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 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: 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.