Sodas raise #depression risk, in part by disrupting gut microbiome: pubmed.ncbi.nlm.nih.gov/40991280 Diet soda may be worse: Artificial sweeteners cause hippocampal damage and cognitive problems in mice: pubmed.ncbi.nlm.nih.gov/39382230 Evidence: 4/10 (correlation, not causation)

What keeps people active in retirement? A sense of purpose, concludes new prospective cohort study: www.ncbi.nlm.nih.gov/pubmed/40919... Evidence grade: Moderate (5/10) chrisaikenmd.com/ebm/ #psychiatry #pmhnp #therapy #mentalhealth #psychology

New Carlat #Psychiatry Podcast covers meds that require special skill to start: > Trazodone > Carbamazepine > Lithium > Bupropion > Pramipexole > Valproate > Topiramate Plus a research update on #antidepressant withdrawal: www.thecarlatreport.com/blogs/2-the-...

"Don't put antisocials in group therapy. They'll just learn how to be more antisocial!" But new trial of group + individual mentalization-based therapy refuts that: pubmed.ncbi.nlm.nih.gov/39978982 It reduced aggressive behavior with a large effect size compared to controls on parole.

The ketogenic diet reduced #depression 60% in this open-label study that followed 24 young adults with MDD over 3 months. Unfortunately drop-outs = 34%: www.ncbi.nlm.nih.gov/pubmed/40925... It also was neuroprotective (BDNF) Evidence grade: Very low (2/10) chrisaikenmd.com/ebm #psychiatry #pmhnp

Do non-or low-alcohol beers* and cocktails help people reduce #alcohol use? Yes, if the reason for drinking is social conformity, concludes cross-sectional UK study: www.ncbi.nlm.nih.gov/pubmed/40937... Low: < 1.2%; Non: < 0.5% alcohol QUIZ: This bit of trivia in life-saving for which patients?

Is #ketamine neurotoxic? Review concludes ▪ Not in antidepressant doses, even with long-term use ▪ Yes in high doses www.ncbi.nlm.nih.gov/pubmed/40926... ▪ How do they know? Cognitive testing in humans and histopathology in animals ▪ Some more vulnerable to toxicity? Possibly children and elderly

Propranolol and low-dose amitriptyline are both useful for #migraines, and this small RCT suggests propranolol is the better option for prevention (80 mg daily) Evidence grade: Moderate (6/10) chrisaikenmd.com/ebm More on migraines in #psychiatry: www.thecarlatreport.com/articles/454... #pmhnp

Among children prescribed a stimulant: ▪ 1/30 develop psychosis ▪ 1/30 develop #bipolar ▪ Amphetamines riskier than methylphenidate: www.ncbi.nlm.nih.gov/pubmed/40900... From pooled analysis of 288,199 patients, avg age 13. Evidence grade 5/10 chrisaikenmd.com/ebm Art J Clark

Patients recover faster when you measure symptoms, concludes RCT of #depression: www.ncbi.nlm.nih.gov/pubmed/40892... What rating scale do you find useful? My patients have comorbidities so I use a broad scale: chrisaikenmd.com/treatmentupd... Evidence grade: High (10/10) chrisaikenmd.com/ebm

GLP-1 agonist semaglutide reduced diabetes risk (HbA1c) and weight (20 lb) in new RCT of people with #schizophrenia, prediabetes, and obesity: www.ncbi.nlm.nih.gov/pubmed/40900... Evidence grade: High (10/10) chrisaikenmd.com/ebm/ How to use GLP-1’s: www.thecarlatreport.com/articles/535...

Should we start meds for #opioid use disorder like buprenorphine in jail? Yes. Associated with 50% lower overdose risk and lower risk of reincarnation: www.ncbi.nlm.nih.gov/pubmed/40929... Evidence grade: Moderate (5/10) chrisaikenmd.com/ebm/ ▪ 13% of US jails provide it Art: Van Gogh

Here are the new adverse effects of zuranolone (Zurzuvae) in postpartum #depression: ▪ Feeling drunk, hung-over, and thoughts that are slow, rapid, or intrusive. www.ncbi.nlm.nih.gov/pubmed/40935... ▪ 2-week course: $15,900 From post-marketing data, evidence grade low (3/10) chrisaikenmd.com/ebm

How to Start a Psych Med in Carlat #Psychiatry Podcast... ▪ Avoiding inflammation on lamotrigine/clozapine ▪ Can you ever restart lamotrigine after a rash? ▪ Bonus: New trial of propranolol in panic disorder Search "Carlat" in your podcast store or: www.thecarlatreport.com/blogs/2-the-...

FDA cleared accelerated of deep TMS for #depression: ▪ 5 TMS/day over 6-days, then 8 TMS over 4 weeks ▪ Response rate (78%) similar to standard TMS, after 1-5 antidepressant fails ▪ Means faster recovery, easier accessibility, insurance coverage thefrontierpsychiatrists.substack.com/p/depression...

What prevents suicide in #bipolar disorder? Lithium, then to a lesser degree valproate, but not antipsychotics (unless as augmentation), concludes new cohort study of 44,694 from Korea: pubmed.ncbi.nlm.nih.gov/40930182 Evidence grade: Low (4/10) chrisaikenmd.com/ebm/ #psychiatry

Pharma payments for stimulant marketing by clinicians doubled (MDs) or tripled (NPs) from 2021-23: pubmed.ncbi.nlm.nih.gov/40853654 That's odd, as a drug rep once told me "I don't have to market stimulants. They market themselves" (true story). #medicine #psychiatry #pmhnp

Dental health falls behind in most psychiatric disorders, including #ADHD in new analysis: www.ncbi.nlm.nih.gov/pubmed/40846... The BrushDJ app improved that in a RCT (scroll to ADHD): www.chrisaikenmd.com/apps (or, have them listen to favorite song for duration brush, about 3 minutes)

Greetings from the Bipolar Conference in Tokyo, where I've run into some painful facts: Rate of Gun Ownership ▪ Japan = 0.3% ▪ USA = 120% (yes, more guns than people) Annual Gun Deaths per 100,000 ▪ Japan: 0.02 ▪ USA: 4.3 Firearms = leading cause of child/teen death in US

#LSD treated #anxiety in new trial, but it is a dose-finding study, not powered to prove efficacy. Quality = Moderate (7/10)* ▪ Small (40 per group) ▪ High drop-out (25%) ▪ Functional unblinding pubmed.ncbi.nlm.nih.gov/40906494 Risk: Psychosis *New system for rating trials: chrisaikenmd.com/ebm/

In pregnancy, Rx stimulants did not cause neurodevelopmental disorders like ADHD/autism in Swedish registry study of 861,650: pubmed.ncbi.nlm.nih.gov/40148550 They don't cause birth defects, but are linked to premature birth.

Exercise did not improve any aspect of metabolic syndrome in #schizophrenia in new analysis of 10 trials: pubmed.ncbi.nlm.nih.gov/40677207 If ≥ 5% wt gain at 1 mth, start metformin or change med. Probiotics, melatonin, omega3 also help: chrisaikenmd.com/supplements Other ideas?

Should you continue medication after #OCD resolves? New analysis of 9 trials finds good benefit (NNT=5) and acceptability (eg, fewer drop-out vs placebo) with continuation: pubmed.ncbi.nlm.nih.gov/40874319 What is your experience with tapering off? #psychiatry #pmhnp #therapy #psychology

Does fish oil prevent #psychosis? Maybe. Believers say negative trials were too short (longer trials = positive), and new study finds they work but only if people took them: www.ncbi.nlm.nih.gov/pubmed/40855... Dose = similar to #depression; reliable products at: www.chrisaikenmd.com/supplements

How do you dose lumateperone (Caplyta) in #bipolar #depression? From a new dose-response analysis. The response rises up to 42 mg, but so do drop-outs for adverse effects. Effect size is small (0.3), similar to other antipsychotics pubmed.ncbi.nlm.nih.gov/40874771 #psychiatry #pmhnp

Does gabapentin cause #depression? New analysis finds association, but we'd need randomization to be sure: www.ncbi.nlm.nih.gov/pubmed/40859... What's your experience? I'd say: ▪ Watch out for the possibility ▪ Don’t use it for mania (failed there) #psychiatry #pmhnp #neurology

New APA delirium guideline says NO to antipsychotics unless severe danger/distress. They failed in large trials: www.psychiatry.org/getmedia/51e... Use non-pharm approaches (and address underlying cause) in all patients, such as table 9: pmc.ncbi.nlm.nih.gov/articles/PMC...

You’ll find thoughtful interviews on the Psych Rounds podcast - glad I made the cut in this #bipolar episode open.spotify.com/episode/0ilA...

FDA just approved 1st generic GLP-1 for #WeightLoss: Liraglutide, previously generic only in diabetes dose: www.fda.gov/news-events/... How to use it: www.thecarlatreport.com/articles/539... PRO: More trials with antipsychotics than other #GLP1agonists CON: Branded ones cut more pounds

When meds fail in #depression, can #therapy help? Yes, concludes analysis of 12 RCTs www.ncbi.nlm.nih.gov/pubmed/40863... Therapies that work take a more active role, both by #therapist and the patient's involvement in changing their life outside of session. #psychology #psychiatry #mentalhealth

Has society become more polarized? Yes, and in the saddest of ways. People don’t love their in-group more. They hate the out-group more, concludes new analysis of 60 years of studies from 12 Western democracies: www.ncbi.nlm.nih.gov/pubmed/40852... What do you think will turn this tide? #politics

Genetic tests probably don't help in #depression (failed in well-designed trials), but new analysis finds it's: 1. More effective in Asian countries (more slow metabolism) 2. Testing many genes no better than a few genes www.ncbi.nlm.nih.gov/pubmed/40854... Few tests that matter in: amzn.to/47hVTZr

Can't turn off the screen before bed? 30-min electronic free before bed improved performance for elite athletes (w/ bright light in a.m.): www.ncbi.nlm.nih.gov/pubmed/40845249 Pro-atheletes do use blue-light blockers, destigmatizing these #psychiatry tools: chrisaikenmd.com/darktherapy #therapy

RFK Jr in 1971, when MDs were linking long-haired hippie style to psychosis: pubmed.ncbi.nlm.nih.gov/4187224 RFK today: “I see kids that are overburdened with mitochondrial challenges, with inflammation, you can tell from their faces, their body movements and lack of social connection.”

In our August issue we find new reasons to use: > Silexan (lavender) in depression > Topiramate in alcohol use disorder And new concerns with alprazolam and lithium orotate. Then we get back to the common factors of healing in an interview with Julia Frank: www.thecarlatreport.com/newsletters/...

What is the least stigmatizing word for Borderline Personality Disorder? "Emotional Intensity Disorder" = least offensive/clearest in survey of lived experience: pubmed.ncbi.nlm.nih.gov/40827331 How to explain #BPD in our interview with Dr. Choi-Kain www.thecarlatreport.com/articles/318...

New data on antipsychotics and prolactinemia: > Highest risk: Amisulpride, risperidone, paliperidone, ziprasidone > Lowest risk: Quetiapine, clozapine, aripiprazole From study of 6489 w/ #schizophrenia: pubmed.ncbi.nlm.nih.gov/40830714/ I treat w/B6, metformin, bromocriptine. What do you use?

Does #psychotherapy add anything beyond general counseling with buprenorphine-MAT in #opioid use disorder? Not in this analysis of 4 randomized trials: jamanetwork.com/journals/jam... Learn how to use buprenorphine in our Oct 2024 issue: www.thecarlatreport.com/ext/resource... #Addiction #pmhnp

New #ketamine approvals are poised to change how we practice #psychiatry. It's all in the new Carlat Podcast: www.thecarlatreport.com/blogs/2-the-... #pmhnp #neurology #depression #bipolar #mentalhealth

New study links #lithium deficiency to #dementia, cognitive decline: pubmed.ncbi.nlm.nih.gov/40770094 Video details it, arrives at 5 mg lithium-orotate as ideal for prevention, but higher doses unsafe: www.youtube.com/watch?v=vqCV... Reliable products: chrisaikenmd.com/supplements

Cataract surgery raises the risk of depression, but only if blue light-filtering lenses were implanted, concludes new cohort study: www.ncbi.nlm.nih.gov/pubmed/40738... It suggests a similar cause as in winter #depression. #psychiatry #pmhnp #opthalmology

Updates on the alcohol-#cancer link from JAMA: ▪ No safe level, a top modifiable risk (after smoking/obesity) ▪ #Alcohol-related cancers = Oral, throat, esophagus, breast, colorectum, liver ▪ "Flushing" reactions raise risk (common in Asians) pubmed.ncbi.nlm.nih.gov/40768234

CBT-#insomnia doesn't just help people with #SleepApnea sleep better. It has mild benefits for apnea itself, from 3 trials, most recent: pubmed.ncbi.nlm.nih.gov/40078103/ Patient-friendly apps and written/audio guides to this #therapy are here (under #Sleep): chrisaikenmd.com/apps

Positive reinforcement works in parenting, behavior change, and #mentalhealth policy? This study finds clinicians are less likely to address patients' tobaccco use in states that mandate it, and more likely to address it in states that incentivize it: pubmed.ncbi.nlm.nih.gov/40787855

What can go wrong when starting atomoxetine and prazosin? Find out in new Carlat podcast: www.thecarlatreport.com/blogs/2-the-... Includes review of new FDA warnings on stimulants. #psychiatry #ADHD #PTSD #PMHNP

Methylphenidate (Ritalin) did not improve exams or studying in new randomized controlled trial: pubmed.ncbi.nlm.nih.gov/40762809 Stimulants are not cognitive enhancers. Studies outside of #ADHD show little to no difference, or even worsening (from sleep disruption, hyperfocus).

Is low-dose quetiapine safe for #insomnia? Nope. Weight gain and dyslipidemia still there, not to mention tardive dyskinesia: pubmed.ncbi.nlm.nih.gov/40772433 It deepens sleep quality, but I'd use only if needed for another disorder like #depression, #bipolar, or #schizophrenia.

Dynamic lights that dim in the evening and brighten in the morning improved #depression and #sleep in this new randomized, inpatient trial: pubmed.ncbi.nlm.nih.gov/40755281 Benefits built gradually over 6 months. SmartBulbs and dawn simulators will do it: chrisaikenmd.com/dawnsimulator

FDA just approved: 1. Ketamine IM (KetaRx) for surgical #pain And fast-tracked IV ketamine for #depression; decision maybe by 12/2025. 2. Cyclobenzaprine for #fibromyalgia SNRI-like muscle relaxant improves pain/sleep, but raises risks for #bipolar, elderly, & on opioids/benzo

I think dopaminergics are underutilized in #depression. Mike Kocsis sees a role for #testosterone. Here, we find some common ground: www.youtube.com/watch?v=NZ3z... We cover risks of stimulants and pramipexole, but we recorded before the largest study came out: pubmed.ncbi.nlm.nih.gov/40659070