Collaborative Psychiatry QuickTakes

Get more practical learning and clinical tools for mental health and substance-use care in outpatient settings at Collaborative Psychiatry.

An antidepressant has made a real difference, but the patient is still struggling. When there is a benefit worth preserving, the next step may be to add treatment for what symptoms remains rather than start over with a different medication. The useful question is: what change are we hoping the add-on will make?

This episode offers a practical approach to antidepressant augmentation: when it makes sense, how to choose an add-on for a specific goal, and how to tell whether it has earned its place. We discuss bupropion for low energy or SSRI-related sexual side effects, mirtazapine for poor sleep or appetite, and aripiprazole when depression remains disabling. We also address combining antidepressants, mirtazapine dosing, and what to watch for at follow-up.

Visit the episode page for the key clinical takeaways and the downloadable Antidepressant Augmentation clinical reference—a one-page comparison of bupropion XL, mirtazapine, aripiprazole, brexpiprazole, and quetiapine XR, with practical doses, key cautions, and follow-up checks. The download is available with a free Collaborative Psychiatry account.

For the broader approach to diagnosis, medication selection, titration, switching, and augmentation, explore the Managing Depression Clinical Framework. It also discusses other augmentation options, including lithium, T3, and modafinil.

You can also browse more Collaborative Psychiatry QuickTakes.

Get more practical learning and clinical tools for mental health and substance-use care in outpatient settings at Collaborative Psychiatry.

A patient can still say, "I'm depressed," even when an antidepressant has changed something meaningful. Low periods may be shorter, mornings may take less effort, or getting to work may be more reliable. Those changes can be easy to miss if the only question is whether the depression has resolved.

This episode looks at how to recognize a partial response, check whether the medication has had an adequate trial, and use the response pattern to decide whether to give it more time, optimize the dose, switch antidepressants, or consider augmentation. Side effects, safety, and the patient's priorities may change the usual next step.

Visit the episode page for the key clinical takeaways and two downloadable resources: Antidepressant Response: Optimize, Switch, or Augment?, a two-page clinical decision tool, and Antidepressant Response Check-In, a worksheet patients can bring to follow-up to describe what has changed. Both downloads are available with a free Collaborative Psychiatry account.

For a broader approach to diagnosis, medication selection, follow-up, switching, and augmentation, explore the Managing Depression in Primary Care Clinical Framework.

You can also browse more Collaborative Psychiatry QuickTakes.

Get more practical learning and clinical tools for mental health and substance-use care in outpatient settings at Collaborative Psychiatry.

A benzodiazepine prescription can remain unchanged for years while the clinical picture around it changes. In this case excerpt, a patient has taken the same clonazepam dose responsibly for more than a decade, but sleep apnea, fatigue, memory concerns, fall risk, alcohol exposure, and improved treatment of his underlying anxiety have created new reasons to reconsider the regimen.

This episode looks at how to decide whether those changes justify attempting a taper, how to explain the recommendation without blaming the patient or dismissing the medication’s prior benefit, and why starting the conversation does not require reducing the dose that day or committing to a predetermined endpoint.

Visit the episode page for the key clinical takeaways and the downloadable Benzodiazepine Prescription Review—a two-page clinical tool for clarifying what the medication is doing, what may have changed, what needs stabilization, and what the next treatment goal should be. The download is available with a free Collaborative Psychiatry account.

For the complete case—including what happens after the first conversation, how the taper is adjusted, and how the eventual endpoint is decided—explore Benzodiazepines in the Grey Zone: A Case Series + Clinical Toolkit.

You can also browse more Collaborative Psychiatry QuickTakes.

Get more high-yield learning on psychiatric management in primary care and outpatient practice at http://collaborative-psychiatry.org.

Billing for mental health visits can feel murky because the work is often cognitive, conversational, and risk-based rather than procedure- or lab-driven. This episode walks through how to think about billing mental health-related visits using medical decision making, time-based E/M billing, and a few key add-on codes.

For access to the high yield take-aways as well as the downloadable clinical references associated with this episode, visit the Episode Page. There, Free Members will find:

• A practical quick-reference guide for using MDM and time-based billing in mental health-related visits, including risk factors that often support moderate complexity.
• Case-based billing examples and documentation language for MDM, time-based E/M, psychotherapy add-ons, and prolonged services.

For deeper training in outpatient mental health decision-making, explore Collaborative Psychiatry’s CME-accredited audio courses on depression, ADHD, and alcohol use disorder at our Audio Courses page.

Season 1 of Collaborative Psychiatry QuickTakes may be complete, but the learning continues.

In this episode, I’m sharing a short excerpt from the full Audio Course Managing Depression in Primary Care. This clip walks through a practical framework for choosing a first-line antidepressant and setting expectations so patients stay on treatment long enough to see benefit.

You’ll hear:

• How I choose between bupropion, escitalopram, and sertraline
• How side effect profiles guide initial selection
• How to frame the “we don’t know which one will work yet” conversation
• Why anticipatory guidance about placebo response and timing matters

If you’ve been enjoying the QuickTakes, this excerpt gives you a feel for how the full Audio Courses go deeper with structured, practical, and high-yield learning designed for real-world outpatient care.

Explore More

Get more high-yield psychiatric education for primary care and outpatient clinicians at: http://collaborative-psychiatry.org

Audio Courses Available Now

• Managing Depression in Primary Care: A comprehensive framework for diagnosis, screening, medication selection, switching and augmentation strategies, treatment-resistant depression, and the broader treatment landscape including psychotherapy, neuromodulation, and ketamine/esketamine.

Coming Soon

• ADHD Pharmacology: A Practical Prescribing Framework
• Managing Alcohol Use Disorder

Keep the Learning in Your Back Pocket

If you’ve been listening to the QuickTakes, don’t forget to download the associated PDF clinic resources and patient handouts available on each episode page. These quick-reference tools are designed to support you in real time — in the exam room, not just in your earbuds.

Check out all the available resources here.

Get more high-yield learning on psychiatric management in primary care and outpatient practice at http://collaborative-psychiatry.org.

Naltrexone is a safe, effective, and often underutilized option for treating alcohol use disorder or even just problematic drinking in primary care. In this episode, we walk through how it works, how to prescribe it, and how to counsel patients on what to expect. You’ll learn practical strategies for dosing, managing side effects, navigating liver function, concurrent opioid use, and the use of approaches like the Sinclair Method when daily use isn’t the patient's goal. Whether you’re already prescribing naltrexone or just getting comfortable with it, this episode offers clear, actionable insights to support your patients and expand your toolkit.

For access to the Show Notes as well as the downloadable clinical references and patients handouts associated with this episode, visit the Episode Page. There, Free Members will find:

• A quick-reference sheet for naltrexone use in primary care and outpatient settings
• A reference sheet with counseling tips and scripts for prescribing naltrexone for AUD
• A handout comparing naltrexone with other AUD medications
• A patient handout on naltrexone for AUD

For a deep dive on managing alcohol use disorder in primary care as well as outpatient mental health settings, check out our Audio Course Managing Alcohol Use Disorder. We have a full course on Managing Alcohol Use Disorder in primary care and outpatient settings coming soon.

Get more high-yield learning on psychiatric management in primary care and outpatient practice at http://collaborative-psychiatry.org.

In this episode, we explore two underused antidepressants—vilazodone (Viibryd) and vortioxetine (Trintellix)—that offer important advantages over traditional SSRIs, particularly when it comes to minimizing sexual side effects and weight gain. You'll learn how these medications work, how to dose them effectively, and where they fit into real-world treatment strategies. By the end, you’ll be able to identify how vilazodone and vortioxetine differ from traditional SSRIs, compare their side effect profiles, understand titration schedules, and determine when to consider them as part of your antidepressant selection framework.

For access to the Show Notes as well as the downloadable clinical references and patients handouts associated with this episode, visit the Episode Page. There, QuickTake Members will find:

• A visual flowchart guiding clinical use of Vilazodone and Vortioxetine.
• A quick-reference table comparing clinically relevant aspects of Vilazodone, Vortioxetine and traditional SSRIs.
• An informational handout for patients considering or being prescribed Vilazodone.
• An informational handout for patients considering or being prescribed Vortioxetine.

For a deep dive on managing antidepressants and treating depression in primary care, check out our Audio Course Managing Depression in Primary Care.

Learning Objectives

By the end of this episode, you'll be able to:

• Identify the key differences between vilazodone, vortioxetine, and traditional SSRIs.
• Compare side effect profiles, especially regarding weight gain and sexual dysfunction.
• Apply practical dosing and titration strategies for these two medications.
• Determine where these medications fit in your antidepressant treatment algorithm.

Get more high-yield learning on psychiatric management in primary care and outpatient practice at http://collaborative-psychiatry.org.

Switching antidepressants is one of the most common—and often most confusing—tasks in primary care and outpatient mental health management. In this episode, we’ll walk through a clear, practical framework for how to approach antidepressant switches with confidence. You’ll learn when to consider switching, how to choose a new medication, and how to carry out the transition using one of three main strategies: taper and switch, direct switch, or cross-taper. We’ll cover how to assess withdrawal risk, use loose dose equivalence ranges, and tailor your approach based on patient needs and medication classes. Whether you’re dealing with a lack of response, antidepressant burnout, or just want to make a strategic change, this guide will help you do it safely and effectively.

For access to the Show Notes as well as the downloadable clinical references and patients handouts associated with this episode, visit the Episode Page. There, QuickTake Members will find:

• A quick-reference overview of how to switch antidepressants, and a rating of withdrawal risk by medication.
• A flowchart detailing when to employ each of the three switching strategies.
• A table with approximate dose-range equivalencies for the major antidepressants, to aid in planning switches.
• Example cross-tapers, to help guide you when designing your own.
• An informational handout for patients about switching antidepressants. Also includes a schedule on second page that can be filled in to provide instructions.

For a deep dive on managing antidepressants and treating depression in primary care, check out our Audio Course Managing Depression in Primary Care.

Learning Objectives

By the end of this episode, you'll be able to:

• Identify common clinical scenarios that warrant switching antidepressant medications, including inadequate response and antidepressant tolerance (“burnout”).
• Differentiate between the three primary strategies for switching antidepressants—taper and switch, direct switch, and cross-taper—and describe the risks and benefits of each.
• Apply a dose-range framework to guide antidepressant transitions, using low, medium, and high dose equivalents across common medications.
• Evaluate antidepressant withdrawal risk based on medication class and duration of treatment, and incorporate this risk into switch planning.

Get more high-yield learning on psychiatric management in primary care and outpatient practice at http://collaborative-psychiatry.org.

In this high-yield episode, we break down five psychiatric screeners every primary care provider should have in their toolbox: the PHQ-9, GAD-7, C-SSRS, Rapid Mood Screener, and Maclean Screening Instrument for BPD. You'll learn when and how to use each screener to streamline your workflow, sharpen your diagnostic thinking, and navigate complex mental health presentations. Whether you're managing depression, anxiety, suicidality, bipolar disorder, or borderline traits, these tools can help you focus your assessment and guide smarter treatment decisions--without adding to your cognitive load or taxing your time.

For access to the Show Notes as well as the downloadable clinical references and patients handouts associated with this episode, visit the Episode Page. There you will find:

• Direct links to all screeners discussed in this episode
• A quick-reference chart reviewing the most helpful psychiatric self-report screeners for general use in primary care
• A flow chart describing how and when to use psychiatric screeners in your clinical workflow
• A quick-reference chart describing a case-based approach to use of these screeners
• A quick-reference tool to assist in differentiating Bipolar Disorder from Borderline Personality Disorder, including questions you can use to guide the process.

For a deep dive on managing antidepressants and treating depression in primary care, check out our Audio Course on Managing Depression in Primary Care.

Learning Objectives

By the end of this episode, you'll be able to:

• Identify a go-to psychiatric screener for depression, anxiety, suicidality, bipolar disorder, and borderline personality disorder in primary care.
• Determine when to use each screener—before, during, or between visits—to streamline your workflow.
• Apply targeted screening to help distinguish between complex conditions such as bipolar disorder and borderline personality disorder.

Get more high-yield learning on psychiatric management in primary care and outpatient practice at http://collaborative-psychiatry.org.

Buprenorphine is one of the most powerful tools we have to fight the opioid epidemic but many primary care providers still feel uncertain about how and when to use it. In this episode, we break down the key pharmacologic concepts behind buprenorphine’s safety, misuse potential, and clinical challenges. By the end, you’ll have a clearer understanding of partial agonism, receptor affinity, and the mechanism behind precipitated withdrawal—so you can prescribe with more confidence.

For access to the Show Notes as well as the downloadable clinical references and patients handouts associated with this episode, visit the Episode Page. There, QuickTake Members will find:

• A quick-reference review of how buprenorphine works
• A suboxone initiation guide
• A patient handout on precipitated withdrawal

For a deep dive on managing antidepressants and treating depression in primary care, check out our Audio Course Managing Depression in Primary Care.

Learning Objectives

By the end of this episode, you'll be able to:

• Differentiate between partial and full agonism at the mu opioid receptor, and explain how partial agonism contributes to buprenorphine’s safety and reduced misuse potential.
• Describe the clinical implications of buprenorphine’s high receptor affinity, including its blocking effect on full agonist opioids.
• Analyze the receptor-level mechanism of precipitated withdrawal, and identify the conditions under which it may occur.

Feeling overwhelmed by the endless list of ADHD medications? In this episode, we break down stimulant prescribing into a simple, practical framework designed for busy primary care providers. You’ll learn how to distinguish between amphetamine and methylphenidate classes, when to start with each, and how to think about long-acting vs. short-acting formulations. By the end, you’ll feel more confident starting and adjusting the core stimulant medications, without needing to memorize the innumerable brand names. Whether you're new to ADHD treatment or just looking for a clearer mental model, this episode offers a streamlined approach you can put into practice right away.

For access to the Show Notes as well as the downloadable clinical references and patients handouts associated with this episode, visit the Episode Page. There, QuickTake Members will find:

• A stimulant reference chart
• A stimulant prescribing flowchart
• Patient handouts on amphetamines and methylphenidates
• A stimulant medication and skill use tracker for patients

For a deep dive on managing antidepressants and treating depression in primary care, check out our Audio Course Managing Depression in Primary Care.

Learning Objectives

By the end of this episode, you'll be able to:

• Identify the two main stimulant classes used to treat ADHD in adults and understand their core similarities and differences.
• Apply a practical framework for choosing between amphetamine and methylphenidate classes based on symptom severity and patient characteristics.
• Confidently select from a core group of stimulant medications and adjust dosing using long-acting and short-acting formulations for optimal symptom control throughout the day.

In this episode, we take a step back from the rush to diagnose and explore why so many adults are reporting attention difficulties today — and how primary care providers can begin to thoughtfully assess for ADHD. We unpack sociocultural forces shaping the rise in self-diagnosis, discuss the limitations of adult-onset ADHD as a clinical entity, and offer a practical entry point for evaluating attentional complaints using tools like the ASRS and WURS. If you’ve been feeling unsure about how to approach adult ADHD in a busy primary care setting, this episode offers a clear and manageable starting point.

For access to the Show Notes as well as the downloadable clinical references and patients handouts associated with this episode, visit the Episode Page. There, if you sign up for a free membership, you'll find:

• Links to the ASRS and WURS screeners
• A quick-reference reviewing the key points on evaluating ADHD in aduls
• A table reviewing the differential for chief complaints of inattention
• A patient handout on "Why you might feel distracted" that helps patient understand other factors involved in their (in)attention
• A patient handout on "How to improve focus without medications" that works for those with and without ADHD

For a deep dive on managing antidepressants and treating depression in primary care, check out our Audio Course Managing Depression in Primary Care.

Learning Objectives

By the end of this episode, you'll be able to:

• Recognize the sociocultural and environmental trends contributing to increased self-reported attentional difficulties in adults.
• Describe key clinical considerations that may suggest a diagnosis of ADHD versus other contributing factors
• Outline a basic approach for initiating an ADHD assessment in primary care, including the use of the ASRS and WURS screening tools

SSRIs are among the most widely prescribed medications in primary care, but side effects are one of the top reasons patients stop taking them. Nausea, fatigue, weight gain, and sexual dysfunction can derail treatment before it even has a chance to work. In this episode, we decode the four most common SSRI/SNRI side effect domains and give you a clear, practical framework for managing each one. Learn how to set expectations early, adjust timing, and use targeted strategies to help your patients stay on track and feel better faster. If you’ve ever found yourself guessing how to manage SSRI side effects, this episode gives you the confidence to handle them head-on.

For access to the Show Notes as well as the downloadable clinical references and patients handouts associated with this episode, visit the Episode Page. There, if you sign up for a free membership, you'll find:

• A clinical reference sheet on managing SSRI-related side effects, for quick recall of the topics discussed in this episodes
• An SSRI comparison table comparing the various antidepressant and their clinical + side effects
• An SSRI counseling phrase sheet to help you discuss these issues with patients
• A patient handout on What to Expect When Starting an SSRI
• A patient handout on Sexual Side Effects from SSRIs

For more comprehensive guidance on managing antidepressants and treating depression in primary care, check out our Audio Course Managing Depression in Primary Care.

Learning Objectives

By the end of this episode, you'll be able to:

• Recognize the most common early-onset side effects of SSRIs (e.g., GI upset and headaches) and apply evidence-based strategies to counsel patients and manage these symptoms.
• Differentiate between more activating and more sedating SSRIs, and implement p ractical dosing schedule adjustments to mitigate energy-related side effects.
• Identify pharmacologic interventions for SSRI-induced sexual dysfunction and weight gain, including when to switch medications versus when to consider adjunctive treatments (e.g., bupropion, buspirone, PDE-5 inhibitors).

Bringing practical psychiatry to primary care.

Checkout the website for the episode pages and access to all of the clinical resources: QuickTakes Page.