Offered by the Department of Psychiatry at Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School.

Emerging Strategies in the Assessment and Treatment of Depression and Anxiety: Integrating Psychopharmacology and Psychotherapy

Russell Vasile, MD

July 29 – August 2, 2019 • Monday – Friday
See Accreditation

The objective of this seminar is to familiarize the clinician with emerging strategies in the assessment and treatment of major depression, bipolar illness and anxiety disorders. The course will also highlight key comorbid conditions associated with mood and anxiety disorders, including axis II personality disorders, management of patients with medical conditions and management of the geriatric patient. An essential theme of the seminar will be formulating an integrated psychopharmacologic and psychotherapeutic treatment approach. The psychotherapy of the mood and/or anxiety disorder patient, including those with comorbid personality disorder will be examined in detail. Issues around the choice of specific antidepressants, mood stabilizers and anti-anxiety medications and psychopharmacologic management of the treatment resistant patient will be highlighted with a discussion of the use of augmenting medication strategies and combinations of psychopharmacologic agents. Psychotherapeutic approaches to mood and anxiety disorders will be studied with a focus on differing strategies including psychodynamic psychotherapy, cognitive and behavioral therapy, interpersonal psychotherapy for depression and other psychotherapeutic approaches. The seminar will update the clinician on recent developments in neuropsychiatry, including brain imaging and therapeutic stimulation techniques.

Issues related to the clinical efficacy of transcranial magnetic stimulation (TMS) and its role as an alternative to electroconvulsive therapy (ECT) will be explored. Emerging data on which subgroups of depressive disorders may respond to TMS will be presented. The role of Ketamine infusion in the treatment of acute depression and suicidal ideation will be presented; the risks and benefits of this controversial treatment will be examined.

Neuropsychiatric presentations of depression secondary to head trauma, post-concussive syndrome, post-stroke depression and ischemic brain disease as a source of depression will be discussed. The range of anxiety disorders to be reviewed will include anxiety disorders in the Obsessive-Compulsive Disorder Spectrum including skin-picking disorder, trichotillomania and body dysmorphic disorder; anxiety disorders related to trauma including posttraumatic stress disorder. Emphasis will be placed on the integration of psychopharmacology and cognitive behavioral therapy in the treatment of anxiety disorders including generalized anxiety disorder, posttraumatic stress disorder and panic disorder.

Upon completion of this activity, participants will be able to:

  • Evaluate emerging strategies in the use of psychotropic medications in the treatment of major depression and anxiety disorders and integrate psychopharmacologic treatments into patient care;
  • Integrate psychodynamic assessment, psychotherapy and psychopharmacology into the management of depression and anxiety disorders;
  • Describe strategies for the psychopharmacological and psychotherapeutic management of treatment resistant depression;
  • Examine new developments in the treatment of depression in bipolar patients with a focus on newer medications including lurasidone and cariprazine;
  • Identify an evidence-based approach to suicide risk assessment and prevention of suicide;
  • Analyze the latest epidemiological data on changing patterns of suicide risk;
  • Develop psychopharmacologic management strategies for geriatric depression and anxiety including in patients with cognitive deficits;
  • Assess the role of Cognitive Behavioral Therapy (CBT) in the treatment of depression and anxiety disorders;
  • Critique recent developments in the implementation of CBT, including Commitment and Acceptance Therapy and inclusion of exposure therapy in CBT;
  • Determine the specific role for vigorous exercise in the treatment of mood disorders;
  • Explain emerging brain stimulation antidepressant treatment techniques, including transcranial magnetic stimulation;
  • Describe new psychopharmacological and psychotherapeutic techniques in the treatment of PTSD;
  • Manage the tapering and discontinuation of chronic benzodiazepine usage in an evidence-based manner; • Discuss the treatment of depression and anxiety in patients with personality disorders including Borderline Personality Disorder;
  • Explore the role of novel enhancements to treatment of mood disorders including omega-3 fatty acids, 1-methylfolate and zinc;
  • Formulate an integrated psychopharmacological and psychotherapeutic approach to personality-disordered patients in the borderline and severely narcissistic spectrum presenting with depression and anxiety;
  • Manage anxiety disorders in patients vulnerable to alcohol abuse and psychological dependence on marijuana;
  • Differentiate strategies for treating patients with marijuana abuse disorder;
  • Give examples of relaxation and meditation applications on smart phone and/or computer for treatment of anxiety disorders.

Risk Management Credits: This activity meets the criteria of the Massachusetts Board of Registration in Medicine for Risk Management Study. This includes 3.0 credits in Marijuana Education and Pain Management training. Please check your individual state licensing board requirements before claiming these credits.

FACULTY

Russell G. Vasile, MD is an Associate Professor of Psychiatry, Harvard Medical School and Director of the Affective Disorders Consultation Program at the Beth Israel Deaconess Medical Center. Dr. Vasile has published in diverse areas related to the assessment and treatment of anxiety and affective disorders. Dr. Vasile is also a graduate of the Boston Psychoanalytic Society and Institute. He is a past recipient of the Elvin V. Semrad Award for Excellence in Teaching at the Massachusetts Mental Health Center.

Date and timeAgenda Item
Monday July 29
8:30am – 9:00amRegistration
9:00am – 10:15amDSM-V assessment and treatment of subtypes of depression; new SNRI medications and traditional SSR!s, SNR!s MAO inhibitors; augmenting agents for depression including lithium, thyroid, low dose stimulant; combinations of antidepressants tricyclics and SSR!s; assessing and treating refractory depression; the role of ECT and transcranial magnetic stimulation.
10:15am – 10:30amCoffee Break
10:30am – 12:15pmWhen to augment or combine antidepressants; treatment of psychotic depression; MAO inhibitors in treatment resistant depression, including the use of the MAO-I transdermal patch; mood disorders in pregnancy and post-partum; novel neuroleptics as antidepressant boosters; adjunctive use of novel neuroleptics such as quetiapine, olanzapine, lurasidone in the treatment of unipolar depression; differing techniques in administering TMS; review of different modes of administration of ketamine and differential effects of intranasal versus intravenous administration; role of ketamine in suicide prevention.
Tuesday July 30
9:00am – 10:15amAssessment and treatment of Bipolar Disorder; new DSM-V classification of Bipolar Spectrum Disorders and its clinical implications; lithium, lamotrigine, lurasidone and quetiapine in bipolar depression; managing both prevention of cycling and acute mania -use of olanzapine, risperidone, quetiapine and other novel neuroleptics; role of clozapine in refractory mood disorder.
10:15am – 10:30am Coffee Break
10:30am – 12:15pmBipolar Depression and different psychopharmacological interventions; New psychopharmacologic options for treatment of bipolar depression; bipolarity in relation to personality disorder, attention deficit disorder; long term management of mood cycling; mitigating risks of chronic lithium administration; combinations of mood stabilizers for rapid cycling bipolar disorder. Q&A
Wednesday July 31
9:00am – 10:15amDSM-V diagnostic changes in formulation of Anxiety Disorders; assessment and treatment of anxiety disorders including panic, obsessive compulsive disorder, post-traumatic stress, generalized anxiety and social anxiety disorders; use of benzodiazepine and non-benzodiazepine anxiolytics; role of SSRI, SNRI, tricyclic and MAO-I medications for the treatment of anxiety and panic disorder; new treatments for PTSD including clonidine and other alpha blocking medications; assessment and prevention of suicide risk in depression, anxiety and co-morbid anxiety and depression; management of anxiety in the recovering alcoholic; new developments in the medication management of chronic marijuana abuse. Meditation and relaxation apps found on cell phone or computer for treatment of anxiety.
10:15am – 10:30am Coffee Break
10:30am – 12:15pmManagement of refractory PTSD; strategies for discontinuation of chronic benzodiazepine use; psychotherapeutic approaches to Anxiety Disorders, including CBT, relaxation and meditation and exposure and response prevention; efficacy of computer apps for administration of CBT for treatment of anxiety disorders.
Thursday August 1
9:00am – 10:15amPsychodynamic perspectives on depression and anxiety; different psychotherapies of depression - CBT, psychodynamic expressive psychotherapy and behavioral strategies; the assessment and treatment of axis II disorders in relation to depression and anxiety. Integrating psychodynamic and biological perspectives on treatment of borderline personality disorder; discussion of factors in the development of healthy and pathological narcissism in relation to vulnerability to depression; psychopharmacological management of disorders of impulse and anger.
10:15am – 10:30am Coffee Break
10:30am – 12:15pmPsychodynamic vulnerability to depression; psychotherapy of depressive and anxiety disorders differing strategies; biological treatments for anger and impulse disorders; integrating psychotherapy and medication
management in depressed and/or anxious patients with personality disorders. Examination of the spectrum of persistent depressive disorder, psychobiological and psychodynamic factors Q&A
Friday, August 2
9:00am – 10:15amBrain imaging in anxiety and depressive disorders documenting brain imaging changes on MRI in response to psychotherapy alone and in combination with antidepressant medications; baseline brain imaging predicting when CBT will work to treat anxiety or depression; brain imaging in depressed patients – clinical implications; repetitive transcranial magnetic stimulation and other emerging brain stimulation techniques; efficacy data on transcranial magnetic stimulation- clinical factors that may predict response to TMS; ECT versus TMS -how to choose between them?
10:15am – 10:30am Coffee Break
10:30am – 12:15pmAssessment and treatment of the geriatric patient; psychopharmacological management of the geriatric patient with depression and/or anxiety, including the use of stimulants as an adjunctive treatment in geriatric depression; complex bereavement disorder, including discussion of reminiscence psychotherapy for complex bereavement disorder; medical illness and depression with an emphasis on cardiac disease and neurological conditions; assessing dementia versus the pseudo-dementia secondary to depression; does the use of benzodiazepines cause dementia in the elderly?; depression in Medical Illness.
12:15pmAdjourn

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