Ep. 9: Three Current Transformations in Psychiatry (and Their Implications)

Recorded on-location in Washington, DC, this episode of Psychopharmacology Today features Dr. George Kapalka, joined by Dr. Judi Steinman and Dr. Jim Phelps, to discuss Hawaii’s newly enacted prescriptive authority pilot program for appropriately trained prescribing psychologists. After decades of advocacy, Hawaii has become the ninth state to authorize prescribing psychologists, with the three-year pilot focused on federally qualified health centers on Kauai and Hawaii Island—areas with particularly limited access to psychiatric prescribers. The conversation explores how prescribing psychologists could help address nationwide mental-health workforce shortages and complement primary care providers who are increasingly called upon to manage psychiatric medications. The guests discuss the importance of combining psychological assessment, psychotherapy, and psychopharmacology training, particularly when evaluating complex presentations such as bipolar disorder that may be overlooked when antidepressants become the default treatment. They also consider the evidence and practical experience surrounding prescribing psychologists, the potential benefits of psychopharmacology training even in states without prescriptive authority, and the remaining challenges—including Hawaii’s current age restrictions and the need to expand access to children and older adults.

Dr. Merrill Norton provides an in-depth look at psychotropic drug interactions and what clinicians need to understand to prescribe safely in this episode of Psychopharmacology Today. He explains the distinction between pharmacokinetic interactions (what the body does to a drug) and pharmacodynamic interactions (what drugs do to the body), with particular attention to the CYP450 enzyme system, renal clearance, protein binding, and pharmacogenomic differences. Dr. Norton highlights high-risk combinations involving opioids, benzodiazepines, antidepressants, antipsychotics, stimulants, and mood stabilizers, while exploring potentially serious complications including respiratory depression, serotonin syndrome, QT prolongation, seizures, anticholinergic toxicity, and lithium toxicity. He also addresses the added complexity of treating patients with co-occurring mental health and substance use disorders, emphasizing medication reconciliation, patient-specific risk assessment, careful monitoring, and patient education.

Psychedelic-assisted therapy is rapidly transitioning from experimental research into mainstream clinical discussion, making it increasingly important for mental health professionals to understand the science behind these compounds. In this episode of Psychopharmacology Today, Dr. Judi Steinman explores the pharmacology of classic psychedelics (including LSD, psilocybin, mescaline, MDMA, ketamine, and related compounds) and explains how these substances interact with serotonin receptors, glutamate signaling, and broader neural networks involved in perception, cognition, and emotional processing. Drawing on her background as a pharmacologist and educator, Dr. Steinman examines the biochemical similarities and differences among psychedelic compounds, emerging research into their therapeutic potential for conditions such as depression and PTSD, and the mechanisms that may underlie their profound psychological effects. She also discusses CYP450 metabolism, clinically significant drug interactions, the risk of serotonin syndrome, evolving FDA research guidance, and why prescribing clinicians must understand both the opportunities and limitations of these therapies as the field continues to evolve.

Medical cannabis returns to Psychopharmacology Today, reflecting the rapidly evolving legal, scientific, and clinical landscape surrounding cannabis use. Drawing on a newly revised version of his popular webinar, Dr. Randall Tackett examines what clinicians need to know in 2026 as more patients use cannabis-derived products and more states expand medical cannabis access. Separating evidence from misinformation, Dr. Tackett reviews the pharmacology of cannabinoids, including THC, CBD, and newer hemp-derived compounds such as Delta-8 and Delta-10 THC. He explains the therapeutic evidence supporting approved cannabinoid medications, discusses where research remains limited, and highlights emerging concerns involving product labeling, drug testing, driving impairment, employment, and the unintended consequences of hemp-derived cannabinoid products following the 2018 Farm Bill. Throughout the episode, listeners gain a practical, evidence-based framework for evaluating the benefits, risks, and limitations of medical cannabis in ever-evolving contemporary clinical practice.

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.