The Carlat Psychiatry Podcast

A Silicon Valley founder built a telehealth company to make ADHD treatment as easy as ordering takeout, until federal prosecutors traced 37 million pills of Adderall back to the clinic. We follow Done from venture-backed startup to criminal conviction, and ask what the case means for how we diagnose and treats ADHD. Plus: a new FDA approval adds a third option to the ADHD reuptake-inhibitor family. CME: Take the CME Post-Test for this Episode Published On: 09/14/2026 Duration: 13 minutes, 34 seconds Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Today, we’re tackling a deceptively simple question that comes up all the time in clinical practice: When should we prioritize medication, when should we emphasize psychotherapy, and when can we recommend both? This question comes up especially often with patients who are new to treatment. They’ll ask, “Do I need a medication?” or “Can I just do therapy?” And while it’s tempting to answer in generalities, the evidence actually gives us much clearer guidelines, depending on the substance that the patient is using. CME: Take the CME Post-Test for this Episode Published On: 09/07/2026 Duration: 10 minutes, 57 seconds Noah Capurso, MD, and Suzanne Decker, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Dr. Donn Posner is a leading expert in Cognitive Behavioral Therapy for Insomnia (CBT-I), founder and president of Sleepwell Consultants, and an adjunct clinical associate professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. He is co-author of Cognitive Behavioral Therapy for Insomnia: A Session-by-Session Guide, and he has trained and consulted with clinicians nationally and internationally across nearly four decades of clinical practice. In this second of two episodes, the conversation turns from what CBT-I is to how clinicians actually learn and deliver it. Dr. Posner reviews the available training pathways and what proficiency really requires, and explains why sleep hygiene — the advice most patients have already heard many times over — does not treat chronic insomnia, even though it has a place later in the work. He identifies the high-yield principles any clinician can apply immediately, including a fixed morning wake time, early light exposure, and getting out of bed when not sleeping. He then examines sleep effort as a perpetuating factor and CBT-I as fundamentally a therapy of acceptance, describing how he prepares patients for a treatment that will make them feel worse before it makes them better, and how cognitive work addresses the fear and resistance that follow. He closes with what clinicians should expect from a course of treatment — typical length and spacing, responder and remitter outcomes, and the durability of gains — along with how he handles sleep medication and why guidelines place CBT-I ahead of hypnotics. Learning Objectives After completing this educational activity, participants should be able to: Explain why sleep hygiene is ineffective as a monotherapy for chronic insomnia, and describe the more limited role it plays within a full course of CBT-I. Identify high-yield behavioral sleep medicine principles — including a fixed morning wake time, early light exposure, and getting out of bed when not sleeping — that clinicians can apply before completing formal CBT-I training. Describe sleep effort as a perpetuating factor, and summarize how the cognitive and acceptance-based components of CBT-I address the dysfunctional beliefs and resistance that arise during treatment. Summarize the expected course and outcomes of CBT-I (including typical session number and spacing, responder and remitter outcomes, and durability of gains) and explain why guidelines position CBT-I ahead of hypnotic medication. Topics Covered in This Interview Pathways to training in CBT-I and behavioral sleep medicine Board certification in behavioral sleep medicine Why sleep hygiene alone does not treat chronic insomnia: the dental hygiene analogy Where sleep hygiene does belong within CBT-I Available CBT-I training programs and online options How clinicians become proficient: consultation, community, and case experience High-yield behavioral sleep principles any clinician can apply Sleep regularity, fixed wake times, and morning light exposure Why getting out of bed is the hardest intervention for patients to accept Sleep effort as a perpetuating factor What good sleepers do — and do not do — to fall asleep CBT-I as a therapy of acceptance Preparing patients for the work: “I'm going to make you worse before I make you better” The cognitive component: uncovering and debunking dysfunctional beliefs Common patterns of resistance, and exposure as the remedy Typical treatment length, session spacing, and pacing Responders versus remitters, and what the outcome data show Durability of gains and the role of sleep self-efficacy Managing and tapering sleep medication alongside CBT-I Why guidelines position CBT-I ahead of hypnotic medication

Dr. Donn Posner is one of the most active educators in CBT-I. He's founder and president of Sleepwell Consultants, adjunct clinical associate professor in Psychiatry and Behavioral Sciences at Stanford, and spent twenty-five years before that as director of behavioral sleep medicine at the Sleep Disorders Center of Lifespan Hospitals. In this first of two episodes, Dr. Posner explains that chronic insomnia is a disorder in its own right — not just a symptom of something else — driven by perpetuating factors that become the targets of treatment. He covers: How insomnia disorder is defined, and what a proper CBT-I assessment looks like The sleep diary as the clinician's version of an X-ray The two core behavioral components — sleep restriction (more accurately, time-in-bed restriction) and stimulus control — and the mechanisms each one targets: homeostatic sleep drive and conditioned arousal Why sleep can't be willed — it's never under a patient's voluntary control How far the protocol can flex for individual patients The evidence base showing CBT-I works even alongside depression, anxiety, PTSD, or chronic pain — and that those conditions don't need to be treated first Length: 28 Minutes

How to separate adult ADHD from other causes of cognitive problems like bipolar disorder, sleep apnea, medication effects, brain injury, temperament, and malingering. CME: T ake the CME Post-Test for this Episode Published On: 08/17/2026 Duration: 15 minutes, 35 seconds Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The modern DSM began as a short list of 12 well-validated diagnoses. But the list expanded as the authors changed the goals from validity to reliability. Lost in this history is a missing page that helps separate adult ADHD from its mimics. CME: Take the CME Post-Test for this Episode Published On: 08/10/2026 Duration: 14 minutes, 39 seconds Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Nine studies have tried to find out whether ADHD can start in adulthood, we dig into the data and find some answers to the controversy. CME: Take the CME Post-Test for this Episode Published On: 08/03/2026 Duration: 13 minutes, 07 seconds Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

DSM-5 loosened the criteria for adult ADHD, but did it get too lose? We look at what recent prosecutions of telehealth companies mean for those trying to diagnose this disorder on the front-lines. CME: Take the CME Post-Test for this Episode Published On: 07/27/2026 Duration: 15 minutes, 10 seconds Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Dr. Shireen Rizvi provides an overview of Dialectical Behavior Therapy (DBT) and the treatment of Borderline Personality Disorder.

Women clear some psychiatric medications more slowly, lose bone density at higher rates, and face greater medical consequences from alcohol and smoking than men. This final episode in a four-part series covers side effects, drug metabolism, drugs of abuse, urine incontinence, and what we do — and don't — know about prescribing for transgender patients. CME: Take the CME Post-Test for this Episode Published On: 07/13/2026 Duration: 17 minutes, 37 seconds Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Estrogen shapes nearly every neurotransmitter system in the brain, and when it starts to fall, psychiatric disorders often follow. This episode walks through what psychiatrists need to know about the perimenopause: which conditions worsen, which treatments help, and when to call the OB-GYN about hormone replacement therapy. CME: Take the CME Post-Test for this Episode Published On: 07/06/2026 Duration: 18 minutes, 37 seconds Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Premenstrual hormones can destabilize mood, worsen ADHD, trigger psychosis, and drive binge eating. This episode walks through the tools to manage hormonal fluctuations in female patients, from SSRIs to overlooked supplements to the lamotrigine-contraceptive drug interaction. CME: Take the CME Post-Test for this Episode Published On: 06/23/2026 Duration: 23 minutes, 32 seconds Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Women and men respond to psychiatric medications differently. In this first of a four-part series, Chris Aiken and Kellie Newsome walk through why valproate is risky for women, and when it’s worth using; why the FDA cut the zolpidem dose in half for female patients, and why SSRIs outperform tricyclics in women with depression. Plus: a sneak preview of DSM-6. CME: Take the CME Post-Test for this Episode Published On: 06/22/2026 Duration: 27 minutes, 32 seconds Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Psilocybin is going mainstream: Trump has signed an executive order opening psychedelics to patients with severe mental illness, and one in eight American adults has already tried it. But as we dig into the research, a more complicated picture emerges, one that separates the profound personal experience from the clinical evidence. CME: Take the CME Post-Test for this Episode Published On: 06/15/2026 Duration: 18 minutes, 34 seconds Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Dr. Roger Solomon provides a comprehensive introduction to Eye Movement Desensitization and Reprocessing (EMDR), explaining the adaptive information processing model that underlies the treatment, walking through all eight phases of the protocol, and discussing how EMDR can be applied across a wide range of presentations—from single-incident trauma to complex trauma with dissociation. Dr. Solomon also addresses how clinicians can determine client readiness, navigate repressed memories, and leverage the generalization effect when working with patients who have extensive trauma histories.

What if the patients we assume are safest from suicide are actually the ones we miss? Today we're talking about suicide risk in autistic youth, why it's higher than many clinicians expect, how distress shows up differently, and what small changes in our assessment process and treatment can make a real difference. CME: Take the CME Post-Test for this Episode Published On: 06/01/2026 Duration: 18 minutes, 29 seconds Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

It's 1979, and Johns Hopkins has just shut down the first gender surgery clinic in the US. But investigations into the biological roots of gender identity are about to reopen those doors — and reshape how medicine thinks about sex, gender, and who gets to decide. CME: Take the CME Post-Test for this Episode Published On: 05/25/2026 Duration: 11 minutes, 52 seconds Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

In 1966, Johns Hopkins opened the first gender surgery clinic in the US. Thirteen years later, a single study shut it down. We examine what the research said, what it didn't say, and how new standards of care emerged from the ashes. CME: Take the CME Post-Test for this Episode Published On: 05/18/2026 Duration: 13 minutes, 39 seconds Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The president of the US branch of WPATH built one of the largest youth gender clinics in the country, then watched it close under political fire. Now she's facing a malpractice lawsuit from a former patient. We examine the unpublished study at the center of the controversy. CME: Take the CME Post-Test for this Episode Published On: 05/11/2026 Duration: 16 minutes, 11 seconds Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this

Medical societies are reversing decades of support for gender-affirming care in youth — but is it the science driving the shift, or the politics? This episode walks through the evidence, from randomized trials to regret rates, and finds a more complicated picture than either side presents. CME: Take the CME Post-Test for this Episode Published On: 05/04/2026 Duration: 13 minutes, 09 seconds Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.