New interaction between tobacco and cannabis: Together, they suppress anandamide, the "bliss molecule," which may be why those who smoke both have more #depression, #anxiety, #cannabis withdrawal/dependence (compared to people who use cannabis alone): pubmed.ncbi.nlm.nih.gov/40799255 Art J Mecier

#Antidepressant withdrawal becomes a bigger problem (rising 10-fold) after 2 years of use, from new NHS study: pubmed.ncbi.nlm.nih.gov/40404538 Evidence grade Low 3/10 More on stopping meds in our interview with lead author, Mark Horowitz: www.thecarlatreport.com/articles/487... #psychiatry

Should you test iron in psychiatry (serum ferritin)? ▪ Deficiency common in children and in menstruating women ▪ Correcting improves cognition, #ADHD, energy, #depression, #anxiety in new analysis, even when there is no anemia (when < 50 μg/L): pubmed.ncbi.nlm.nih.gov/40945632 #psychiatry #pmhnp

How social media causes #depression: ▪ Rumination, triggered in part by comparing self to others pubmed.ncbi.nlm.nih.gov/41529738 ▪ Relationship conflict from politics (particularly with ≥ 2 hr/day use) pubmed.ncbi.nlm.nih.gov/41495403 What are you seeing with clients? #psychology #therapy

Which psych meds treat nausea? ▪ Olanzapine and lorazepam are often used for chemotherapy-nausea ▪ Mirtazapine beat ondansetron in new trial of morning sickness in pregnancy pubmed.ncbi.nlm.nih.gov/41478546 For nausea on meds, I often start with ginger caps: chrisaikenmd.com/gingerinfo

FDA just approved Flow for general #depression and ProLive after an antidepressant fails: ▪ Flow: Transcranial direct current stimulation (tDCS), 30 min/day ▪ ProLiv: External combined occipital and trigeminal afferent stimulation" (eCOT-AS), 40 min twice a day www.prnewswire.com/news-release...

In part II of our Borderline Personality podcast... 1. Medications that make the disorder worse 2. The cultural forces that moved #therapy from psychoanalysis to DBT 3. How Marsh Linehan's personal struggles inspired the #DBT skills www.thecarlatreport.com/blogs/2-the-... #psychology #bpd

#Probiotics are a low-cost, well-tolerated way to improve #depression and cognition, with a meaningful effect size in this new meta-analysis: www.ncbi.nlm.nih.gov/pubmed/41319... Learn how to use them in “Difficult to Treat Depression” Ch 40: www.audible.com/pd/Difficult... #psychiatry #pmhnp

First large RCT of omega-3s in pediatric depression = negative. Why? ▪ Few had omega-3 deficiency or inflammation ▪ High placebo response, or... ▪ They don't work in peds Evidence: Strong (10/10) pubmed.ncbi.nlm.nih.gov/41481294/ They work in adults; how to use: chrisaikenmd.com/supplements

When do conspiracies cross the line to delusions? A tough call, and one that we need to make with amphetamine and cannabis on the rise. Find out in our interview with Joseph Pierre: www.thecarlatreport.com/articles/582... And updates on #lithium, #depression, PTSD, and nicotine.

Does bupropion worsen anxiety? From new analysis: ▪ No worsening of #anxiety in trials ▪ Worked just as well as SSRIs for anxious #depression ▪ Small advantage for SSRIs if high level of anxiety www.ncbi.nlm.nih.gov/pubmed/41465... Tip: Start 75mg, raise slow, in anxious patients. #psychiatry

Did Marsha Linehan have #borderline personality disorder? Get the facts, and learn how her personal struggles inspired #DBT #therapy in the Carlat Podcast: www.thecarlatreport.com/blogs/2-the-... #psychiatry #psychology #pmhnp #mentalhealth #bpd

What happens when healthy stressed people take omega 3s? Improvements in stress, anxiety, depression, sleep quality, and memory in new, small RCT: www.ncbi.nlm.nih.gov/pubmed/41461... Evidence grade: 8/10. How to use chrisaikenmd.com/supplements

Are creative people at risk for #bipolar? Maybe, concludes large 2-year study of young adults, but only those with 1) High accomplishments in creative fields 2) Other risk factors for bipolar (they were 7-times more likely to develop BP) www.ncbi.nlm.nih.gov/pubmed/41469... What’s your take?

This paper's title says it all: "Prescribing clozapine to 10% of patients with #schizophrenia may save 320,000 lives and cost 2400 deaths from agranulocytosis" pubmed.ncbi.nlm.nih.gov/41442889 How? Mostly by suicide reduction. Also, the body lasts longer when the brain works better. #psychiatry

Cannabidiol (#CBD) failed as adjunct in controlled trial of opioid use disorder: www.ncbi.nlm.nih.gov/pubmed/41467... Dashes hopes that #cannabis will cure the opioid epidemic. Evidence grade: 7/10 But CBD does reduce cannabis use; here’s how to dose it: chrisaikenmd.com/cbdinfo #psychiatry

Confirm autism w/ structured interview; screen w/ ▪ Social Comm. Q. Lifetime ▪ Autism-Spectrum / Empathy Quotients ▪ Ritvo Autism Asperger Diagnostic Scale-R ▪ Social Responsiveness Scale-2 ▪ Camouflaging Autistic Traits Q. From: pubmed.ncbi.nlm.nih.gov/41446803 novopsych.com/assessments

Important memories are encoded during sleep, but sometimes we slip, merging similar memories into a composite event. That theory finds support here, where false memories of associated words were created during slow-wave sleep (where memories are consolidated): pubmed.ncbi.nlm.nih.gov/41443433

Transcranial magnetic stimulation (TMS) is one of the few therapies that works in vascular #depression. In a new RCT, it improved cognition after a stroke, using 2 sessions of iTBS per day over 4 weeks: pubmed.ncbi.nlm.nih.gov/41447629 Evidence grade: Moderate (8/10) #psychiatry #pmhnp #neurology

Group sports or solo aerobics for social #anxiety? Group = better for women but not men (group sports involved therapeutic activity borrowed from Irving Yalom’s approach): www.ncbi.nlm.nih.gov/pubmed/41310... Evidence grade: Moderate (6/10, a secondary finding in unblinded study) #psychiatry

What's your go-to for acute agitation? In a new small RCT, haloperidol-promethazine outperformed chlorpromazine-promethazine for efficacy and safety (PRN INJ): www.ncbi.nlm.nih.gov/pubmed/41420... Evidence Grade: 8/10. Not an easy study to do! #psychiatry #pmhnp #emergencymedicine

A once-dismissed #therapy is rising in the evidence for #depression with... ▪ 3 large RCTs ▪ Positive meta-analyses Transcranial direct current stimulation (tDCS) www.ncbi.nlm.nih.gov/pubmed/41398... How to use: www.thecarlatreport.com/articles/478... #psychiatry

Benzos with bup-MAT is controversial in opioid UD, so here's new data on people who use street benzos in MAT: pubmed.ncbi.nlm.nih.gov/41388433 Though uncontrolled, found 65% reduction in street benzo use by prescribing diazepam w/ education on harm reduction. (I prefer lorazepam; lower risk of OD)

Can healthy people have a little #OCD or psychosis? Explore with us, and learn what "hyperphantasia" has to with it in our new podcast on Carl Jung: www.thecarlatreport.com/blogs/2-the-... #therapy

Probiotics improved executive functioning in #ADHD in new RCT of 84 children, bringing their tally in ADHD to: ▪ 4 positive RCTs (one large) ▪ 2 negative RCTs Evidence for this trial: Moderate (8/10): pubmed.ncbi.nlm.nih.gov/41450035 How to use them in #psychiatry: chrisaikenmd.com/supplements

ECT lowers death rates 30% over a year in severe #depression, from analysis of 17 studies involving over a million cases (unipolar and #bipolar): pubmed.ncbi.nlm.nih.gov/41407487 The finding is a challenge to Scientology doctrine, which holds that ECT is deadly.

Cannabis loosened to schedule III ▪ Not official yet ▪ Main impact = less criminality (started under Biden) ▪ No FDA approvals ▪ Only accepted use: Chemotherapy-nausea, HIV-anorexia (risk of psychosis/addiction limit use) CBD oil safer; helps people get off #cannabis: chrisaikenmd.com/cbdinfo

First modern image of Santa (from Coca Cola 1930). ▪ 1886: Coke invented to help vets get off opium (didn't work) ▪ 1929: Cocaine fully removed (and still is in NJ by only company w/ DEA auth to import coca) ▪ Today: Sodas linked to #depression, esp diet, which impairs brain's memory center

New FDA approval: Cariprazine (Vraylar) in peds #bipolar/#schizophrenia: ▪ Data unpublished; new doses due 2026 ▪ Cariprazine/quetiapine = work in bp mania+depression ▪ Cariprazine = only one with (small) benefit for negative schizophrenia symp ▪ Antipsychotics = higher metabolic risks in peds

Are older adults ready to stop or reduce benzos? With some education from their clinician, 60% were in this study: www.ncbi.nlm.nih.gov/pubmed/41342... Barriers to stopping: Satisfaction with benzo, lack of belief in side effects, fear of withdrawal, lack of skills or support to manage #anxiety.

Sleep deprivation raises appetite, worsens rumination... So when this new study links insomnia to greater binge-eating and restricting symptoms in #EatingDisorders, I suspect the causation flows from lack of sleep: pubmed.ncbi.nlm.nih.gov/41389187 CBT-insomnia guide: chrisaikenmd.com/cbtinsomnia

Which causes more switching into #bipolar: SSRI or SNRI #antidepressants? Both were equal in this new cohort study: www.ncbi.nlm.nih.gov/pubmed/41391... Evidence grade is low (3/10), but it’s in line with other investigations, except venlafaxine has double the risk of SSRIs in some studies.

How does exercise help #sleep? People fall asleep faster, sleep longer, and have better quality. Regulates circadian rhythms, stress hormones (HPA axis), neuroprotection (BDNF), anti-inflammatory, and raises sleep-related neurotransmitters. From: www.ncbi.nlm.nih.gov/pubmed/41308... #therapy

Do SSRIs reduce violence? Or make it worse? Sertraline was decidedly neutral in this large, one-year RCT of highly impulsive, violent offenders from Australia: www.ncbi.nlm.nih.gov/pubmed/41399... Evidence: Moderate (8/10, high drop-out): chrisaikenmd.com/ebm #psychiatry #pmhnp #therapy

Top brain food: Anthocyanins from red/purple fruits & veggies (blueberries!) They improved mood in small trials, and sharpened cognition in 59 randomized trials (med. effect size): www.ncbi.nlm.nih.gov/pubmed/41351... More in Difficult to Treat #Depression Ch 14: www.audible.com/es_US/pd/Dif...

Tune in as we explore how lived experience shapes psychiatric research and practice in a new Carlat Podcast series: www.thecarlatreport.com/blogs/2-the-... #psychotherapy #therapy #psychoanalysis #psychiatry #pmhnp #depression #bipolar

These do not prevent #depression ▪ Rapid #antidepressant taper ▪ Slow tapers without support These do: ▪ Slow taper with psychological support ▪ Continuing antidepressant From new analysis of 76 trials: pubmed.ncbi.nlm.nih.gov/41386898 #psychiatry #pmhnp #therapy

Light (and dark) #therapy make sense for #shiftwork, but studies are few, so this RCT of 80 female nurses is welcome: www.ncbi.nlm.nih.gov/pubmed/41330... "Morning" light device improved energy & sleep quality after 2-4 weeks. Evidence: 7/10 Top blue-light blockers: chrisaikenmd.com/darktherapy

People with #OCD wait 7-17 yrs to seek treatment for reasons below Those with attention to religious/sexual obsessions are particularly hesitant. Screen w/ YBOCS: chrisaikenmd.com/wp-content/u... or Florida OCI: chrisaikenmd.com/wp-content/u... From new review: pubmed.ncbi.nlm.nih.gov/41384033

Semaglutide improved metabolic health in RCT of #schizophrenia spectrum + prediabetes on clozapine/olanzapine (Evidence High): www.ncbi.nlm.nih.gov/pubmed/41335... No change in psych symptoms. INTEGRATE guide recommends GLP-1’s with AP for new BMI cut-offs in picture. #psychiatry #pmhnp

Probiotics improve #depression, #anxiety, and #sleep with a medium effect size (0.4-0.5): ▪ Depression (46 RCTs) ▪ Anxiety (49 RCTs) ▪ Insomnia (12 RCTs) From new meta-analysis: pubmed.ncbi.nlm.nih.gov/41310510 They're in the Difficult to Treat Depression book: www.audible.com/pd/Difficult...

New study of 417 w/ #PTSD explains why FDA rejected brexpiprazole there: ▪ 95% of patients would not have met the inclusion criteria pubmed.ncbi.nlm.nih.gov/41334977 Also, only 1 of 2 large trials of this antipsychotic-sertraline combo were positive, and drop out rates high (30-40%). #psychiatry

Top research findings of 2025, from UNC grand rounds chrisaikenmd.com/2025top10dec Distilled by ▪ Scanning 45,000 papers/yr, to... ▪ 2,000 abstracts read, to... ▪ 365 research posts... ▪ With help of your comments... ▪ The top 10 Request a talk for your institution: chrisaikenmd.com/speakerrequest

Antidepressants no longer recommended in #bipolar: ▪ Small, brief benefit, but ▪ Outweighed by risks: Mania, mixity, rapid cycling ▪ Exception: Olanzapine-fluoxetine combo (2nd line due to metabolic risks) ▪ Never use without a mood stabilizer in bipolar From: pubmed.ncbi.nlm.nih.gov/41312697

Can AI diagnose #autism through home videos? It did so with 75% accuracy is this new large trial; good enough to aid in next-level referrals: www.ncbi.nlm.nih.gov/pubmed/41073... The brief videos captured name --> response, imitation, and ball-playing. How do you make the diagnosis? #psychiatry

Lithium better for sleep quality than valproate in nw observational study of #bipolar: pubmed.ncbi.nlm.nih.gov/41281526 Already known for #lithium, which restores circadian rhythms and enhances slow-wave sleep; valproate rarely studied here. Evidence: Low (4/10) chrisaikenmd.com/ebm #psychiatry

Suicide risk is high 1st month after psych hospital, confirmed in new Swiss study of 72,275. Those at higher risk: • Younger • Male • Single • Personality or substance d/o • Self-harm 1 in 30 died by suicide in first 4 years after discharge: pubmed.ncbi.nlm.nih.gov/41280555 Help: Dial 988 #pmhnp

Undisclosed industry support by journal authors: ▪ Only 14% did not disclose ▪ But around 90% of those were among the "top 10 highest-earners" pubmed.ncbi.nlm.nih.gov/41224314 At Carlat we use the same methods in this study to verify that our authors disclose and are conflict free. #psychiatry

In our SAINT TMS podcast.... ▪ A 5-day treatment that brings recovery to 80% of highly refractory #depression s ▪ Where to find SAINT centers ▪ A tribute to its architect, the late Nolan Williams www.thecarlatreport.com/blogs/2-the-... #psychiatry #pmhnp

When is medical #cannabis useful? • Chemotherapy nausea • Weight restoration in HIV+ Risks: • 1 in 3 medical users develop use disorder • Heart disease with inhalation • High potency #THC (≥10%) never recommended due risk of anxiety and psychosis From JAMA: pubmed.ncbi.nlm.nih.gov/41296368