Journal of psychiatric practice
September 1, 2023
Amir Garakani, Jeanne L Alexander, Calvin R Sumner et al.
6 citations
Public and clinical interest in psychedelics is growing, with many studies underway for depression, anxiety, PTSD, and substance use disorders. This paper focuses on psilocybin, explaining its mechanism, psychedelic effects, and dosing. It reviews treatment studies, primarily for treatment-resistant depression and cancer-related anxiety, and discusses future directions and potential limitations in studying and regulating psilocybin and other psychedelics.
Journal of Psychiatric Practice
November 1, 2021
Amir Garakani
Three case reports illustrate challenges in treating treatment-resistant depression (TRD). A 73-year-old man with a liver transplant 26 years earlier responded well to 9 bitemporal electroconvulsive therapy (ECT) sessions despite his transplant history. A 28-year-old woman with chronic TRD who had only partial response to antidepressants and maintenance ECT achieved remission after twice-weekly 90-minute heated yoga sessions. A 52-year-old woman with TRD and chronic migraines, already on antidepressants and migraine medication, presented with agitation and paranoia after receiving intranasal ketamine from multiple providers, suggesting misuse; her symptoms resolved without prescribed antipsychotics. ECT remains safe even after organ transplantation, heated yoga shows promise as an adjunctive treatment, and esketamine requires careful monitoring to prevent misuse.
Journal of psychiatric practice
May 1, 2025
Amir Garakani
A 37-year-old man with no prior psychiatric history developed agitation, self-inflicted arm lacerations, paranoia, and hallucinations after about six months of increasing recreational nitrous oxide use. He had low vitamin B12 and anemia, with normal lab results and head imaging. His symptoms suggested psychosis and delirium with withdrawal-like features due to nitrous oxide abuse. He improved with olanzapine, a diazepam taper, and sertraline. The case underscores challenges in identifying and treating nitrous oxide misuse, as there is no drug test and no consensus on classification or management. Further research on both the risks of misuse and potential therapeutic uses of nitrous oxide is needed.