Jim Phelps returns for another episode of Psychopharmacology Today, exploring three major shifts reshaping modern psychiatry: 1) the move from categorical to dimensional diagnosis, 2) emerging biological mechanisms underlying bipolar disorder, and 3) the evolving role of lithium in brain health and dementia prevention.

Drawing on epidemiologic research, clinical experience, and recent neuroscience findings, Dr. Phelps explains how mood disorders often exist along a spectrum rather than within rigid DSM categories, emphasizing the importance of diagnostic humility when assessing depression, anxiety, trauma, and bipolarity. He also reviews practical treatment implications, including social rhythm therapy, circadian stabilization, blue-light reduction strategies, and the potential therapeutic value of low-dose lithium. Throughout the discussion, Dr. Phelps highlights how advances in chronotherapy, metabolism, inflammation research, and dimensional assessment may fundamentally change how clinicians understand and treat mood disorders in the years ahead.

In this episode of Psychopharmacology Today, Dr. Daubney Boland offers a practical and compassionate overview of gender-affirming care, emphasizing the critical role prescribing psychologists play in creating inclusive, respectful, and medically informed treatment environments for transgender and nonbinary patients. Drawing on clinical experience and case studies, she explores how affirming language, accurate pronoun use, and culturally competent systems reduce barriers to care, while delayed or withheld treatment can intensify depression, dysphoria, self-harm, and other mental health concerns. Dr. Boland also reviews key psychopharmacology considerations, including hormone therapy risks, informed consent, fertility counseling, and monitoring issues such as testosterone-related polycythemia, highlighting the importance of interdisciplinary collaboration and individualized, patient-centered decision-making in ethical gender-affirming practice.

In this episode of Psychopharmacology Today, Dr. James Phelps explores the diagnostic and treatment challenges associated with bipolar spectrum disorders and mixed mood states. Drawing on decades of clinical experience, he explains why traditional categorical diagnoses (such as unipolar depression versus bipolar disorder) often fail to capture the complexity of real-world presentations.

Dr. Phelps introduces the concept of the mood spectrum and highlights the overlapping symptoms between depression, anxiety disorders, ADHD, PTSD, and bipolar mixed states. He emphasizes the importance of evaluating “non-manic markers,” including family history, illness course, and antidepressant response, when determining whether bipolarity may be present.

The episode also discusses practical treatment considerations. Dr. Phelps outlines the risks associated with antidepressants in patients with mixed states and reviews alternative strategies, including social rhythm therapy, mood stabilizers such as lamotrigine and low-dose lithium, and the careful tapering of antidepressants. Throughout the discussion, he argues that prescribing psychologists are uniquely positioned to manage these complex cases due to their combined expertise in psychotherapy and medication management.

The session concludes with a framework for shared decision-making with patients and a practical approach to stabilizing mood symptoms while navigating diagnostic uncertainty.