About

Karl Rickels is a faculty member in the Department of Psychiatry at the University of Pennsylvania's Perelman School of Medicine. His educational background includes an M.D. from Muenster University, Germany, obtained in 1951, and he completed his early education in Berlin-Lichtenberg in 1942. His professional work focuses on mood and anxiety disorders, as indicated by his association with the Mood and Anxiety Disorders Treatment and Research Program at the University of Pennsylvania. Rickels has contributed to research on generalized anxiety disorder, including treatment remission and relapse, and has authored works on the life and legacy of notable figures in psychiatry. His contact information is listed as being at 3535 Market Street, Suite 670, Philadelphia, PA, with an email address of KRICKELS@MAIL.MED.UPENN.EDU.

Research topics

• Medicine
• Psychology
• Psychiatry
• Internal medicine
• Clinical psychology

Selected publications

• Nonspecific Factors and Drug and Placebo Response in Psychiatry

  2024-02-23

  book-chapterSenior author

  For those who become involved in clinical trials conducted to assess the efficacy of psychotropic drugs, it very quickly becomes apparent that a broad range of factors other than the pharmacological properties of the drugs themselves affect or modify treatment. A double-blind, placebo-controlled drug trial can readily demonstrate that an anxiolytic as effective as chlordiazepoxide or diazepam induces a significantly greater amount of symptom ameliorization than does placebo in a group with specifiedly appropriate target symptomatology. However, the degree of symptom reduction varies greatly both in the group treated with an active agent and in the placebo group. Further, side effects are encountered more frequently in the active treatment group than in the control group. Still, the range of severity of the side effects of which drug-treated patients complain is considerable and the extent to which patients are able to tolerate or accept side effects at a given level of severity varies widely.

  PublisherDOI

• Chapter 23. Buspirone

  American Psychiatric Association Publishing eBooks · 2024-03-22

  book-chapter
  PublisherDOI

• The rise and fall and rise of benzodiazepines: a return of the stigmatized and repressed

  Brazilian Journal of Psychiatry · 2020-03-09 · 54 citations

  articleOpen access

  Americanae nace como un proyecto conjunto que surge dentro de la Red Europea de Información y Documentación sobre América Latina (REDIAL), y que ha afrontado la Biblioteca de la Agencia Española de Cooperación Internacional para el Desarrollo (AECID). Esta nueva biblioteca virtual hace más accesibles los libros digitales de tema americanista a los investigadores y usuarios interesados de cualquier parte del mundo.

  PublisherOA PDFDOI

• The Course of Adverse Events in Venlafaxine XR Treatment in Generalized Anxiety Disorder

  Journal of Clinical Psychopharmacology · 2019-03-29 · 3 citations

  article1st authorCorresponding

  PURPOSE: The time course of adverse events is an important factor for patient management. Clinicians are better able to prepare patients for specific adverse events, which leads to better treatment adherence. METHODS: Adverse events were followed longitudinally for 6 months during the open-label phase of a relapse prevention trial with 264 patients with generalized anxiety disorder. Adverse events were assessed at each treatment visit using a 21-item checklist. Logistic regression modeling, continuation ratio modeling, and hierarchical linear modeling were used to determine whether adverse events led to early attrition and whether adverse events decreased in enrolled patients over time. FINDINGS: Adverse events were found to have decreased highly significantly during treatment. A highly significant race effect was found in that whites had a significantly higher adverse event rate than did nonwhites. Early attrition rates were predicted by presence of nausea and fatigue, late attrition by dizziness, nervousness, and sexual dysfunction. IMPLICATIONS: Our findings provide information for clinicians on the course of adverse events over treatment, useful to prepare patients for treatment adherence.

  PublisherDOI

• Benzodiazepines, antidepressants and addiction: A plea for conceptual rigor and consistency

  Journal of Psychopharmacology · 2019-09-26 · 5 citations

  letterOpen access

  The editorial by Jauhar et al. (2019) discusses the recently published concerns about “addiction” to antidepressants (mainly serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors) in light of an increasing number of publications addressing antidepressant withdrawal symptoms. They (Jauhar et al., 2019) ask a crucial question (“Are antidepressants addictive?”), examine conceptual and methodological issues and arrive at a conclusion that “there is minimal evidence, using established classification systems and concepts, that antidepressants should be classified as addictive substances” (p.657). We agree with their conclusion that antidepressants are not addictive and that the main argument invoked in support of addiction to antidepressants – the presence of withdrawal symptoms – is not valid. However, we would like to point that the same standard

  PublisherOA PDFDOI

• International Task Force on Benzodiazepines

  Psychotherapy and Psychosomatics · 2018-01-01 · 34 citations

  editorialOpen access
  PublisherOA PDFDOI

• Contribution of parasympathetic muscarinic augmentation of insulin secretion to olanzapine-induced hyperinsulinemia

  American Journal of Physiology-Endocrinology and Metabolism · 2018-01-06 · 17 citations

  articleOpen access

  Atypical antipsychotic drugs have been associated with the development of obesity and diabetes. In particular, olanzapine can induce peripheral insulin resistance and compensatory hyperinsulinemia independent of weight gain or psychiatric disease. To determine if this compensatory increase in insulin is mediated by parasympathetic muscarinic stimulation, we randomized 15 healthy subjects 2:1 to receive double-blind olanzapine or placebo for 9 days under diet- and activity-controlled inpatient conditions. Before and after 7 days of study drug administration, subjects underwent frequently sampled intravenous glucose tolerance tests with either saline or atropine infused on subsequent days to assess insulin secretion and hepatic insulin extraction in the absence or presence of muscarinic blockade. We found that olanzapine led to an increase in the acute insulin response to glucose, which was not seen with placebo, and was attenuated in the olanzapine group by atropine. Deconvolution of C-peptide data confirmed an increase in insulin secretion with olanzapine, which was blocked by atropine, with a modest reduction in hepatic insulin extraction with olanzapine. These results support the contribution of muscarinic augmentation of insulin secretion to olanzapine-induced hyperinsulinemia, and provide a mechanism for the compensatory hyperinsulinemia that normally serves to prevent deterioration of glucose tolerance under conditions of metabolic challenge.

  PublisherOA PDFDOI

• Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

  Psychotherapy and Psychosomatics · 2018-01-01 · 79 citations

  reviewOpen access

  BACKGROUND: The aim of this paper was to perform a systematic review and, when feasible, a meta-analysis of randomized controlled trials (RCT) which used benzodiazepines (BZD) as a monotherapy versus placebo, antidepressant drugs (AD), or both. METHODS: Keyword searches were conducted for identifying RCT comparing BZD and AD, and/or placebo in the treatment of depression, using electronic databases from their inception up to April 2017. We selected reports of RCT in which BZD were compared to AD and/or placebo in the treatment of adult patients with a primary diagnosis of depressive disorder or anxious depression. When feasible, data were subjected to meta-analysis. RESULTS: A total of 38 studies met the criteria for inclusion and were then included in the systematic review. Only 1 study concerned a newer AD, fluvoxamine. For the meta-analysis, we submitted data on response rate from 22 RCT, considering BZD versus placebo (8 comparisons) and BZD versus tricyclic antidepressants (TCA) (20 comparisons). There was a lack of significant differences as to response rate between BZD and placebo, as well as between BZD and TCA. Analysis of individual studies disclosed that, in more than half of the studies comparing BZD to TCA and/or placebo, BZD were significantly more effective than placebo and as effective as TCA. CONCLUSIONS: BZD are a therapeutic option in anxious depression and there are no indications that AD are preferable. There is a pressing need for RCT of adequate methodological quality and follow-up comparing BZD to second-generation AD and placebo in anxious depression.

  PublisherOA PDFDOI

• Benzodiazepines in anxiety disorders: Reassessment of usefulness and safety

  The World Journal of Biological Psychiatry · 2018-09-25 · 29 citations

  review1st authorCorresponding

  Importance: Benzodiazepines (BZs) are still widely prescribed for the treatment of anxiety disorders despite many publications in the literature which favour antidepressants (ADs) instead. What is the evidence?Observations: Treatment guidelines favour ADs over BZs for treatment of anxiety disorders without any head-to-head comparison of both drug groups with placebo. BZs are claimed to cause less efficacy and more safety issues than ADs, yet ADs also cause disturbing adverse events and, similar to BZs, discontinuation symptoms. Until evidence-based data become available, a look at two 6-month generalized anxiety disorder trials conducted by the same research group, one with a BZ and the other with an AD, might provide some guidance for the clinician. Most improvement with a BZ was obtained by 4 weeks, suggesting that BZ treatment longer than 4 weeks should only be offered to patients maximally improved at 4 weeks. In contrast, ADs may have to be prescribed for 3–6 months to obtain maximal benefits.Conclusion: Results of a controlled trial as proposed will go a long way in providing clinicians missing information to guide them in the appropriate use of both BZs and ADs in anxiety disorders.

  PublisherDOI

• Supplementary Material for: Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

  Figshare · 2018-01-01

  reviewOpen access

  <b><i>Background:</i></b> The aim of this paper was to perform a systematic review and, when feasible, a meta-analysis of randomized controlled trials (RCT) which used benzodiazepines (BZD) as a monotherapy versus placebo, antidepressant drugs (AD), or both. <b><i>Methods:</i></b> Keyword searches were conducted for identifying RCT comparing BZD and AD, and/or placebo in the treatment of depression, using electronic databases from their inception up to April 2017. We selected reports of RCT in which BZD were compared to AD and/or placebo in the treatment of adult patients with a primary diagnosis of depressive disorder or anxious depression. When feasible, data were subjected to meta-analysis. <b><i>Results:</i></b> A total of 38 studies met the criteria for inclusion and were then included in the systematic review. Only 1 study concerned a newer AD, fluvoxamine. For the meta-analysis, we submitted data on response rate from 22 RCT, considering BZD versus placebo (8 comparisons) and BZD versus tricyclic antidepressants (TCA) (20 comparisons). There was a lack of significant differences as to response rate between BZD and placebo, as well as between BZD and TCA. Analysis of individual studies disclosed that, in more than half of the studies comparing BZD to TCA and/or placebo, BZD were significantly more effective than placebo and as effective as TCA. <b><i>Conclusions:</i></b> BZD are a therapeutic option in anxious depression and there are no indications that AD are preferable. There is a pressing need for RCT of adequate methodological quality and follow-up comparing BZD to second-generation AD and placebo in anxious depression.

  PublisherDOI

Recent grants

• NIH Grant R01MH008957

  NIH · $1.1M · 1992

• NIH Grant R37MH008957

  NIH · $2.7M · 1996

• NIH Grant R01MH065963

  NIH · $2.1M · 2009

Frequent coauthors

• Edward E. Schweizer

  94 shared

• Moira A. Rynn

  Duke University

  86 shared

• R. Downing

  68 shared

• Ronald S. Lipman

  University of Pennsylvania

  56 shared

• Jacques P. Barber

  Adelphi University

  52 shared

• Robert Gallop

  51 shared

• Marna S. Barrett

  University of York

  50 shared

• Laura A. Mandos

  49 shared

Labs

• Mood and Anxiety Disorders Treatment and Research ProgramPI

Awards & honors

• Remission of generalized anxiety disorder after 6 months of…
• Time to relapse after 6 and 12 months' treatment of generali…
• Physician Withdrawal Checklist (PWC-20)
• Good chemistry: The life and legacy of valium inventor Leo S…
• Early childbearing: Perspectives of black adolescents on pre…