E290 - ADHD and Substance Use Disorders: Treatment Challenges with Dr. Timothy Wilens

In this episode, Dr. Andy Cutler speaks with Dr. Tim Wilens about the complex relationship between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders. They discuss how to distinguish ADHD from substance-related cognitive symptoms, determine when co-occurring conditions should be treated concurrently, and select appropriate ADHD medications based on the substance involved. Dr. Wilens also examines stimulant misuse and diversion, the role of nonstimulants, what is known about centanafadine's abuse potential, and practical approaches to monitoring treatment without undermining the therapeutic relationship.  Timothy E. 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 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.  Fall Congress   Get $100 off NEI Fall Congress registration with code POD26. Go to https://nei.global/fall to sign up today!   Membership  As a valued NEI Podcast listener, Dr. Cutler's offering you 20% off new NEI Membership with code CUTLER20. Go to https://nei.global/member and join now!  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

Originally released in 2021, this episode features Dr. Thomas Schwartz discussing common mistakes in psychopharmacology and how psychiatric clinicians can recognize and manage them. He explores diagnostic uncertainty, medication dosing, informed consent and monitoring, and rational versus irrational polypharmacy. He also considers how clinicians can reassess inherited diagnoses, learn from prescribing errors, and preserve the therapeutic relationship when mistakes occur.   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.  Fall Congress  Get $100 off NEI Fall Congress registration with code POD26. Go to https://nei.global/fall to sign up today!  Membership  As a valued NEI Podcast listener, Dr. Cutler's offering you 20% off new NEI Membership with code CUTLER20. Go to https://nei.global/member and join now!  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 of PsychopharmaPearls, Dr. Andy Cutler and Dr. Will Sauvé discuss what clinicians need to know about kratom. They review why patients use it, signs of misuse, dependence, or withdrawal, and key pharmacologic and safety concerns. The conversation also offers practical guidance for discussing kratom use and incorporating it into treatment planning.  William Sauvé, MD, is a board-certified psychiatrist and Chief Medical Officer at Osmind. He has extensive experience in interventional psychiatry, including TMS and esketamine, and previously served for 11 years as an active-duty Navy psychiatrist. He also serves on the faculty of the Neuroscience Education Institute.  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.   Fall Congress  Get $100 off NEI Fall Congress registration with code POD26. Go to https://nei.global/fall to sign up today!   Membership  As a valued NEI Podcast listener, Dr. Cutler's offering you 20% off new NEI Membership with code CUTLER20. Go to https://nei.global/member and join now!  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  X: https://nei.global/twitter  Instagram: https://nei.global/instagram  Facebook: https://nei.global/facebook  LinkedIn: https://nei.global/linkedin

In this episode, Dr. Andy Cutler is joined by Drs. Stephen Stahl and Jeffrey Strawn to discuss deprescribing practices in psychiatry. They explore why deprescribing is an essential clinical skill, how to determine whether a patient still needs a medication, dose, or combination, and how to approach tapering in a way that balances relapse prevention, withdrawal risk, and patient-centered care. The conversation also covers practical considerations for deprescribing antidepressants, antipsychotics, benzodiazepines, and sedative-hypnotics, with attention to common pitfalls and strategies for safer, more intentional medication management.  Stephen M. Stahl, MD, PhD, DSc (Hon.), is a psychiatrist, psychopharmacologist, and internationally recognized educator in clinical neuroscience and psychopharmacology. He is the author of widely used educational resources including Stahl's Essential Psychopharmacology, Stahl's Prescriber's Guide, and Stahl's Deprescriber's Guide, and his work focuses on translating complex neurobiology into practical clinical concepts for mental health clinicians.  Jeffrey R. Strawn, MD, FAACAP, is a Professor of Psychiatry, Pediatrics, and Clinical & Translational Pharmacology at the University of Cincinnati, Ohio. He is Director of the UC Anxiety Disorders Research Program and Associate Vice Chair of Research in the Department of Psychiatry & Behavioral Neuroscience at UC, and he is the author of Stahl's Deprescriber's Guide.  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  Strawn, JR, Stahl SM. Stahl's Deprescriber's Guide. Cambridge University Press; 2026. https://doi.org/10.1017/9781009642187  Fall Congress   Get $100 off NEI Fall Congress registration with code POD26. Go to https://nei.global/fall to sign up today!   Membership  As a valued NEI Podcast listener, Dr. Cutler's offering you 20% off new NEI Membership with code CUTLER20. Go to https://nei.global/member and join now!  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 is joined by Dr. Roger McIntyre to discuss GLP-1 receptor agonists in psychiatry and why these medications may be relevant beyond weight loss. They explore the emerging role of GLP-1s in metabolic psychiatry, including potential connections with mood disorders, cognition, reward pathways, cardiometabolic health, and psychiatric medication-associated weight gain. Dr. McIntyre also discusses what psychiatric providers should know now, where the evidence is still evolving, and what future research is needed before GLP-1 or incretin-based therapies could be considered part of psychiatric treatment.  Roger S. McIntyre, MD, FRCPC, is Professor of Psychiatry and Pharmacology at the University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network in Toronto. He is an internationally recognized expert in mood disorders and psychopharmacology, with published scholarship and presentations exploring the relevance of GLP-1 receptor agonists to 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.  Fall Congress   Get $100 off NEI Fall Congress registration with code POD26. Go to https://nei.global/fall to sign up today!   Membership  As a valued NEI Podcast listener, Dr. Cutler's offering you 20% off new NEI Membership with code CUTLER20. Go to https://nei.global/member and join now!  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 

Originally released in June 2023, this episode features Dr. Cynthia Bulik in a discussion of eating disorders, nutrition, and the brain. The conversation explores anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, common misconceptions about eating disorders, and the evolving understanding of how biology, genetics, and environment shape risk, diagnosis, and recovery.   Cynthia Bulik, PhD, FAED, is a Distinguished Professor of Eating Disorders in the Department of Psychiatry at the University of North Carolina at Chapel Hill and Professor of Nutrition in the Gillings School of Global Public Health. She is the founding director of the UNC Center of Excellence for Eating Disorders and directs the Centre for Eating Disorders Innovation at Karolinska Institutet, with research focused on the biology, genetics, prevention, and treatment of eating disorders.  Fall Congress   Get $100 off NEI Fall Congress registration with code POD26. Go to https://nei.global/fall to sign up today!   Membership  As a valued NEI Podcast listener, Dr. Cutler's offering you 20% off new NEI Membership with code CUTLER20. Go to https://nei.global/member and join now!  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. Bhagwan Bahroo about nutritional interventions in psychiatry, including diet, supplements, metabolic health, inflammation, and the gut-brain axis. They explore where the evidence is strongest, where hype outpaces the data, and how clinicians can discuss nutritional strategies as adjunctive tools without losing focus on core treatments.  Bhagwan A. Bahroo, MD, DLFAPA, is a board-certified psychiatrist in adult, addiction, and forensic psychiatry and an Assistant Professor at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He has extensive clinical experience at Walter Reed National Military Medical Center and has worked in interventional psychiatry, including TMS and esketamine, with an interest in nutrition and its role in mental health.   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.   Fall Congress   Get $100 off NEI Fall Congress registration with code POD26. Go to https://nei.global/fall to sign up today!   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 of PsychopharmaPearls, Dr. Andy Cutler talks with Dr. Leslie Citrome about akathisia, a common but often misdiagnosed antipsychotic side effect that can look like agitation, anxiety, irritability, or worsening psychiatric symptoms. They discuss how to recognize akathisia in clinical practice, distinguish it from true agitation, identify key timing and symptom clues, and avoid common treatment mistakes, including why benztropine is not an appropriate treatment for akathisia.  Leslie Citrome, MD, MPH, is Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College and an internationally recognized expert in psychopharmacology and clinical trial interpretation. He has authored more than 600 scientific publications and frequently lectures on applying research findings to real-world psychiatric practice.  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.   Fall Congress   Get $100 off NEI Fall Congress registration with code POD26. Go to https://nei.global/fall to sign up today!   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 

This episode features extended Q&A sessions addressing unanswered audience questions from select presentations delivered at the 2026 NEI Spring Congress in Kissimmee, Florida:   (00:53) From Avoidance to Action: Evidence-based Pathways to Recovery for Difficult-to-Treat Anxiety by Jeffrey R. Strawn, MD, FAACAP  (15:21) Perhaps the Grass Is Greener: Why, When, and How to Switch or Combine Treatments for Schizophrenia by Christoph U. Correll, MD  (34:42) The Other Side of Motherhood: Advances in the Treatment of Postpartum Mood and Anxiety Disorders by Jennifer L. Payne, MD  Fall Congress   Get $100 off NEI Fall Congress registration with code POD26. Go to https://nei.global/fall to sign up today!   Membership   As a valued NEI Podcast listener, Dr. Cutler's offering you 20% off new NEI Membership with code CUTLER20. Go to https://nei.global/member and join now!  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. Neill Epperson about how to evaluate cognitive complaints in women. They discuss how to differentiate between ADHD, hormonal changes (such as perimenopause), mood and anxiety disorders, and age-related cognitive decline. The conversation highlights key clinical clues, including symptom timing and fluctuation, to improve diagnostic accuracy. Practical strategies for assessment and treatment are reviewed to help clinicians make more informed, individualized decisions.   C. Neill Epperson, MD, is the Robert Freedman Endowed Professor and Chair of the Department of Psychiatry at the CU Anschutz School of Medicine. She is an internationally recognized expert in women's mental health, with research focused on the effects of hormonal transitions—such as puberty, pregnancy, and menopause—on mood, cognition, and psychiatric disorders.  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.  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