Michael Ostacher, MD, MPH

Just had a patient tell me today that my prescribing acamprosate saved his life. Hasn't drank since. "I just don't think about it anymore." Never had someone taking gabapentin tell me that, so just a reminder to all of you out there to follow the data and to watch your biases.😀

Shrimp fried rice to go with other leftovers. #twittersupperclub

@BadreNicolas x.com/recoverydoctor…

30 psychiatrists are calling Trump unfit... again… sigh, when will we/psychiatrists learn to stop diagnosing and labeling people we don’t actually know? It starts with: • “The following is not a political statement. It is a medical one” (aka we are not biased; this is expertise - sarcasm) It the lists a bunch of symptoms based on political disagreement rather than evidence: • “disorganized” speech • “factual confusions” • “Grandiose and delusional beliefs” • “impaired judgment” • “loss of self-control” • “he presents a clear and present danger” How to respond? Famed Judge Bazelon described psychiatrist aggrandizement of knowledge and expertise using jargon over facts best: "Psychiatry, I suppose, is the ultimate wizardry... In no case is it more difficult to elicit productive and reliable expert testimony... In my experience they try to limit their testimony to conclusory statements couched in psychiatric terminology." Bazelon, 1974 Link to the letter below.

A white chocolate macadamia nut Clif Bar before a workout. It was pretty terrible but I still ate it. It might taste good after a 7 mile hike in the wilderness but I didn’t do that. #twittersupperclub

@cremieuxrecueil If you said the effects were large you’d have 80,000 likes and 5.6 M views by now.

The within-person correlations between daily physical activity and affective well-being are small at most This literature developed such that it started off with people thinking physical activity had huge effects, then they thought it had no effect, and now it has a small effect

@cremieuxrecueil @BadreNicolas These poor guys, if they’d lived long enough, look like they’d be at higher risk of dementia.

@cremieuxrecueil @BadreNicolas Even air pollution, which is down by 2/3 since the 1970’s siepr.stanford.edu/publications/p…

The odds of having dementia at age 85 were close to 1 in 3 in the 80s; now they are 1 in 10. I don’t think we have a great explanation: better cardiovascular health, diet, and education are often mentioned. Good news nonetheless. Carnall Farrar. (2025, March 27). Dementia trends.

@chrisaikenmd I’m thinking CBT without the esketamine would have done just fine

Esketamine works fast, but how do you make it last? Adding CBT to the end of 4-week esketamine course reduced depression and suicidality in this randomized trial, though lacking an active control group. Learn what the did in the therapy: psych-partners.com/cbt-helps-sust…

@DrJMarine @KellyMorrisonMN I would take any of those transitory side effects over the flu, as we have discussed.

@KellyMorrisonMN That shot is not so great, actually:

Too bad they canceled all the mRNA research

@dawso007 @DrJMarine It would be nice to have good data about whether flavors successfully help smokers quit smoking, but anecdotally they do. @ChaunceyGardner

@RecoveryDoctor @DrJMarine Based on the number of adults I have treated who were using higher doses of vape solutions because they liked the cake flavor more than ordinary cigarettes - this is a potential small scale disaster. Nobody seems to answer the obvious question about why flavors are necessary.

Good article on this no-win situation for FDA. One wonders whether the entire federal tobacco regulatory scheme should just be replaced with two words: caveat emptor.

@TheBorisLab Early trials probably have an ethical responsibility to make sure an errant safety problem doesn’t scuttle the efficacy programs, but not including higher risk patients will leave us not knowing if there are dangers to the drugs.

Much needed work here- overly conservative exclusions in psychedelic trial make our trials less representative of real world patients

@ProfRobHoward It’s quite remarkable how much this is the triumph of hope over experience.

Not less that I expected. These drugs are an amazing faff for patients and clinical services and have effects that are too small to detect in an individual patient. Longer term treatment data doesn’t suggest disease course modification either.

"I was on the inside but now I'm on the outside here to give you the truth." This is one of the most commonest angles in grifting. Dr. Josef charges $30 to (Ive heard) $60k/year per patient for deprescribing counselling. I really hope more people notice the patterns emerging.

@NTFabiano I frown on posts like this

Depression may be contagious through a dysfunctional mirror neuron system.

@dsowens17 And that somehow makes me wrong about Moncrieff and “critical psychiatry”? Really? Argue on the merits. She is in fact smart enough to know that what she is saying is not true.

Please remember that Professor Ostacher has been sponsored by Neurocrine, Otsuka, Janssen/J&J, Freespira/Palo Alto Health Sciences, Eli Lilly, Supernus, Sunovion, Lundbeck, Acadia, Alexza, BMS, AstraZeneca, GSK, and Pfizer. Yet it is others who apparently have sacrificed their intellectual integrity for money….

@IljaOblomow Mold. It’s only on the peel, like a ripe cheese.

@RecoveryDoctor But the Fungus?

Just right for banana bread. #twittersupperclub

@AlobhaPatrick Before lithium use was widespread there were nonsense, frankly derogatory, articles like this: psychiatryonline.org/doi/epdf/10.11…

@RecoveryDoctor I agree different treatments work differently at different phases

Lithium certainly works. The better question is: In what ways, and in what circumstances, is Lithium the best of bad choices. Secondarily, what are better choices for life threatening mania, psychosis, etc?

I'm sorry @joannamoncrieff, but lithium ranks as one of the most effective prophylactic drugs of all time.