharmacology, including co-authoring The Clozapine Handbook, The Clinical Use of Antipsychotic Plasma Levels, and The Lithium Handbook with Dr. Stephen Stahl.  Andrew J. Cutler, MD, is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and EMA Wellness. He is a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Save $100 on registration for 2026 NEI Spring Congress with code NEIPOD26  Register today at nei.global/spring  Never miss an episode!🎙SUBSCRIBE to the NEI Podcast– available on all your favorite platforms: https://nei.global/podcast  Interested in Psychopharmacology?  Learn about the NEI Master Psychopharmacology Program: https://nei.global/mpp   Stay updated with email alerts and join our conversations on social. Follow us on:  YouTube: https://nei.global/youtube  Instagram: https://nei.global/instagram  LinkedIn: https://nei.global/linkedin  Facebook: https://nei.global/facebook  X: https://nei.global/twitter 

In this episode, Dr. Andy Cutler and Dr. Jeff Strawn unpack common misconceptions that complicate real-world use of antidepressants. They review evidence on efficacy, suicidality risk, mechanisms, and early side effects, and discuss how to navigate hesitancy and misinformation. The conversation also addresses when to start medication, how to balance caution with timely intervention in youth, and practical ways to strengthen trust and therapeutic alliance.  Jeffrey R. Strawn, MD, FAACAP, is a Professor of Psychiatry, Pediatrics, and Clinical & Translational Pharmacology at the University of Cincinnati (UC) in Cincinnati, Ohio. He is the Director of the UC Anxiety Disorders Research Program and the Associate Vice Chair of Research in the Department of Psychiatry & Behavioral Neuroscience at UC.   Andrew J. Cutler, MD, is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and EMA Wellness. He is a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Resources  Zhang K et al. Functional connectivity predicting transdiagnostic treatment outcomes in internalizing psychopathologies. JAMA Netw Open 2025;8(9):e2530008. doi: 10.1001/jamanetworkopen.2025.30008  Lagerberg T et al. Selective serotonin reuptake inhibitors and suicidal behaviour: a population-based cohort study. Neuropsychopharmacology 2022;47(4):817-23. doi: 10.1038/s41386-021-01179-z  Never miss an episode!🎙SUBSCRIBE to the NEI Podcast– available on all your favorite platforms: https://nei.global/podcast  Interested in Psychopharmacology?  Learn about the NEI Master Psychopharmacology Program: https://nei.global/mpp   Stay updated with email alerts and join our conversations on social. Follow us on:  YouTube: https://nei.global/youtube  Instagram: https://nei.global/instagram  LinkedIn: https://nei.global/linkedin  Facebook: https://nei.global/facebook  X: https://nei.global/twitter 

As 2025 comes to an end, we revisit our most downloaded episode of the year. Join Dr. Andy Cutler and Dr. Carla Sharp as they explore the current conceptualization of borderline personality disorder (BPD), including diagnostic challenges, evidence-based treatments, and strategies to reduce stigma by framing BPD as a treatable condition. The conversation also highlights recent updates to the APA's BPD guidelines and what they mean for clinical practice.  Carla Sharp, PhD is a distinguished clinical psychologist specializing in developmental psychopathology, particularly borderline personality disorder (BPD). She is a professor in the Clinical Psychology Doctoral Program and serves as the Associate Dean for Faculty and Research at the University of Houston. Additionally, she directs both the Adolescent Diagnosis, Assessment, Prevention, and Treatment Center and the Developmental Psychopathology Lab at the university.    Andrew J. Cutler, MD, is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and holds the position of Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Never miss an episode!🎙SUBSCRIBE to the NEI Podcast– available on all your favorite platforms: https://nei.global/podcast  Interested in Psychopharmacology?  Learn about the NEI Master Psychopharmacology Program: https://nei.global/mpp   Stay updated with email alerts and join our conversations on social. Follow us on:  YouTube: https://nei.global/youtube Instagram: https://nei.global/instagram LinkedIn: https://nei.global/linkedin Facebook: https://nei.global/facebook X: https://nei.global/twitter

Join Drs. Andy Cutler and Roger McIntyre as they discuss the most significant advancements in psychopharmacology over the past year. Their conversation highlights groundbreaking developments and innovations in the field of psychiatry.   Roger McIntyre, MD, FRCPC, is a globally recognized psychiatrist and psychopharmacologist who holds pivotal roles in academia, research, and leadership. His research primarily focuses on the phenomenology, neurobiology, and development of novel therapeutics for mood disorders. Dr. McIntyre is currently a Professor of Psychiatry and Pharmacology at the University of Toronto.   Andrew J. Cutler, MD, is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and holds the position of Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Resources  Thanarajah ES et al. Soft drink consumption and depression mediated by gut microbiome alterations. JAMA Psychiatry 2025;82(11):1095–1102. doi:10.1001/jamapsychiatry.2025.2579  Durgam S et al. Lumateperone as adjunctive therapy in patients with major depressive disorder: results from a randomized, double-blind, phase 3 trial. J Clin Psychiatry 2025;86(4):25m15848. doi: 10.4088/JCP.25m15848  Hendershot CS et al. Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry 2025;82(4):395–405. doi: 10.1001/jamapsychiatry.2024.4789  Aron L et al. Lithium deficiency and the onset of Alzheimer's disease. Nature 2025;645:712–21. doi: 10.1038/s41586-025-09335-x  Never miss an episode!🎙SUBSCRIBE to the NEI Podcast– available on all your favorite platforms: https://nei.global/podcast  Interested in Psychopharmacology?  Learn about the NEI Master Psychopharmacology Program: https://nei.global/mpp   Stay updated with email alerts and join our conversations on social. Follow us on:  YouTube: https://nei.global/youtube  Instagram: https://nei.global/instagram  LinkedIn: https://nei.global/linkedin  Facebook: https://nei.global/facebook  X: https://nei.global/twitter