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Recent episodes
Catching Cognitive Decline Early with Gary W. Small, MD
May 5, 2026
Unknown duration
The Emerging Role of GLP-1s in Psychiatry with Roger S. McIntyre, MD, FRCPC
Apr 21, 2026
Unknown duration
Bridging Research and Reality in Mental Health Care with A. John Rush, MD
Apr 7, 2026
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What Clinicians Should Know About Alzheimer’s Treatment with Marc Agronin, MD
Mar 24, 2026
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Behind the Manuscript: Inpatient Treatment of Suicidality with Brett Jones, MD, MSc, PhD, FRCPC
Mar 10, 2026
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| Date | Episode | Description | Length | ||||||
|---|---|---|---|---|---|---|---|---|---|
| 5/5/26 |  Catching Cognitive Decline Early with Gary W. Small, MD | Dr. Gary W. Small, Director of Behavioral Health Breakthrough Therapies at Hackensack Meridian Health and Professor of Psychiatry and Behavioral Health at the Hackensack Meridian School of Medicine, shares decades of clinical and research insight as he discusses the early detection and treatment of age-related cognitive decline. In this episode, he explores the continuum from normal aging to mild cognitive impairment to dementia, the real-world role of biomarkers, the promise and limits of current pharmacologic options, and the lifestyle interventions—especially aerobic exercise—with the strongest data behind them.For most patients, cognitive decline unfolds gradually rather than suddenly, and the tools we have to detect it have outpaced the clarity of what to do next. Amyloid and tau assays, PET imaging, and APOE genotyping are increasingly available in primary care, but they raise as many questions as they answer, and disclosure can have real psychological consequences. Emerging evidence points to inflammation as a shared mechanism across many forms of decline, with anti-inflammatory drugs, curcumin, Omega-3s, sleep, and exercise all converging on the same target. Dr. Small frames a pragmatic, patient-centered approach: educate, contextualize tests, rule out reversible causes, treat symptomatically and aggressively when appropriate, and above all, move.🧠 PROTECT, DON’T REPAIR [05:10]:“It’s easier to protect a healthy brain rather than try to repair damage once it becomes extensive.”Dr. Small articulates the case for early detection and prevention that has shaped his entire career.🔬 TREAT THE PERSON, NOT THE SCAN [23:40]:“You don’t treat a blood test, you treat a person. The good news with some of these early anti-amyloid drugs—the brain scan looks great. The bad news is, you’re going to forget this conversation.”Dr. Small urges clinicians to resist reflexive, biomarker-driven treatment and instead anchor decisions in symptoms, goals, and risk–benefit conversations.🏃 ONE RECOMMENDATION ABOVE ALL [44:50]:“Physical exercise. There’s no question about it. We have the strongest data on it… Get on the treadmill, or even better, get outside and take a brisk walk or jog.”Asked for a single, universal recommendation for brain health, Dr. Small is unequivocal.CHAPTERS:00:00 - Introducing Dr. Gary W. Small02:20 - From Math to Metaphysics to Medicine03:30 - Finding a Path into Psychiatry04:20 - The Road to Geriatric Psychiatry and the Case for Early Detection06:10 - Defining the Continuum: Normal Aging, MCI, and Dementia09:00 - Interpreting Cognitive Complaints and the Weight of Information12:30 - The Biology of Cognitive Decline and the Role of Inflammation16:00 - What Is Lost When We Wait, and the Curcumin Story20:20 - The PCP’s Role in Early Intervention and Lifestyle Counseling22:10 - Biomarkers and Imaging: From Research Tool to Clinical Reality25:00 - Biomarker vs. Surrogate Marker27:20 - Differential Diagnosis and the Brain as a Rheostat29:30 - Pharmacologic Treatment: Symptomatic vs. Disease-Modifying Drugs32:40 - Lifestyle Modification and the Evidence for Aerobic Exercise35:40 - Train, Don’t Strain: Exercising the Mind Socially37:50 - Knowing When to Refer and Building Specialist Relationships41:00 - Comorbid Conditions and the Whole-Person Approach42:40 - Looking Ahead: The Next 5–10 Years44:20 - The Single Best Recommendation: Physical Exercise45:30 - Closing ThoughtsLinks:Full transcript and show notes: https://www.psychiatrist.com/jcp/ep14-early-detection-cognitive-decline-gary-w-small/ Journal of Clinical Psychiatry: https://www.psychiatrist.com/jcp/Dr. Gary W. Small: https://www.hmhn.org/find-a-provider#CognitiveDecline #AlzheimersDisease #GeriatricPsychiatry #BrainHealth | — | ||||||
| 4/21/26 |  The Emerging Role of GLP-1s in Psychiatry with Roger S. McIntyre, MD, FRCPC | Dr. Roger S. McIntyre, Professor of Psychiatry and Pharmacology at the University of Toronto, shares groundbreaking insights as he discusses the profound connection between metabolism and mental well-being. In this episode, he explores how GLP-1s treat psychiatric illness and common metabolic comorbidities.The historical reliance on serotonin, norepinephrine, and dopamine models has proven incomplete, and many individuals with psychiatric illness continue to struggle with inadequate care. New science suggests a deeper connection between metabolism and brain health which challenges long-held beliefs about disease causes. Emerging research highlights how metabolic disruptions contribute to mental health conditions, and that GLP-1 drugs offer a path forward as they could treat mental health conditions and common metabolic problems. In essence, they have the potential to bring about profound improvements in mental health and overall well-being.⚠️ BEYOND NEUROTRANSMITTERS [07:53]:"For seven decades, we've really been at this altar of serotonin, norepinephrine and dopamine… That paradigm has been remarkably durable… but it's not been fully explanatory. Most people do not benefit adequately from current treatments."Explaining why traditional models are incomplete, Dr. McIntyre shows how new science offers hope.💊 COMBAT MEDICATION SIDE EFFECTS [45:34]:"Clinicians would be certainly on a reasonable evidentiary base of practice if they were prescribing a GLP-1 to target, for example, clozapine-induced weight gain or clozapine-induced diabetes, that would be reasonable."Dr. McIntyre offers a proven strategy for mitigating adverse effects of psychiatric medications.🚀 TRANSFORMING LIFESPANS [01:04:30]:"GLP-1s… have the potential to transform the health span and the lifespan of people living with mental illnesses by targeting on-label considerations today and potentially targeting the underlying pathophysiology of the brain-based disorder tomorrow. So stay tuned."Revealing the future of mental health, Dr. McIntyre presents a vision that offers new hope for long-term well-being.CHAPTERS:00:00 - Why GLP-1 Drugs Are Transforming Mental Health Research03:08 - The Career Shift That Linked Metabolism and Mood Disorders06:45 - Moving Beyond Serotonin to Metabolism13:18 - How GLP-1 Drugs Influence Brain Function and Neuroplasticity23:40 - Can GLP-1 Medications Reach the Brain? What the Evidence Shows32:00 - The Four Key Brain-Protective Effects of GLP-1 Therapies34:54 - How GLP-1 Reduces Cravings, Addiction, and Food Noise42:18 - When Clinicians Should Prescribe GLP-1s in Psychiatry Today53:10 - Safety Risks and Drug Interactions Psychiatrists Must Consider01:00:57 - The Future of Treatments in Psychiatry01:04:27 - Summing Up GLP-1s and Mental HealthLinks:Full transcript and show notes: https://www.psychiatrist.com/jcp/ep13-emerging-role-glp-1s-psychiatry-roger-s-mcintyre/Journal of Clinical Psychiatry: psychiatrist.com/jcp/Dr. Roger S. McIntyre: https://www.linkedin.com/in/roger-mcintyre-976bb167/#GLP1Drugs #AddictionTreatment #DepressionTreatment #MentalIllnessPrevention | — | ||||||
| 4/7/26 |  Bridging Research and Reality in Mental Health Care with A. John Rush, MD | Dr. A. John Rush, renowned for leading the famous STAR*D depression study, addresses a critical challenge in modern psychiatry: while physicians often rely on their clinical intuition to treat complex depression, new data proves this approach has a significant blind spot. Experience alone can miss the full extent of a patient's suffering, leaving crucial progress untracked.Dr. Rush reveals a system to fix this clinical blind spot using the psychology of clinical measurement. He explains how doctors can implement simple assessment tools to gather objective data, leading to more precise treatment adjustments. This straightforward method gives physicians the power to see what is truly working and can significantly boost patient remission rates.🎯 BIGGEST LESSON [12:17]:"By bringing measurement to the bedside, we bring precision and science. The evidence is very clear right now. We make better decisions about what to do with patients."🎯 OTHER KEY TAKEAWAYS:⚠️ THE HIDDEN GAP IN PSYCHIATRIC CARE [8:10]:"We don't know anything about in what order, in what combination, and by what methodology we implement that 'what'."Dr. Rush explains why knowing a treatment can work is only half the battle. This is the crucial gap between research and real-world results that most clinicians overlook.✨ WHY 'PROVEN' TREATMENTS FAIL YOUR PATIENTS [20:45]:"Does this apply to everybody with depression, no matter how they show up? Absolutely not. That's where it really gets very, very interesting because now we're going from efficacy research to effectiveness research."Learn the critical difference between a treatment working in a controlled trial versus in your complex, real-world patient population.⚡ THE LAW OF DIMINISHING RETURNS IN DEPRESSION [34:57]:"The more steps you take, the problem is, the less likely you are to get into remission. So remission rates were like 35% in the first step, 28% in the second step, 15% in the third step, 15% in the fourth step."Dr. Rush reveals the stark data from the STAR*D study. Use this critical insight to set realistic expectations with patients about the challenges of treatment-resistant depression.CHAPTERS:00:00 - Introducing Dr. A. John Rush02:20 - Why Dr. Rush Chose Psychiatry & a Career in Clinical Research05:45 - How Cognitive Therapy Shaped Evidence-Based Psychiatry07:10 - Strategies, Tactics, and the Research Gap10:59 - Using AI & Clinical Data to Guide Treatment Decisions18:39 - Why Clinical Trial Results Don't Match Real-World Patients22:54 - Pragmatic Trials That Reflect Everyday Psychiatric Practice30:48 - The STAR*D Trial: Sequencing Treatments for Depression36:32 - Dose Optimization & Long-Term Depression Recovery39:56 - Building a Learning Healthcare System in Psychiatry43:48 - Dr. Rush’s Advice for Researchers and CliniciansLinks:Full transcript and show notes: https://www.psychiatrist.com/jcp/ep12-bridging-research-reality-mental-health-care-a-john-rushJournal of Clinical Psychiatry: psychiatrist.com/jcp/Dr. A. John Rush: https://www.linkedin.com/in/a-john-rush-8aa46042/American Psychiatric Association (APA) Website: https://www.psychiatry.org/psychiatrists/research/registry#Psychiatry #ClinicalResearch #Depression | — | ||||||
| 3/24/26 |  What Clinicians Should Know About Alzheimer’s Treatment with Marc Agronin, MD | Families expect cognitive decline as a normal part of getting older. We watch relatives lose their memories and accept the loss. Past medical trials regarding Alzheimer's disease failed 99 percent of the time, early signs of brain changes were missed, and precious years for early screening and treatment were lost.But new science changes this reality. Doctors now use blood tests and brain imaging for accurate diagnosis. They prescribe immunotherapy treatments that clear toxic brain plaques and slow cognitive decline by 30 percent. Dr. Marc Agronin shares his exact methods for geriatric psychiatry and dementia care. Learn how early medical intervention stops memory loss as he reveals his new research.🎯 PRIMARY DISCOVERY[19:51]:"Someone goes from thinking, ‘I have a terminal disease,’ to ‘I have a manageable disease and I am going to continue to live and do things.’ Their whole mindset changes."Dr. Agronin reveals the exact medical advancements that give patients their lives back.🩺 PRACTICE UPGRADE [30:56]:"We have all sorts of vital signs we check by routine. We need to have a cognitive vital sign that we check, and something like a Mini-Mental, Montreal Cognitive Assessment, something like that is practical to be done in primary care."Discover how doctors catch memory loss early with simple annual tests.✨ MEDICAL MILESTONE [46:29]:"We see over the 18 months of the studies that the rate of decline in terms of both cognition and function is on average about 30 percent slower. And then we know that after 18 months, it is a very slow rate of reaccumulation."Hear how new monoclonal antibodies melt away brain plaques and stop memory loss.CHAPTERS:00:00 - Meet Alzheimer’s Research Leader Dr. Marc Agronin01:45 - Why a Career in Geriatric Psychiatry and Dementia Care?06:17 - Why Alzheimer’s Research Is Entering a Breakthrough Era08:07 - Why Alzheimer’s Disease Is Rising Worldwide11:04 - How to Explain Alzheimer’s Diagnosis to Patients and Families16:11 - The Biggest Scientific Breakthroughs in Alzheimer’s Disease24:30 - How New Biomarker Guidelines Are Changing Alzheimer’s Diagnosis29:57 - Why Early Screening for Cognitive Decline Matters36:13 - Brain Health Habits That May Reduce Alzheimer’s Risk42:50 - Current Alzheimer’s Medications and How They Help Cognition45:45 - New Anti-Amyloid Treatments That Slow Alzheimer’s Progression50:01 - Understanding ARIA Side Effects in Alzheimer’s Immunotherapy54:09 - Emerging Alzheimer’s Treatments and Future Research Directions01:02:09 - The Role of Empathy and Person-Centered Dementia CareLinks:Full transcript and show notes: https://www.psychiatrist.com/jcp/ep11-what-clinicians-should-know-about-alzheimers-treatment-marc-agronin/ Journal of Clinical Psychiatry: psychiatrist.com/jcp/Dr. Marc Agronin: https://www.marcagronin.com/Figure referenced at 53:35 comes from Figure 1 in the paper “Alzheimer’s Disease Drug Development Pipeline: 2025.”: https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/trc2.70098#AlzheimersResearch #BrainHealth #GeriatricPsychiatry | — | ||||||
| 3/10/26 |  Behind the Manuscript: Inpatient Treatment of Suicidality with Brett Jones, MD, MSc, PhD, FRCPC | Psychiatric hospitals admit patients for severe mental illness and high suicide risk every day. While mental health professionals treat acute suicidality during these intense crises, standard depression medications can take weeks to work. Traditional clinical psychiatry often leaves vulnerable patients in danger after hospital discharge. Medical teams need rapid suicide prevention treatments to help stabilize psychiatric inpatients quickly.Learn about potential improvements to inpatient suicide care as Dr. Brett Jones, Medical Head of the Bipolar Disorder Clinic at Toronto’s Center for Addiction and Mental Health, reveals the results of his research review into the best evidence-based medical interventions.🎯 KEY EPISODE HIGHLIGHTS:🛑 RESEARCH BLINDSPOT [10:25]:"I think there are a lot of studies out there. I was reading, I was seeing the evidence, but the consensus as to what would be the most effective treatment and for whom really wasn't there."Hear Dr. Jones explain the massive missing piece in psychiatric care.🧠 CLINICAL BREAKTHROUGH [23:45]:"Some of the chronotherapy was something I actually didn't know about. That certainly is a low cost intervention. So that's quite promising if it turns out to be effective."See how simple sleep treatments change inpatient psychiatry.🛠️ STRATEGIC ACTION [34:50]:"We showed a good effect with a digital version of DBT… So we're going to look at trying to replicate that in a multicenter study."Get the exact details on digital therapy for hospital units.CHAPTERS:00:00 - Honoring Dr. Nolan Williams03:07 - Career Path into Psychiatry and Suicide Research07:59 - Why Inpatient Suicide Treatment Needs Better Evidence12:59 - Key Limitations in Suicide Intervention Research14:57 - Ketamine and Rapid Acting Treatments for Suicidality19:48 - Emerging Treatments Beyond Traditional Depression Care25:47 - Translating Research into Real World Inpatient Practice30:38 - Major Research Gaps and Need for Better Clinical Trials33:04 - Hospitalization as a Critical Window to Prevent Suicide37:41 - Up Next: Dr. Marc AgroninLinks:Full transcript and show notes: https://www.psychiatrist.com/jcp/ep10-inpatient-treatment-suicidality-brett-jones/ Journal of Clinical Psychiatry: psychiatrist.com/jcp/Inpatient Treatment of Suicidality: A Systematic Review of Clinical Trials:https://pubmed.ncbi.nlm.nih.gov/39832343/Dr. Brett Jones: https://www.linkedin.com/in/brett-jones-1b308260/?originalSubdomain=caCenter for Addiction and Mental Health: https://www.camh.caUniversity of Toronto Psychiatry: https://psychiatry.utoronto.ca#AcuteSuicidality #InpatientPsychiatry #ClinicalResearch | — | ||||||
| 2/24/26 |  How Sleep Issues Show Up In Psychiatric Practice with Dr. Avinesh Bhar, CEO of SLIIIP | Feeling tired despite a full night's sleep? The problem may not be the hours you get, but the quality of your breathing. According to sleep medicine expert and founding physician of SLIIIP, Dr. Avinesh Bhar, many people dismiss fatigue, snoring, or frequent waking, using caffeine and over-the-counter aids to cope.This masks a deeper problem. Undiagnosed sleep-disordered breathing, like sleep apnea, is a silent driver of serious health issues, from heart disease to mental health conditions. Ignoring the root cause makes other medical treatments less effective, creating a cycle of declining health. 90% of people with mental health conditions also struggle with sleep issues. Getting help is easy at SLIIIP.com. No travel required. Insurance accepted.🎯 KEY EPISODE TAKEAWAYS:⚠️ THE SURVIVAL MODE TRAP [08:49]:"If you don't sleep well, your whole day changes in perspective. You are in survival mode, and you can't be your best self. You can't perform."Are you just surviving instead of thriving? Watch this segment to understand the biological cost of poor sleep and why feeling "just okay" is a major red flag for your health.✨ THE MENTAL HEALTH BREAKTHROUGH [29:24]:"If you're a therapist or psychiatrist managing mental health, you should also make sure the sleep is evaluated…otherwise, your improvements in mental health aren't going to reach the level that actually makes the patient feel like they've actually turned the corner.”Unlock better patient outcomes. See how integrating a sleep evaluation can be the missing piece in treating depression, anxiety, and PTSD effectively.⚡️ THE 2-QUESTION DIAGNOSTIC [59:40]:"'Are you sleeping well? Are you waking up refreshed?' If you have a 'no' to either one of those questions, the patient needs an evaluation."This is the simple, powerful framework you need. Listen to this section to learn the exact questions that tell you if it's time to refer a patient (or yourself) to a sleep specialist and how easy it is via www.sliiip.com. SLIIIP is making advanced sleep care fast & convenient, offering patients same week appointments with board-certified sleep medicine physicians instead of the months‑long wait typical of traditional sleep labs.CHAPTERS:00:00 - Introducing Dr. Avi Bhar03:48 - From ICU to Sleep Medicine and What Clinicians Miss06:52 - What Sleep Does Biologically and Why Quality Beats Hours13:23 - Sleep Myths That Keep You Sick and Tired16:24 - Sleep Hygiene That Works19:54 - When to Suspect a Real Sleep Disorder Beyond Stress23:00 - How Sleep Apnea Drives Heart, Metabolic, and Inflammatory Disease27:51 - Sleep and Psychiatry30:35 - Solving Access With Home Sleep Tests and Step-Based Care39:33 - The Ideal Telemedicine Sleep Care Pathway48:28 - Stop Masking Sleep Problems With OTC Aids and Melatonin52:33 - When to Retest and How Treatment Lowers Long-Term Healthcare Costs1:01:03 - Up Next: Dr. Brett JonesKey Takeaways:"Sleep is a reparative opportunity. It heals and repairs the trauma of the day. It's essential, not optional." "Quality and quantity of sleep matter. Sleeping 7-8 hours is good, but waking refreshed is key." "Sleep disturbances don't just coexist with illnesses; they can drive medical and psychiatric morbidity." "Evaluate sleep in patients with mental health issues. It's both a driver and symptom of psychiatric illness." "Speed and efficiency in sleep evaluation are crucial. It reflects the urgency and importance of the issue."Links:Full transcript and show notes: https://www.psychiatrist.com/jcp/ep9-sleep-issues-psychiatric-practice-avinesh-bhar/Journal of Clinical Psychiatry: psychiatrist.com/jcp/SLIIIP: https://sliiip.com/#SleepApnea #MentalHealth #SleepDisorders | — | ||||||
| 2/10/26 |  Clinical Pearls of Early Use of Xanomeline–Trospium in the In-patient Setting with Michael Halassa MD, PhD | Ben welcomes psychiatrist Dr. Mike Halassa back to the podcast to discuss the shifting landscape of inpatient schizophrenia treatment. An early adopter of Cobenfy, Dr. Halassa shares real-world insights from his research published in Nature Mental Health in this conversation that bridges technical neuroscience with the high-stakes reality of managing acute psychiatric crises.The discussion focuses on Cobenfy’s muscarinic mechanism, the first novel approach to psychosis in seventy years. Dr. Halassa details his "dose-sparing" strategy, reducing reliance on traditional D2 blockers and their metabolic burdens, and he shares case studies of treatment-resistant patients who succeeded on this agent after clozapine failed. Finally, Ben and Dr. Halassa explore functional recovery, precision psychiatry, and the empathic connection required to treat society's most vulnerable individuals.Episode Highlights:00:00 - Welcoming Back Dr. Mike Halassa01:46 - ‘Spending a Day in Someone Else’s Brain’04:21 - Empathy, Parenting, and Staying Grounded in Psychiatry06:37 - Why Inpatient Psychiatry Works: Acuity, Speed, and Team-Based Care09:31 - Evaluating Acute Psychosis: Intake, Chronicity, and Treatment Decisions12:46 - Discovering XT as the First Novel Schizophrenia Mechanism in Decades16:19 - A Remarkable XT Case Study23:26 - XT Dosing Tolerability and Early Clinical Results30:15 - From Observation to Evidence: Identifying XT Response Patterns35:12 - Testing Negative Symptoms in Real Time on the Inpatient Unit40:33 - XT vs D2 Blockers for Positive and Negative Symptom Control50:28 - Redefining Success in Schizophrenia Through Functional Recovery54:15 - The Future of Precision Psychiatry and Treating the Whole Person56:42 - Up Next: Dr. Avi BharKey Takeaways:"Inpatient psychiatry demands quick thinking and rapid decisions. It's a critical care type environment.""I find my kids keep me grounded and empathetic. They're my window into empathy.""XT offers a fundamentally different way of engaging the system. It's not just another antipsychotic.""Seeing patients become more socially connected on XT is remarkable. It's a new light in their eyes.""Negative symptoms have been intractable. XT offers hope for functional recovery.""The multidisciplinary team is crucial in schizophrenia care. It requires coordination and dedication.""XT allows for dose sparing of traditional antipsychotics, potentially reducing side effects.""We must aspire to help patients engage with life fully, beyond just managing symptoms."Links:Full transcript and show notes: https://www.psychiatrist.com/jcp/ep8-early-use-xanomeline-trospium-michael-halassa/ Journal of Clinical Psychiatry: psychiatrist.com/jcp/Dr. Halassa’s Substack: michaelhalassa.substack.comThe Halassa Lab: https://halassalab.tufts.edu/Preliminary real-world predictors of response to muscarinic targeting in psychosis: https://www.nature.com/articles/s44220-025-00529-wReal-World Implementation of Xanomeline-Trospium in Schizophrenia: A Consensus Panel Report: https://pubmed.ncbi.nlm.nih.gov/41201439/ | — | ||||||
| 1/27/26 |  Behind the Manuscript: Developing Algorithmic Psychiatry with Michael Halassa MD, PhD | Host Ben Everett sits down with Tufts University physician-scientist Dr. Michael Halassa to discuss algorithmic circuit psychiatry. This framework aims to modernize mental health care by mapping subjective experiences onto objective neural computations. By shifting focus to brain circuit mechanics, they explore a new paradigm for treating complex psychotic disorders. This conversation redefines psychiatry as a data-driven, precision-oriented field of medicine.The episode moves beyond the "chemical imbalance" theory to examine the dynamics of excitation and inhibition. Dr. Halassa explains how large language models and machine learning provide new test beds for analyzing reasoning and belief updating, and that, by using "behavioral clamps" and task-based biomarkers, researchers can now operationalize delusions through the study of counterfactual decision-making. He also notes that causal circuit validation in animal models remains essential for identifying precise drug targets and improving clinical outcomes. The discussion finishes up by touching on emerging muscarinic therapies and the future of psychiatric training.Episode Highlights:00:00 – Why Algorithmic Circuit Psychiatry Could Modernize Mental Health Care02:36 – From Physics to Psychiatry: Building a Scientist-Clinician Lens05:52 – Decoding Brain Circuits With Computational Models and Modern Tools10:37 – Returning to Inpatient Psychosis Care and Reframing Clinical Reality14:47 – Moving Beyond “Chemical Imbalance” Thinking in Schizophrenia Treatment20:43 – Fixing Computational Psychiatry Limits With Mechanistic, Circuit-Based Models25:08 – Creating Task-Based Biomarkers to Measure Belief Updating and Reasoning29:10 – Operationalizing Delusions Through Counterfactual and Decision-Making Tasks33:59 – Translating Algorithms Into Drug Targets and Better Animal Research37:54 – Using LLMs and Machine Learning to Test Psychiatric Mechanisms In Silico44:57 – Redesigning Animal Models to Validate Causal Brain Circuit Algorithms53:03 – Training the Next Generation for Precision Psychiatry56:44 – Defining Clinical and Scientific Milestones for the Future of Mental Health CareKey Takeaways:"Psychiatry feels different from other fields. We don't have biomarkers to guide decision making.""The brain functions in packets of information sent between areas. It's more complex than a single synapse.""In psychiatry, you absolutely need a behavioral clamp. It's not just about resting state measurements.""Machine learning was inspired by neuroscience. Now, it helps us understand altered thinking in machines.""The burden is on us to train the next generation to tackle psychiatry's complexity.""Talking to patients like equals is my default. We're all vulnerable to mental illness.""Mental health is sidetracked by societal issues. We must agree we're all human beings."Links:Full transcript and show notes: https://www.psychiatrist.com/jcp/ep7-algorithmic-psychiatry-michael-halassa/Journal of Clinical Psychiatry: psychiatrist.com/jcp/“Developing algorithmic psychiatry via multi-level spanning computational models”:https://pubmed.ncbi.nlm.nih.gov/40300598/Dr. Halassa’s Substack: michaelhalassa.substack.comThe Halassa Lab: https://halassalab.tufts.edu/ | — | ||||||
| 1/13/26 |  Behind the Manuscript: The Psychedelic Renaissance and Treatment-Resistant Depression with David Feifel, MD, PhD | Dr. David Feifel, Professor Emeritus of Psychiatry at UC San Diego and founding president of the Kadima Neuropsychiatry Institute, joins the JCP Podcast to kick off the new "Psychedelics in Psychiatry" theme. A pioneer in the field who established the world’s first ketamine infusion program for depression, Dr. Feifel sits down to discuss the paradigm shift currently reshaping mental health care.In this installment of the Behind the Manuscript series, Dr. Feifel breaks down the findings of his recent JCP paper: “Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Depression”. He explains the significance of the 25mg dose in preventing relapse over 52 weeks and offers a critical look at why traditional SSRIs are no longer enough. Beyond the data, the conversation delves into the nuances of "set and setting," the controversy of microdosing versus "heroic" doses, and the practical challenges clinicians face as the field moves toward interventional psychiatry. Dr. Feifel also challenges the traditional medical view of the placebo effect, arguing that harnessing expectation may be the key to the next generation of healing.Episode Highlights:00:00 - Dr. David Feifel and His Breakthrough Career02:13 - How Early Curiosity Led to Psychiatry Instead of Neurology07:33 - Balancing Clinical Practice With Research Innovation11:41 - Psychiatry Entering a Transformational New Era13:51 - Why SSRIs Fall Short and TRD Demands Better Solutions17:27 - What Makes Psilocybin the Leading Psychedelic Candidate20:25 - Why the Psychedelic Renaissance Is Surging Now25:42 - Microdosing Myths and the Power of Expectancy33:55 - How Set and Setting Shape Psychedelic Treatment Outcomes39:51 - Do Psychedelics Really Need Psychotherapy to Work48:58 - Inside the Phase 2 Study and How TRD Patients Were Enrolled56:04 - Why 25mg Psilocybin Delivered the Strongest Clinical Results1:05:39 - What Long-Term Follow Up Reveals About Relapse and Durability1:11:38 - How Clinicians Can Prepare for Psychedelic Medicine Adoption1:16:53 - Why the Future of Psychiatry May Rely on Harnessing Placebo PowerKey Takeaways:"Psychiatry is in the midst of a golden age revolution... I feel like every day I was going to war with Godzilla with a peashooter. Now I feel like we've got some real tools.""We’re in the midst of what I call the Cambrian explosion of treatments... a massive explosion of life forms after a long time of stagnation.""The concept of 'one and done' with psychedelics is dead. We aren't going to have patients come in one time and say, 'You're good for life.'""Doing ketamine is like doing psychotherapy, but you're both the psychotherapist and the patient at the same time."Links:Full transcript and show notes: https://www.psychiatrist.com/jcp/ep6-psychedelic-renaissance-david-feifel/Journal of Clinical Psychiatry: http://psychiatrist.com/jcp/Dr. David Feifel: https://www.linkedin.com/in/davidfeifel/Kadima Neuropsychiatry Institute: https://www.kadimanp.com/“Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Episode of Major Depressive Disorder”:https://www.psychiatrist.com/jcp/long-term-follow-up-study-single-dose-psilocybin-treatment-resistant-episode-major-depressive-disorder/ | — | ||||||
| 12/30/25 |  Advanced Practice Providers in Psychiatry with Michael Asbach, DMSc, PA-C | Dr. Michael Asbach, Associate Director of Interventional Psychiatry at the DENT Neurological Institute and a nationally recognized educator, joins The JCP Podcast to discuss the critical and expanding role of Advanced Practice Practitioners (APPs) in behavioral health. With a background that spans from sports medicine to leading interventional psychiatric programs, Dr. Asbach offers a unique perspective on how the medical model training of Physician Assistants (PAs) uniquely positions them to address the growing psychiatric workforce shortage.In a nuanced discussion, Dr. Asbach tackles the headlines and controversies surrounding the profession, including the recent British Medical Journal rapid review and the UK’s "Leng Report." He dismantles the concept of "scope creep," arguing instead for a model of "autonomous collaboration" that respects physician expertise while maximizing patient access. From the history of PAs emerging after the Vietnam War to the modern "Build, Baby, Build" approach to healthcare staffing, this episode provides a roadmap for how interdisciplinary teams can alleviate burnout and improve outcomes in the golden age of biologic psychiatry.Episode Highlights:00:00 – JCP Podcast Kickoff and Introduction to Dr. Asbach01:34 – Expanding PA Engagement and Education in Psychiatry03:22 – Career Origins and Choosing the PA Path Over Medicine05:11 – Discovering Psychiatry and the Appeal of Interventional Innovation08:46 – Mentorship, Research Culture, and Advancing Psychiatric Treatment12:28 – Understanding PA Training Models and Evolving Clinical Competency16:44 – Addressing Psychiatry Workforce Shortages Through Advanced Practitioners20:36 – Evaluating PA Outcomes and Challenges in Measuring Quality of Care29:24 – Rethinking Workforce Assumptions and Challenging Medical Dogma32:37 – Regulation, Role Clarity, and Key Takeaways from the Leng Report41:25 – Navigating Scope Creep Concerns and Physician Training Protection47:51 – Building Effective Interdisciplinary Psychiatric Care Teams56:44 – Supervision Ratios, Access Disruption, and Real-World Patient Impact1:00:04 – Burnout, Non-Clinical Career Paths, and Retaining Expert Clinicians1:08:09 – Future of Advanced Practice Providers and Closing ReflectionsKey Takeaways:"I think the future of advanced practice providers is going to be one that is collaborative, autonomous, and interdisciplinary.""We are blessed to be able to play such an important role in people's lives... and have this front row seat to their life longitudinally.""I’m very much a ‘build, baby, build’ approach to housing... Healthcare is very similar where the more people that we bring in as helpers, the better.""Psychiatry is... in this golden era of kind of firmly returning back to biologic origin... and the PA medical model means that PAs have taken pathophysiology, gross anatomy, fundamentals of medicine.""The absence of evidence is not the evidence of absence.""It’s not about replacing physicians... but rather adjusting regulations to reflect the modern healthcare environment."Links:Journal of Clinical Psychiatry: psychiatrist.com/jcp/Michael Asbach: https://www.dentinstitute.com/michael-asbach/White Coats of the Round Table: https://healthpodcastnetwork.com/show/white-coats-of-the-round-table/ | — | ||||||
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| 12/16/25 |  Behind the Manuscript: Fluctuating ADHD Across the Lifespan with Margaret Sibley, PhD | Fluctuating ADHD Across the Lifespan with Margaret Sibley, PhDDr. Margaret Sibley, Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle Children’s Hospital, joins The JCP Podcast to discuss the evolving understanding of the trajectory of ADHD across the lifespan. The recipient of the 2024 Paul Wender Best Paper Award, Dr. Sibley shares her journey from political science to clinical psychology and offers a behind-the-scenes look at the landmark Multimodal Treatment of ADHD (MTA) study.Challenging the traditional binary view of ADHD persistence versus remission, Dr. Sibley details the findings of her award-winning paper, revealing that for the majority of patients, ADHD follows a fluctuating course into adulthood rather than a static one. The conversation explores the critical role of "environmental fit," the complex interplay between anxiety and symptom management, and the distinct clinical profiles of those with persistent versus fluctuating ADHD. Today’s thoroughly enlightening episode offers vital nuances on how patient environments and comorbidities shape long-term outcomes beyond childhood diagnosis.Episode Highlights:00:00 – Introducing Dr. Margaret Sibley and the Paul Wender Best Paper Award02:41 – From Political Science to Psychology: A path to public health04:55 – The importance of engaging with patient advocacy groups like CHADD08:06 – A historical look at the Multimodal Treatment of ADHD (MTA) study11:59 – Why childhood treatment doesn't always predict adult outcomes20:17 – Challenging the myth of permanent remission vs. persistence24:53 – Defining the "Fluctuator": The most common ADHD profile28:15 – The "Gas and Brakes" analogy: The role of comorbid anxiety29:48 – Understanding comorbidities in severe, persistent ADHD31:45 – Clinical Pearls: Environmental fit and rising to the occasion34:09 – What’s next for the MTA studyKey Takeaways:"The fluctuators are really kind of like your bread and butter people with ADHD.""We should be thinking about environmental fit as a potential way to help people manage their ADHD better.”"Make sure that you read the Reddit threads about what people are saying that have a condition that you're working with.""Most people were looking at persistence as a finality, a single outcome... But it seems very dynamic.""The persistent ADHD group have many more comorbidities... and are much more impaired in their daily lives. And so this is sort of our severe ADHD profile.”"People do better in behavior therapy for ADHD if they have comorbid anxiety.""Parental psychopathology was a strong predictor of being in that 10% stable ADHD group.""When environmental demands were higher, people were more likely to be experiencing remission."“Make sure that you go out there and try to be non-judgmental about the lenses people see aspects of mental health through, even if it's different than what you were trained in or even what the science says.”Links:Journal of Clinical Psychiatry: psychiatrist.com/jcp/Dr. Margaret Sibley: https://www.margaretsibley.com/Dr. Sibley’s Award-Winning Paper: https://www.psychiatrist.com/jcp/fluctuating-adhd-multimodal-treatment-of-adhd-mta-study/ | — | ||||||
| 12/2/25 |  From Academia to Industry: Dr. Stephen Brannan’s Journey in Shaping Modern Mental Health Care | Dr. Stephen Brannan brings decades of experience from both academic psychiatry and leadership roles at top pharmaceutical companies to the JCP Podcast today. He details his transition from university research to industry, offering a candid look at the forces that drive innovation in mental health care. Dr. Brannan unpacks the complex process of bringing a new drug to market, using his work on treatments like Cobenfy (xanomeline-trospium) as a case study. The discussion covers the critical decisions in clinical trial design, from selecting the right patient populations to establishing meaningful endpoints that satisfy both regulatory bodies and clinical needs. He also addresses some of the most persistent hurdles in psychiatric research including the high placebo response rates that can obscure a drug's true efficacy and the operational complexities of running large, multinational studies. For clinicians seeking to better understand the evidence behind new medications, Dr. Brannan’s insights provide a unique level of enlightenment in the pragmatism, science, and collaboration required to advance patient care.Episode Highlights:00:00 - Introducing Dr. Stephen Brannan01:56 - From Pre-Med Doubts to a Career in Psychiatry06:51 - The "Push and Pull" from Academia to Industry08:50 - Advice for Young Psychiatrists Considering Industry10:56 - Pitfalls and Misconceptions of Pharmaceutical Work14:37 - Balancing Real-World Applicability and Regulatory Realities20:40 - The Science and Strategy Behind Cobenfy22:10 - Understanding and Mitigating the Placebo Effect28:57 - The Role of Expert Steering Committees32:38 - Designing Trials42:37 - The Nuances of Safety Surveillance in Clinical Trials53:27 - Reflections on the Future of Psychiatric TreatmentKey Takeaways:"I will not sacrifice quality for the sake of speed.""I've learned how to talk with people rather than just sort of barking an order.""We're a hell of a lot more alike than we're different.""The better we understand that and we're able to pick treatments based on biomarkers...that's going to make a huge impact.""That's extremely useful in psychiatry because it's rare when you first see somebody...you absolutely know what's going on. It usually takes time and patience and a tolerance for ambiguity.""You also want to be able to talk to people who will tell you what's wrong with your thinking.""You want your beachhead. And your beachhead is...what's the best segment of patients?"Links: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep3-academia-to-pharma-stephen-brannanJournal of Clinical Psychiatry: psychiatrist.com/jcp/ Dr. Stephen Brannan: https://www.linkedin.com/in/steve-brannan-b7376019/ | — | ||||||
| 11/18/25 |  Leadership in Clinical Psychopharmacology with Joseph Goldberg, MD | Dr. Joseph Goldberg, Clinical Professor at the Icahn School of Medicine at Mount Sinai and immediate past president of the American Society of Clinical Psychopharmacology (ASCP), shares insights from his remarkable career, from his beginnings in neuroscience to his influential leadership roles. Along the way, he explores the future of mental health, focusing on mentorship, innovative education, and translating research into patient-centered care.Throughout the episode, Dr. Goldberg recounts his unique journey into psychiatry, which began with studying frogs and led to a focus on bipolar disorder. He offers an insider’s view of the ASCP, detailing initiatives from his presidency, including task forces on ketamine and de-prescribing. A key highlight is ASCP’s revolutionary AI-enhanced "living textbook," a new approach to medical education designed to transform how clinicians learn about psychopharmacology, ensuring the latest knowledge is always accessible.Episode Highlights:00:00 - Introducing Dr. Joseph Goldberg, MD01:13 - From Frogs to Psychiatry: A Scientist’s Origin Story02:51 - Why Bipolar Became the Focus: Early Pharmacology Momentum04:20 - ASCP’s Patient-Centered Mission & Why It Became “Home”05:08 - Mentorship Pipeline: NCDEU Roots and Career Breaks08:10 - Leadership Model in Action & New President Anita Clayton11:17 - ASCP Task Forces: Ketamine/Esketamine and Deprescribing Guidance14:13 - CME 2.0 & AI “Living Textbook” (edYOU) for Psychopharm Education18:43 - Limbic Learning & Nasrallah Award: Make Education Stick20:18 - Early-Career Lift: Posters, Committees, New Investigator Awards23:18 - What’s Next in Psychopharm: Tangible Advances for Patients25:44 - ASCP × JCP Synergy & Membership Call to Action27:40 - Looking Ahead: Bridging Bench to Bedside with Future GuestsKey Takeaways:"The frogs brought me to med school, brought me to research in psychiatry and psychopharmacology, and, well, here I am today.""ASCP has always been my professional home, intellectually, scientifically, even socially.""It's really about the pragmatic translation of findings into clinical care, which just really spoke to my interest in the kind of 'so what' factor of what it is we do.""It's a living textbook in psychopharmacology, so it can be continually updated. We hope it's going to revolutionize the way we teach psychopharmacology.""Steve and I both call this 'limbic learning.' You remember things when they're presented in an impactful kind of way. It's almost like PTSD in reverse.""We live in a time and an era of true advances. We have things in our pharmacopeia now that did not exist 5 years ago.""This is a home. This is a place where I think you will find like-minded people. You'll make friends for life.""If you interact with ASCP or JCP, you will not ask the question, 'What does this have to do with my patients?'"Links: Full transcript and show notes: https://www.psychiatrist.com/jcp/ep2-clinical-psychopharmacology-joe-goldberg/ Journal of Clinical Psychiatry: psychiatrist.com/jcp/ Dr. Joseph Goldberg, MD: https://www.josephgoldbergmd.com/American Society of Clinical Psychopharmacology: https://ascpp.org/ | — | ||||||
| 11/4/25 |  The Mission of JCP with Editor-in-Chief Marlene P. Freeman, MD | In its inaugural episode, the JCP Podcast features a foundational conversation with Dr. Marlene Freeman, Editor-in-Chief of The Journal of Clinical Psychiatry, in which she discusses the journal's core mission to empower busy mental health professionals with cutting-edge, evidence-based research. Providing insights into academic publishing, from the peer review process to the journal's vision for psychiatric education, today’s discussion offers essential listening for those at the intersection of clinical practice and scientific discovery.Dr. Freeman details her professional journey into women's mental health and perinatal psychiatry, and goes on to explore how the journal balances scientific rigor with clinical relevance to support shared decision-making in patient care. Navigating the complex publication landscape, the episode addresses industry-sponsored studies, the importance of diverse voices, and emerging trends like digital therapeutics, biomarkers, and the potential impact of artificial intelligence on psychiatric research. Episode Highlights:00:00 - JCP Podcast Mission for Busy Clinicians00:37 - Introducing Dr. Marlene Freeman, Editor-in-Chief02:36 - Choosing Psychiatry for Patient-Centered Impact04:19 - JCP’s Purpose: Clinician-Ready, Evidence-Based Guidance08:03 - Faster Access to Research: Summaries, Email TOCs, Podcasts, Specialty Sections11:33 - Shared Decision-Making in Practice & ASCP Corner Quick Reviews15:11 - What JCP Publishes & How Peer Review Ensures Clinical Quality25:11 - Promoting Diversity, Inclusion, and Ethical Publication Standards27:00 - Emerging Priorities: Novel Treatments, TRD, and Real-World Effectiveness30:24 - Digital Therapeutics & Biomarkers Must Prove Clinical Utility36:02 - AI in Publishing: Verify References and Read Full Papers40:00 - Clinician-First Perspective: Practice Informs Editing & Research42:03 - Editorial Impact and Evolving Ethical Responsibilities45:18 - Reflections on Leadership, Legacy, and Lifelong LearningKey Takeaways:"I really want to emphasize that a rejection of a paper doesn't mean it isn't high quality.""We want to be user-friendly to authors. We want to save them time. So if we're not a good fit for their paper, I'm very comfortable looking at whatever people want to send me in advance.""We want to make sure that we're making collaborative decisions with patients, but we have to make sure that we're offering good choices.""The work could not be done without peer reviewers.""You get so much out of reading the full paper. The introduction section is like a mini review of that topic and gives you so much more information.""We want to make sure that what we're putting out there is not a result of the financial investment that a company has made. We want it to be based purely on the research and what it has to add for patients.""We want to make sure that we are providing treatments that everyone can access.""I think that all the roles inform each other, but at the heart of it, I'm a clinician."Links: Full transcript and show notes: psychiatrist.com/jcp/ep1-mission-jcp-marlene-freeman Journal of Clinical Psychiatry: psychiatrist.com/jcp/ Interested in becoming a peer reviewer? psychiatrist.com/jcp/reviewers/ | — | ||||||
| 10/24/25 |  Trailer | The Journal of Clinical Psychiatry Podcast explores the science, practice, and human side of mental health care. Hosted by Dr. Ben Everett, Senior Scientific Director at Physicians Postgraduate Press, the series brings together leading voices in psychiatry, neuroscience, and behavioral medicine to discuss the evidence shaping clinical care today. Each episode features thoughtful conversations with JCP authors, academic experts, and frontline clinicians exploring disorders across the mental health continuum, from schizophrenia and mood disorders to anxiety, depression, and sleep-related conditions. By bridging research and real-world practice, the podcast delivers insights that empower psychiatrists, nurse practitioners, physician associates, and primary care clinicians to deliver better care for patients with mental illness. Insightful. Evidence-based. Human-centered. | — | ||||||
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