Sunday, February 25, 2018


By SERENA GORDON HEALTHDAY February 22, 2018, 12:11 PM

Antidepressants really work, major new study confirms; some are better than others

Bottles of antidepressant pills Wellbutrin, Paxil, Lexapro, Effexor, Zoloft and Fluoxetine are shown in a 2004 file photo.
Last Updated Feb 22, 2018 1:53 PM EST
Antidepressant drugs actually do help ease depression, countering debate over whether the medications do what they're supposed to, a large research review has found.
Some antidepressants, though, are more effective and better tolerated than others, the findings showed.
The researchers analyzed data from 522 trials -- published and unpublished -- that included more than 116,000 participants. Of the 21 antidepressants studied, all of them worked better than a placebo.
"In the short-term, for acute depression, antidepressants seem to work modestly," said study author Dr. John Ioannidis. He's a professor of disease prevention at Stanford University in California. "They do have some benefit, on average, but they are not a panacea. Clearly, we need more effective interventions."
Antidepressants sold in the United States that the study found to be most effective included:
  • Amitriptyline
  • Effexor (venlafaxine)
  • Lexapro (escitalopram)
  • Paxil (paroxetine)
  • Remeron (mirtazapine)
  • Trintellix (vortioxetine)
Those that made the least-effective list of antidepressant drugs sold in the United States included:
  • Luvox (fluvoxamine)
  • Oleptro (trazodone)
  • Prozac (fluoxetine)
When the researchers checked which depression drugs were tolerated the best, these topped the list:
  • Celexa (citalopram)
  • Lexapro (escitalopram)
  • Prozac (fluoxetine)
  • Trintellix (vortioxetine)
  • Zoloft (sertraline)
The drugs that were found to be less well-tolerated included:
  • Amitriptyline
  • Anafranil (clomipramine)
  • Cymbalta (duloxetine)
  • Effexor (venlafaxine)
  • Luvox (fluvoxamine)
  • Oleptro (trazadone)
The study authors wrote that there's been "a long-lasting debate and concern about [antidepressants'] efficacy and effectiveness, because short-term benefits are, on average, modest and because long-term balance of benefits and harms is often understudied."
However, Dr. Richard Catanzaro, chairman of psychiatry at Northern Westchester Hospital in Mount Kisco, N.Y., said this review shows that "all of these medications can be effective in treating depression."
He explained that "all distinguish themselves from placebo, but there's no hands-down winner."
And, Catanzaro said, if you're looking for the most tolerable and the most effective, you're left with Lexapro and Trintellix.

In addition, Catanzaro noted that while amitriptyline was on the most-effective list, it was also on the least-tolerated list, and he said it's generally not considered a first-line drug for depression treatment.
Ioannidis said that the differences between the medications were small, so even medications on the less-effective list might work very well for some people.
That's another issue with antidepressant medications, Catanzaro explained: What works well for one person doesn't always work well for another, so there may be some trial and error involved in finding the right medication for you.
It's also important to be sure you're getting the right dose of medicine and that you take the drug long enough to give it time to work well, Catanzaro said. That can be as long as four to six weeks.
Both Ioannidis and Catanzaro said that people with depression shouldn't rely on medications alone, whenever possible.
"I would never advocate that antidepressants are the only way to approach this major problem," Ioannidis said, recommending psychotherapy with medications.

Catanzaro said that he, too, recommends therapy along with medication. "But in many areas it can be hard to get good-quality therapy. Medications are often the only treatment people have access to, and if the alternative is nothing, then that's certainly preferable," he advised.
Both experts noted that this study looked only at responses after eight weeks of treatment. How these medications might work for people taking them for years was not assessed.

Sunday, February 18, 2018


I'm happy to announce I passed the new Addiction Medicine board certification. This means I'm current in evidence based care for substance use disorders. This new board certification will set the standards for addiction diagnosis and treatment and supersedes the old ABAM certification.

I am sometimes floored by the misinformation out there. I don't really care about sobriety which I believe is a myopic goal. I care about healthy. Healthy people don't use drugs. That's healthy brain, psychological and body health. Addiction affects your biology, your psychological capacity to cope and your social function (work, relationships, goals, education, identity).

Below is more information about my current board certifications:

My office is accepting patients. I accept insurance for general psychiatry
and addiction medicine services. Specialty out of network services are also available.

Sunday, January 14, 2018

How To Detox Yourself From Alcohol

My new ebook ($1.99) is live! Safe, sane and EASY treatment if you're suffering. 

Saturday, June 10, 2017

A Real Life Patient Experience

I got this message via my website from my patient this morning. The reason I'm posting it here is because this is a typical patient experience when it comes to opiate abuse/dependency issues. Typical. People NEED to know treatment is easy and EFFECTIVE. STOP suffering and get help. Most of the time this CAN be done through a doctor's office. My patient is on top of the moon! Maybe you can be too.

"Dr. Bacchus I just wanted to thank you so much for all you've done for me. I cant begin to tell you how excited I am. You know when I was searching for a dr to help me with my addiction issues. I've seen multiple doctors thruout my long runs on acquiring pills. You are the first one that... forgive my language but "took no shit". I needed that. Maybe the others saw right thru me but didn't care enough. Tough love. I know I can call you in between appointments if I ever needed anything or somthing wasn't right. I also learned real quick when my meds ran out early not to call. Which ultimately put the ball in my court. The first doctor that didn't enable my addiction. All's I'm saying is I thank you so much. Thank you for your patience with me. I know I am an intense person. When all the meds are stopped I still would like to see you for underlying causes along with weekly therapy with you ( if my insirence would cover it) or a sliding scale alternative therapist. I feel I have came along way but I also know my behavior as an addict is still here. A lot of work to do. Somewhat discouraging. Well I woke up this morning and stuck to your instructions and I no longer miss/ want the suboxone. ANYMORE! :-) I'm sorry for ranting again I just wanted to thank you for everything you've done with me. Your a tough doctor man. Respect! Thanks again see you next month"

Sunday, April 16, 2017

Are You Buggin?

Take these simple tests...

Not sure if you need to see a psychiatrist? I find most of patients really don't know. I find most therapists and medical doctors that my patients often see don't know either. My patients are busy trying to do what it takes to be better but something is still "buggin".

The most common undiagnosed mental illnesses I see are anxiety and mood disorders. In fact anxiety is so common 1 out of every 4 people suffers. You might be that one. Even with intensive psychotherapy you will still be symptomatic. Never fear, psychiatrists have "skills" rather, tests that you can do on your own that can tell us a lot. Listed below are my quick and easy faves.

The PHQ-9 is a standard self test questionnaire. This test has great reliability (sensitivity and specificity) for picking up depression. If you score 15 or more on this test, see me-or see any psychiatrist for that matter. I even suggest you start with your primary MD. Word of note though, if your regular doctor starts something and you don't get relief, see a psychiatrist. It just saves time, energy and the exhaustion of suffering.

My next goody is the MDQ which is my new go to for diagnosing more complicated mood disorders like Bipolar Spectrum Disorders. I've enclosed in the link how to score but it might be best to do this test, then take it to your psychiatrist (me) for a clear possible diagnosis. Again the specificity of this exam is greater than 95%.

Another great test is the GAD-7 which is good for generalized anxiety disorder but also for panic disorder, social phobia and post traumatic disorder. Again reliability is over 85%. These ARE the most common disorders I treat. Go ahead take the exam and score. Greater than 10? Score an appointment with a psychiatrist (me) while you are doing therapy.

Do you drink? Take this test, the AUDIT-C, you might be surprised. Three simple questions can identify at risk drinking.

I still use the CAGE questionnaire to identify substance abuse and dependency. Four basic questions can make the difference between life or overdose death.

OK, cool-you now know what's real and what we shrinks look for and use. Take these short tests and let me know what you think. Treatment is easy (seriously) and effective.