And the rates and severity of postpartum depression and postpartum anxiety has only increased during the COVID-19 pandemic.

Anita Clayton, MD, chair of psychiatry and neurobehavioral sciences at the University of Virginia School of Medicine, explained in an interview with 

 why many women are facing these postpartum concerns.

“So I’d say that women who do have postpartum depression often attribute it to other things,” Clayton said. “The baby is up in the night and they need to breastfeed it. That they aren’t getting much sleep. That they need to lose weight.”

2022 Annual Psychiatric Times™ World CME Conference

Clayton also discussed how critical it is for OBGYN doctors to collaborate with psychiatrists when an issue is identified.

“I think the area that OBGYN’s are most concerned about is postpartum depression from their mothers or just from neglect because the mother is depressed,” she said.

Clayton went on to say there is a recommended screening tool commonly used in the US for postpartum depression and there is also an intravenous treatment that has shown promise in this patient population.

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Postpartum depression rates have increased since the COVID-19 pandemic.

Anita Clayton, MD: Women's Issues in Psychiatry

Identifying and forecasting when a patient might become 

 in San Diego on August 12, Michael Thase, MD, professor of psychiatry, Perelman School of Medicine, University of Pennsylvania, spoke about the need for more medications for treatment-resistant depression.

, Thase explained how there is a segment of the population that the existing medications just will not work for them.

“For many people depression is a short lasting somewhat limiting condition,” Thase said. “Sometimes people can’t get out of it.”

Thase said one of the risk factors for this type of depression is substance use, such as drugs and alcohol. And the COVID-19 only exacerbated some of those issues.

“Rates of depression have gone up during the pandemic,” Thase said. “And since one risk factor for becoming chronically depressed is not getting help and since the pandemic has challenged the treatment capability of society, more people are not only depressed but fewer people are getting help. I am fairly confident we are going to have trouble ahead.”

Alcohol, stress, drug use, and not seeking help are all risk factors for chronic depression.

Michael Thase, MD: Risk Factors for Chronically Depressed Patients

 is something that has become much more complex in recent decades.

Whether or not the drug has positive psychiatric effects can be largely based on the individual percentages of the 2 main compounds of marijuana--tetrahydrocannabinol (THC) and cannabidiol (CBD).

, John J. Miller, MD, Medical Director, Brain Health Website, Seacoast Mental Health Center and co-chair of the 

 in San Diego, explained how complicated the guidance for promoting cannabis is for patients with conditions like depression and anxiety.

“One of the biggest issues currently is that cannabis is a very vague and general term,” Miller said. “Back in the early 60s when it was being used recreationally it was from the original plant. Those strains of cannabis had about 2% THC and 2% CBD.”

Miller said the CBD molecule is the part that has shown efficacy in treating conditions like psychosis and anxiety, while also having inflammatory properties.

He also said 1 of the issues with current studies is they will use the term “cannabis” without breaking down the percentages of THC and CBD.

“A lot of the literature because it doesn’t differentiate the components of the cannabis it is hard to draw evidence based conclusions that we can apply clinically,” Miller said.

CBD has shown promise in treating anxiety and psychosis. 

John J. Miller, MD: Guidance on Cannabis Use in Psychiatry

There remains significant gaps in treatment for patients with 

, particularly when the disease is identified early.

 in San Diego on August 12, Christopher Schneck

University of Colorado HIV Clinic, talked about how we can improve treatment strategies when bipolar disorder is identified early.

“Really this is thinking about what groups who have not fully developed bipolar disorder can we stage an intervention,” Schneck said. “And thinking about both psychopharmaceutic interventions and psychotherapeutic interventions. There really isn’t much out there in the literature.”

In combat these gaps in care, Schneck said there have been a number of recent studies involving both adult patients with bipolar disorder and pediatric patients as well.

He also said studies have looked at siblings of patients with bipolar disorder.

“The way families interact with each other has a great influence on a child’s developmental process and ultimately the development or not of the mood disorder.”

Schneck said there is a 12 session model for treatment in which he will educate both the patient and families about the illness and how to effectively communicate with each other.

There remains a need for better treatments for bipolar disorder when it is identified early. 

Christopher Schneck, MD: Early Interventions for Bipolar Disorder

Symptom crossover remains a main reason why diagnostically, mixed feature 

 or unipolar depression are very difficult conditions to identify.

“Someone who is for instance irritable, agitated, just all around moody, might get conceptionally as someone in a mixed state,” Joseph Goldberg, MD, clinical professor of psychiatry at Mount Sinai School of Medicine said in an interview with

. “But you have to rule out other conditions that involve those types of symptoms and there are many.”

Goldberg participated in the “Medical Crossfire: Treatment Approaches to Mixed Features of Bipolar vs Unipolar Depression,” during the conference with Nassir Ghaemi, MD, of Tufts University School of Medicine and Sanjai Rao, MD, of the University of California, San Diego

The doctors discussed issues with mixed feature depression in a debate style format.

Mixed feature depression can be difficult to diagnose because the symptoms can be similar to other psychiatric disorders.

Joseph Goldberg, MD: Treating Mixed Feature Depression

The time immediately following a loss can be challenging for many, often leading to a 

And it is important for psychiatrists and clinicians to identify the differences between grief and depression, while helping an individual deal with the potential for both.

 in San Diego on August 12, M. Katherine Shear, MD, the Marion E. Kenworthy Professor of Psychiatry at Columbia University and the founding Director of the Center for Complicated Grief at Columbia School of Social Work, discussed how clinicians should treat patients dealing with the immediate after effects of grief.

, Shear explained why it can be so difficult to identify and differentiate between grief and depression and why both should be addressed.

“I think a lot of clinicians are not yet totally comfortable working with the grief side,” she said. “So they know how to treat depression really well.”

Shear also said a troubling trend has been while depression has been mostly destigmatized in recent years, there is still a stigma attached to grief.

And Shear said she’d like to see research in the coming years focus on the comorbidity of grief and depression in the first year following a death.

“I think we have an idea of what we should do, but we don’t yet have really good studies of that period of time,” she said.

There remains a need for more research into the connection between grief and depression following a death.

M. Katherine Shear, MD: Addressing Grief After a Loss

 (BPD) remains one of the most challenging and misunderstood disorders in psychiatry.

The disease is often diagnosed when the individual is a young adult, but psychiatrists often have to build trust with the patient over several months in order to really start seeing progress.

And that trust is ultimately hard to build.

 in San Diego on August 11, Larry Culpepper, MD, founding Chairman of the Department of Family Medicine at Boston University discussed studying borderline personality disorder more and how to best care for patients.

, Culpepper explained why the disease can be so challenging and what psychiatrists must do to build that needed trust.

But most of all what is needed is more research into the disease.

“We don’t understand it,” Culpepper said. “We don’t understand its origins and how it developed in the individual. We don’t understand the issues for the patient that play out in their borderline personality disorder responses to the world.”

However, even with that said, Culpepper said psychiatrists do have the ability to make a positive impact in the patient’s life, mainly by promoting the correct course of therapy.

Borderline personality disorder remains one of the most difficult to understand conditions in psychiatry.

Larry Culpepper, MD: The Challenge of Treating BPD

 remains 1 of the biggest challenges in psychiatry, but help could be on the way.

In recent years, investigators and drug developers have paid particular attention to this patient group and have focused on new classes of treatments like psychedelics.

Drugs like psilocybin are some of the more promising treatments that have emerged in a long time.

 in San Diego on August 12, Michael Thase, MD, professor of psychiatry, Perelman School of Medicine, University of Pennsylvania, spoke about some of the new and developing treatments for treatment-resistant depression.

, Thase gave an overview on all the promising treatments in the pipeline for treatment-resistant depression.

“The field changed with the discovery of esketamine and its anti-depressant effects,” Thase said. “That’s the trailblazing drug from an approval standpoint. The exciting thing for us is it is a novel mechanism of action and when it works, it works relatively quickly.”

While eskeatmine is promising, it still only works for up to 30% of patients, still leaving a gap in care. However, existing treatments may only be effective in 10% of the population.

Esketamine is seen as a major breakthrough in finding more treatments for depression.

Michael Thase, MD: New Medications for Treatment-Resistant Depression

While grief is a part of life for most, losing a loved one, particularly if it is unexpected, can spiral an individual into a 

And the challenge for psychiatrists remains identifying whether someone is grieving or whether the patient is truly depressed.

 in San Diego on August 12, M. Katherine Shear, MD, the Marion E. Kenworthy Professor of Psychiatry at Columbia University and the founding Director of the Center for Complicated Grief at Columbia School of Social Work, discussed the connection between bereavement and depression.

The session centered on the similarities and differences between depression and grief and the importance of recognizing both.

, Shear explained how important it is to discuss the connection between bereavement and depression.

“It’s been the source of a lot of controversy and also misunderstanding,” Shear said. “What’s most important is that we pay attention to both so we don’t try to say someone is not depressed because they are grieving and that grief doesn’t protect us against depression.”

The topic comes at a particularly interesting time as many more people have faced grieving situations due to the COVID-19 pandemic.

Dr. Shear talked about the similarities and differences between depression and grief and the importance of recognizing both. 

M. Katherine Shear, MD: Bereavement and Depression

Obesity is a risk factor for cardiovascular disease, but preventive cardiologists may face challenges in counseling a patient on a healthy body weight and strategies to achieve this goal.

2022 American Society for Preventive Cardiology Meeting

, Robert Kushner, MD, Feinberg School of Medicine, Northwestern University, presented a talk on how to treat obesity as a cardiovascular risk factor, referring to it as ‘the one that got away.’

The talk highlighted data that support obesity as a risk factor, including disability-adjusted life years (DALYs) and the effects on the heart, such as heart failure with preserved ejection fraction (HFpEF).

“I am also talking about the benefits of weight loss, not only on reducing cardiovascular risk, but also improving metabolism as it relates to insulin sensitivity and reducing insulin resistance as it relates to metabolic syndrome,” Kushner added.

He additionally discussed how clinicians can better help patients manage their weight by using targeted strategies, such as self-monitoring, meal plans, support and accountability. Kushner described the foundation of obesity treatment as lifestyle management, including diet and exercise, as well as stress reduction and lack of substance abuse.

However, the excitement for Kushner has come in the form of adjunctive pharmacotherapy. He noted that the field is at the verge of a second generation of medicines for obesity, primarily mimicking gut hormones, such as GLP-1s. In addition to treating diabetes and lowering blood sugar, the effects of these agents on appetite have led to double digit weight loss, including up to 20% weight loss, Kushner noted.

“It's not only an incretin hormone for diabetes, but in improving appetite, but also affecting other cardiovascular risk factors, effects on the kidney blood pressure and blood clotting,” Kushner added.

Kushner discussed the continuum of options in obesity management, from lifestyle changes to diet and exercise, but also noted the more aggressive treatments for obesity. The first, as noted above, is pharmacotherapy, but the other is bariatric surgery. He added that the surgery is the most effective treatment for patients with obesity, and that typically leads to significant endurable weight loss.

“I think it's important when we see individuals and we present all the options to them really from the very beginning about what is going to be the most effective treatment,” he said.

For a patient with high risk of cardiovascular disease and a corresponding body mass index (BMI) of ≥40, Kushner is potentially thinking about bariatric surgery for that individual.

“They don't have to fail lifestyle management and then fail pharmacotherapy to then bring up bariatric surgery,” he added. “We want to bring the most effective treatment for that patient as early as possible.”

Kushner further discussed the awareness of social determinants of health in obesity treatment. These social determinants are particularly affecting those who suffer from obesity or excessive weight due to a lack of resources, access to healthy foods, and others necessary to promote health in a community.

He noted that those who are most affected are often of lower socioeconomic status, particularly African-American females who have the highest prevalence of severe obesity in the United States.

“When we make recommendations to individuals and minority groups, we have to think about access and affordability when we're recommending treatments,” Kushner said. “Unfortunately, due to health care resources, a lot of the exciting medications that are being developed, are not affordable or not covered under certain health plans, so we have to be very aware of that and sensitive to the needs.”

Dr. Kushner discusses obesity as a risk factor for CVD and how preventive cardiologists can better target weight management to support patient health. 

Robert Kushner, MD: An Emphasis on Obesity as CV Risk Factor 

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