Anna Lembke

• MD
• Stanford University

Social media can provide real-time insight into trends in substance use, addiction, and recovery. Prior studies have used platforms such as Reddit and X (formerly Twitter), but evolving policies around data access have threatened these platforms’ usability in research. We evaluate the potential of a broad set of platforms to detect emerging trends...

Background and aims Opioid use disorder (OUD) and opioid dependence lead to significant morbidity and mortality, yet treatment retention, crucial for the effectiveness of medications like buprenorphine‐naloxone, remains unpredictable. Our objective was to determine the predictability of 6‐month retention in buprenorphine‐naloxone treatment using el...

Buprenorphine is a partial opioid agonist that is Food and Drug Administration (FDA) approved to treat chronic pain and opioid use disorder (OUD). The national prescribing guidelines in the United States (US) recommend that patients transitioning from full opioid agonists to buprenorphine first undergo 12 or more hours of active opioid withdrawal,...

Background: Shared medical appointments (SMAs) for buprenorphine prescribing are clinical encounters in which multiple patients with opioid problems receive treatment from providers in a group setting. Telehealth, the provision of clinical services remotely using telecommunications technology, is an essential modality for improving access to health...

The COVID-19 pandemic compelled fast adaptation of telehealth to addiction treatment services. This study aims to examine the feasibility and effectiveness of transitioning an in-person hospital addiction consult service (ACS) to telehealth. The Stanford Hospital ACS adapted to the pandemic by transforming an in-person ACS to a telehealth ACS. We c...

Background: Patients with substance use disorders (SUDs) make up nearly one-third (29.1%) of hospitalized patients in the United States. They also have double the 30-day readmission and emergency department visit rates compared to those without SUDs. The Centers for Medicare and Medicaid Services has penalized hospitals $3 billion for higher 30-day...

Background Stigma surrounding substance use disorders (SUDs) is a frequently cited barrier to treatment engagement. Research consistently demonstrates that healthcare professionals' attitudes towards patients with addiction problems are often negative and may adversely impact service delivery. The current study presents a systematic review of stigm...

Online interventions have potential to reach a wide range of people, including heavy drinkers unable or unwilling to seek formal treatment or support groups. This study examined a self-guided alcohol Internet intervention that provides access to several different online social networks and is based on principles of harm reduction, cognitive-behavio...

Objective: A majority of physicians feel poorly trained in the treatment of chronic pain and addiction. As such, it is critical that medical students receive appropriate education in both pain management and addiction. The purpose of this study was to assess the pre-clinical curriculum in pain medicine and addiction from the perspective of student...

This pharmacoepidemiology study uses Medicare Part D data to describe the use of buprenorphine-naloxone in the United States in 2013. Despite public policy efforts to prevent opioid overdose and addiction, opioid overdose rates reached record high numbers in 2014.1 The population that uses Medicare, the federal insurance program for Americans who h...

Evidence supports the use of opioids for treating acute pain. However, the evidence is limited for the use of chronic opioid therapy for chronic pain. Furthermore, the risks of chronic therapy are significant and may outweigh any potential benefits. When considering chronic opioid therapy, physicians should weigh the risks against any possible bene...

Background: As opioid overdose rates continue to pose a major public health crisis, the need for naloxone treatment by emergency first responders is critical. Little is known about the views of those who administer naloxone. The current study examines attitudes of health professionals on the social media platform Twitter to better understand their...

Corresponding Author: Anna Lembke, MD, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd, MC 5723, Stanford, CA 94305 (alembke@stanford.edu). Published Online: December 14, 2015. doi:10.1001/jamainternmed.2015.6662. Author Contributions: Dr Chen had full access to all of the data in the study and takes responsibi...

Background Heroin has emerged as the primary drug of concern in China, with as many as three million contemporary users. Once a Chinese citizen has been identified by Chinese law enforcement as a ‘drug addict’, that individual is ‘registered’ in an official government tracking system for the rest of his or her life, independent of verified rehabili...

This commentary points out that smoking is increasingly concentrated among people with psychiatric problems and other substance use disorders (eg, alcohol use disorder), and argues that for clinical, ethical and efficiency reasons, such individuals should be routinely enrolled in smoking cessation research. Published by the BMJ Publishing Group Lim...

Prescription drug abuse is a pressing public health issue, and people who misuse prescription drugs are turning to online forums for help. Are such forums effective? We analyze the process of opioid withdrawal, recovery and relapse on Forum77, MedHelp.org's online health forum for substance abuse recovery. Applying Prochashka's Transtheoretical Mod...

Alcohol misuse adversely affects health outcomes, but alcohol misuse and alcohol use disorders (AUDs) are often ignored by healthcare providers in primary and specialty ambulatory care clinics. Data show that early identification and brief intervention for alcohol misuse in these settings can effectively reduce alcohol consumption and its medical s...

The concept of recovery has been an influence on addicted individuals for many decades. But only in the past 15 years has the concept had a purchase in the world of public policy. In the USA, federal and state officials have promulgated policies intended to foster 'recovery-oriented systems of care' and have ratified recovery-supportive laws and re...

Genetic variation underlying hypothalamic pituitary adrenal (HPA) axis over-activity in healthy controls and patients with severe forms of major depression has not been well explored but could explain risk for cortisol dysregulation. 95 participants were studied: 40 patients with psychotic major depression (PMD); 26 patients with nonpsychotic major...

As a quality improvement metric, the US Veterans Health Administration (VHA) monitors the proportion of patients with alcohol use disorders (AUD) who receive FDA approved medications for alcohol dependence (naltrexone, acamprosate, and disulfiram). Evidence supporting the off-label use of the antiepileptic medication topiramate to treat alcohol dep...

Although access to and consideration of pharmacological treatments for alcohol dependence are consensus standards of care, receipt of these medications by patients is generally rare and highly variable across treatment settings. The goal of the present project was to survey and interview the clinicians, managers, and pharmacists affiliated with add...

The neuropeptide oxytocin (OT) promotes social behavior and attenuates stress responsivity in mammals. Recent clinical evidence suggests OT concentrations may be dysregulated in major depression. This study extends previous research by testing whether: 1) OT concentrations vary systematically in depressive disorders with and without hypercortisolem...

a b s t r a c t Psychotic major depression (PMD) is associated with deficits in verbal memory as well as other cognitive impairments. This study investigated brain function in individuals with PMD during a verbal declarative memory task. Participants included 16 subjects with PMD, 15 subjects with non-psychotic major depression (NPMD) and 16 health...

Sixty percent of the opioids that are abused in the U.S. are obtained through a physician's prescription. Changes in philosophy about pain treatment, trends in attitudes toward suffering, and financial disincentives for treating addiction contribute to this problem.

Background: The Self-Medication Hypothesis (SMH) of addictive disorders as articulated by Edward Khantzian in his seminal 1985 paper postulates that individuals with psychiatric disorders use substances to relieve psychiatric symptoms and that this pattern of usage predisposes them to addiction. Khantzian's SMH also postulates that the preferred s...

Introduction: Hypothalamic-pituitary-adrenal (HPA) axis dysregulation has been linked with major depression, particularly psychotic major depression (PMD), with mineralocorticoid receptors (MRs) playing a role in HPA-axis regulation and the pathophysiology of depression. Herein we hypothesize that the MR agonist fludrocortisone differentially inhi...

Severe alcohol misuse as measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is associated with increased risk of future fractures and trauma-related hospitalizations. This study examined the association between AUDIT-C scores and two-year risk of any type of trauma among US Veterans Health Administration (VHA) patients...

Moderation Management (MM) is a mutual-help organization for problem drinkers who are not alcohol-dependent. MM members pursue a goal of moderate drinking as defined by specific guidelines for frequency and quantity of alcohol consumption. MM's program for change is based primarily on cognitive restructuring and behavioral self-control enhancement...

Neuropsychological functioning, in relation to positive and negative symptoms in psychotic major depression (PMD), has not been as thoroughly studied as it has been in schizophrenia. Thus, the current study investigated the associations between positive and negative symptoms with cognitive functioning, with an emphasis on verbal memory in PMD. Atte...

Excessive alcohol use is associated with a variety of negative health outcomes, including liver disease, upper gastrointestinal bleeding, and pancreatitis. To determine the 2-year risk of gastrointestinal-related hospitalization and new-onset gastrointestinal illness based on alcohol screening scores. Retrospective cohort study. Male (N = 215, 924)...

Lithium, valproate, and lamotrigine are all effective first-line agents in the treatment of mood disorders, however, they are also associated with serious adverse events. Lithium is known to cause neurotoxicity, renal toxicity, thyroid toxicity, and teratogenic effects. Valproate can result in fulminant hepatic necrosis, acute hemorrhagic pancre-at...

Psychotic major depression appears to be a unique subtype of depres-sion with its own phenomenology and treatment response. However, the symptom profile of psychotic depression is not well described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the psychotic symptom features of psychotic depression may be distinc...

Depression and smoking are highly comorbid. The vast majority of psychiatrists treating depressed patients do not target or treat nicotine dependence, and many inpatient psychiatric facilities implicitly condone smoking by providing 'smoke breaks'. The reasons for failure to treat are unclear, but are probably linked to the notion that depressed sm...

Review of a Randomized-Controlled Trial of Adjunctive Bupropion in the Treatment of SSRI-Induced Sexual Dysfunction - Volume 2 Issue 1 - Anna Lembke, Charles DeBattista

Randomized trials indicate that psychosocial interventions effective adjuncts to pharmacotherapy in bipolar disorder (1,2). A one-year naturalistic-prospective design was used to examine the association between psychotherapy use and the symptomatic and functional outcomes of patients with bipolar disorder. Patients with bipolar disorder in a depres...

Most patients in acute depression trials fail to achieve remission with antidepressant monotherapy. Many patients seem to require more than one medication to achieve remission or adequate response. Augmentation strategies are commonly used in clinical practice, but most have been poorly studied. In addition, better-studied strategies, such as the u...

Although patients with bipolar disorder have been shown to benefit from psychosocial interventions, the proportion that utilizes these interventions is unknown. We set out to clarify the determinants of psychosocial service utilization in adults with bipolar disorder. We investigated psychosocial service utilization among the first 500 patients adm...

Modafinil is a wake-promoting agent approved by the Federal Drug Administration for the treatment of narcolepsy. Preliminary evidence indicates that modafinil may improve fatigue and excessive sleepiness associated with a variety of conditions. The purpose of this study was to investigate the utility of modafinil as an adjunctive treatment of depre...

Interventions that have been utilized to control seizures in people with epilepsy have been employed by the psychiatric community to treat a variety of disorders. The purpose of this review will be to give an overview of the most prominent uses of antiepileptic drugs (AEDs) and devices like the Vagus Nerve Stimulator (VNS) and Transcranial Magnetic...

Until the 1980s, the two major classes of antidepressants, the tricyclics and the monoamine oxidase inhibitors (MAOIs), were effective but had severe side effects, requiring monitoring by psychiatrists. The past several years have brought new classes of antidepressants that are safer for the patient to take and far easier for the non-psychiatrist t...

Timbre is a major structuring force in music and one of the most important and ecologically relevant features of auditory events. We used sound stimuli selected on the basis of previous psychophysiological studies to investigate the neural correlates of timbre perception. Our results indicate that both the left and right hemispheres are involved in...

These temporal domains of affective experiences are related to one another, with different temperaments yielding predispositions to varying moods, which in tum yield tendencies to diverse emotions. Influence also occurs in the opposite direction, with intense emotional experiences in rapid succession yielding particular moods, and repeated or chron...

This volume is a comprehensive roadmap to the burgeoning area of affective sciences, which now spans several disciplines. The Handbook brings together, for the first time, the various strands of inquiry and latest research in the scientific study of the relationship between the mechanisms of the brain and the psychology of mind. In recent years, sc...

To evaluate effects of olanzapine in diverse exacerbations of bipolar disorders. Twenty-five evaluable bipolar disorder [14 bipolar I (BPI), 10 bipolar II (BPII) and one bipolar disorder not otherwise specified (BP NOS)] outpatients received open olanzapine (15 adjunctive, 10 monotherapy). Thirteen had elevated (11 syndromal, two subsyndromal) and...

The authors discuss the use of guidelines and algorithms for the treatment of depression as well as implementation.

Recognition of facial emotion was examined in manic subjects to explore whether aberrant interpersonal interactions are related to impaired perception of social cues. Manic subjects with bipolar I disorder (N=8), euthymic subjects with bipolar I (N=8) or bipolar II (N=8) disorder, and healthy comparison subjects (N=10) matched pictures of faces to...

•Depression in epilepsy patients is not only extremely common, but is often poorly recognized and inadequately treated. •Depression can have significant consequences including increased medical utilization, poor quality of life, social disability, and mortality. •Etiology of depression is multifaceted with prominent psychosocial determinants. Salie...