CARLAT PODCAST: #Epstein on the Couch Part II We explore R. Maxwell's links to psychiatry (& anti-psych) journals and age old questions... ▪ How does stress cause depression? ▪ Does money lead to happiness? ▪ Why did FDA change new drug approvals? www.thecarlatreport.com/blogs/2-the-...

ProLivRx is at-home wearable device for #depression, FDA-approved based on one trial: ▪ 124 w/ failure of avg of 1.8 antidepressants ▪ Large effect size over 8 wk, more benefit at 16 wks ▪ Blind intact Detailed report at practice implications: psych-partners.com/wearable-hea... #psychiatry #pmhnp

Who's at risk for sleep med misuse? ▪ Higher income/education ▪ White (non-Hispanic) race ▪ Same-sex attraction ▪ Chronic health conditions ▪ Poor mental health ▪ History of incarceration From large cross-sectional study: psych-partners.com/sleep-med-mi... #psychiatry #pmhnp #medicine #therapy

First fecal transplant in #bipolar #depression failed; small-db RCT: pubmed.ncbi.nlm.nih.gov/41785480 Undaunted, authors speculate sham had active benefits But 3 probiotic bipolar RCTs = negative, despite positive in non-bipolar depression using these strains: chrisaikenmd.com/supplements

Diagnosing #Epstein. A 4-part fact based podcast from the editor of the Carlat #Psychiatry Report: www.thecarlatreport.com/blogs/2-the-... Script below or search for "Carlat" in your podcast app. #psychology #pmhnp #CriminalPsychology #ForensicPsychology

Clozapine after 1 failed antipsychotic? Response rates in new open-label RCT of: ▪ Clozapine 63% ▪ Amisulpride 45% ▪ Olanzapine 32% pubmed.ncbi.nlm.nih.gov/41811299 Guidelines recommend clozapine after 1 failed antipsychotic in #schizophrenia with suicidality/violence

New consensus guidelines on deprescribing features many pearls. Here's one ▪ Taper potent anticholinergics over 2-4 wk ▪ Avoids rebound: Anxiety, insomnia, confusion, sweats, drooling, diarrhea ▪ eg: Clozapine, tricyclics, some sleep meds: acbcalc.com pubmed.ncbi.nlm.nih.gov/41739481 #psychiatry

Leucovorin just approved for ▪ Rare genetic cause of autism ▪ Central Folate Deficiency w/ CFD-FOLR1 gene ▪ Only 35 cases identified www.fda.gov/news-events/... They promised it for autism, but with 3 flawed trials the data was not close enough for government work.

New study adds weight to the brain risks of US #football: pubmed.ncbi.nlm.nih.gov/41758517 ▪ Cross-sectional, n=3970 ▪ Football linked to worse later-life cognitive and neuropsychiatric function ▪ Worse with longer or professional play #neurology #psychiatry #psychology #therapy #pmhnp

Update on a RCT that greater quetiapine > lithium as augmentation in treat-resist #depression. Reanalyzed, quetiapine's superiority limited to those with severe anxiety: pubmed.ncbi.nlm.nih.gov/41762225 But they had similar anxiolytic effects, so maybe greater severity marks quetiapine response

High rate of #autism (39%) in transgender youth seeking psychiatric treatment: pubmed.ncbi.nlm.nih.gov/41736599 Study quality low, but backed by other findings: #Nonbinary 7-times higher in #autistic children. #Autistic patients less likely to test identities publicly before trying hormones.

Which psych disorders worsen during menopause? ▪ Schizophrenia, bipolar, depression, ADHD... And new analysis adds #OCD, which worsened in 27% but improved in 11%: pubmed.ncbi.nlm.nih.gov/41249024 #psychiatry #pmhnp #womenshealth #therapy

Spirituality lowers the risk of #alcohol and drug use by 13%, and more for group religious practice (18%). From new analysis: pubmed.ncbi.nlm.nih.gov/41706493 Learn how Carl Jung inspired the spiritual direction of #AA in the Carlat Podcast: www.thecarlatreport.com/blogs/2-the-... #therapy #pmhnp

We've unleashed the pramipexole chapter from Difficult to Treat #Depression in new Carlat #Psychiatry Podcast: www.thecarlatreport.com/blogs/2-the-... From the audiobook: amzn.to/47lzsl9 #pmhnp #medicaleducation #bipolar

Benzo use has fallen in the US, particularly in older adults (7.2% to 4.7%), accelerating a trend that began in 2013. pubmed.ncbi.nlm.nih.gov/41734365 Our latest coverage on how to use and deprescribe them: www.thecarlatreport.com/articles/536... #psychiatry #pmhnp #anxiety

Extra virgin olive oil improved cognition in 5 small RCTs involving 747 older adults in new meta-analysis: pubmed.ncbi.nlm.nih.gov/41740793 The "extra" = more antioxidants, which protects it for cooking (up to 325-400°F) and may explain depression benefits: chrisaikenmd.com/antidepressa...

I'll speak on new FDA approved devices for #depression - Flow and ProLivRx - in New York City: ▪ Sat, March 28th, 2026 ▪ One-day CME conference Talks on TRD, TMS, GLP-1s, digital therapeutics and more: nycpsych.memberclicks.net/annual-events#schedule (early register discount extended to 3/8)

Antidepressants increased risk of mania/mixed states 30% in new, large cohort study of #bipolar I disorder over one year: pubmed.ncbi.nlm.nih.gov/41699856 Evidence grade low (4/10): chrisaikenmd.com/ebm What are you seeing with them in practice? #psychiatry #pmhnp #mentalhealth

Saffron in #depression and #anxiety: ▪ 34 RCTs involving 1769 patients ▪ Significant effect in self-reported scales ▪ Effects on objective scales less clear pubmed.ncbi.nlm.nih.gov/41693488 Also improves sleep quality, sexual function, weight. How to use: chrisaikenmd.com/supplements #pmhnp

Inflammation did not predict response to esketamine in new trial: pubmed.ncbi.nlm.nih.gov/41740751 Nor in a meta-analysis of 26 earlier trials: pubmed.ncbi.nlm.nih.gov/35760879 Meds below work better for inflammatory depression (hs-CRP ≥ 3), from Difficult to Treat #Depression: amzn.to/3MZrNC6

Should we withhold opioids when people with #opioid use disorder (OUD) are in pain? New article agues "No," as it leads to pain, withdrawal, and higher relapse upon discharge. It may even increase OD risk by reducing tolerance: pubmed.ncbi.nlm.nih.gov/41731958

Gen X more depressed/lonely than earlier generations and ▪ Poorer physical strength and memory But problem is limited to US, which has more: ▪ Income inequality ▪ Migration ▪ Processed foods ▪ Fewer social services How do you explain it? From: pubmed.ncbi.nlm.nih.gov/41608078

How do you deprescribe in psychiatry? Short answer: Taper gradually Long answer: Add behavioral strategies for over-medicated symptoms. Learn them for #ADHD and #anxiety in the Feb Carlat Report: www.thecarlatreport.com/newsletters/... #psychiatry #pmhnp #therapy #mentalhealth

What happens in the brain's reward center on GLP-1s like #Mounjaro? ▪ Shut down food-craving circuits ▪ Quieted obsessive thoughts in a pt w/ obesity-binge eating ▪ But effects faded after few mths in study using electrodes in brain: pubmed.ncbi.nlm.nih.gov/41249493 Evidence: low

Which sleep meds have lowest risk of misuse/withdrawal? Orexin antagonists were safest in new analysis of FDA reports: www.ncbi.nlm.nih.gov/pubmed/41684... They also improve next-day cognition and don't cause falls. Anyone have luck getting approved? #psychiatry #pmhnp Art: Duane Michals

FDA dropped approval standard from TWO well-designed trials to ONE: pubmed.ncbi.nlm.nih.gov/41707146/ ▪ 65% of meds are already approved this way (accelerated) ▪ Still require another source of support, like animal models or a mechanism of action, but #FDA has a lax record of upholding this

What's you're favorite AI Scribe? We'll incorporate your opinions for a Carlat Report review ▪ MD Hub ▪ Heidi ▪ Berries ▪ Psynopsis ▪ PMHScribe ▪ Medwriter ▪ Twofold Health ▪ S10 ▪ Aura (InsightHealth) ▪ HealthOrbit ▪ The free ones... Medscape, Doximity, ScopeHealth, DoctorScribe ▪ Something else?

Took 2 years of treatment for patients with #bipolar to get the first-line med (#lithium) in new study: www.ncbi.nlm.nih.gov/pubmed/41688... Only about 1 in 40 with BP get lithium early in treatment (when it is recommended): www.thecarlatreport.com/blogs/2-the-... What do you think holds it back?

Steve Hayes developed Acceptance and Commitment #Therapy (ACT) after searching for a way out of his own panic disorder. We interview Hayes in the Carlat #Psychiatry Podcast: www.thecarlatreport.com/blogs/2-the-... #anxiety #pmhnp #therapist #mentalhealth #psychology

DSM-6 hopes to bring attention to: ▪ Spectrum disorders ▪ Quality of life ▪ Environmental, cultural, and biological contributions And a new name: Diagnostic and SCIENTIFIC Manual The party begins in the new issue of AJP: psychiatryonline.org/journal/ajp #psychiatry #pmhnp #psychology #therapy

Give Auvelity as brand, separate, generic ingredients, for #depression? PRO: Lower cost, flexible dosing CON: Separation may raise risk of misuse Those on PRO side will find guidance in this case report: 30-45 mg BID dextromethorphan with 450 mg QAM bupropion: pmc.ncbi.nlm.nih.gov/articles/PMC...

GLP-1s linked to 5% difference in alcohol use in a observational study (not focused on AUD): pubmed.ncbi.nlm.nih.gov/41646707 Evidence grade moderate Ozempic is proclaimed a "cure" for alcoholism in latest New Yorker, but best designed randomized trial? Negative: pubmed.ncbi.nlm.nih.gov/36066977

Nortriptyline failed in its 2nd RCT of functional dyspepsia: pubmed.ncbi.nlm.nih.gov/41616902 Other tricyclics (imipramine/amitriptyline) work and are recommended in practice guidelines. Anyone guess why? Functional dyspepsia = unexplained GI pain, burning, early fullness, bloating. #medicine

Social robots for #depression? While the #science builds in this feasibility trial pubmed.ncbi.nlm.nih.gov/41650992 I'm reminded of a warning “The world has achieved brilliance without wisdom, power without conscience. Ours is a world of nuclear giants and ethical infants” —Omar Bradley

#Probiotics improved cognition in aging adults with moderate effect size (0.76) in 19 small trials in new meta-analysis: pubmed.ncbi.nlm.nih.gov/41630163 Multi-strains worked better than single strains. They also improve cognition in #depression. How to use probiotics: chrisaikenmd.com/supplements

Valentine's is a melancholy day for many, not just the unpartnered ▪ Searches for divorce lawyers rise 40% ▪ People with depressive or borderline traits approach 2/14 with dread: pubmed.ncbi.nlm.nih.gov/38031633 Thank you Dellino Law for help with these studies: dellinolaw.com/blog/valenti...

#Lithium lowered #dementia risk 13% in 5-year, non-randomized study of older adults with #bipolar, compared to anticonvulsants: pubmed.ncbi.nlm.nih.gov/41646718 Evidence grade moderate (4/10): chrisaikenmd.com/ebm Unproven, but a larger trial is underway in dementia. #psychiatry #neurology #pmhnp

In 2026 I'll speak on Depression, Research Updates, Deprescribing and more in: > San Francisco > Salt Lake City > Michigan > Connecticut > Virginia Beach > South Carolina > Connecticut > Alaska > Turkey Ge the dates, or request a talk for your organization at: chrisaikenmd.com/speakerrequest

Headspace app improved #sleep in large randomized trial of healthy volunteers, esp. sleep quality, in line with other trials of #mindfulness and Headspace: pubmed.ncbi.nlm.nih.gov/41637757 Evidence grade 5/10 (wait list control; 44% drop-out) More evidence-based apps: chrisaikenmd.com/apps

In 1980, a psychology professor woke up to the worst panic attack of his life. When CBT and meds didn't work, he found a new path, and brought it to the world 20 yr later as Acceptance and Commitment #Therapy (ACT). In our podcast interview with Steve Hayes: www.thecarlatreport.com/blogs/2-the-...

Study reminds us that bupropion (Wellbutrin) is not benign in the elderly, with a higher risk of falls than aripiprazole: pubmed.ncbi.nlm.nih.gov/41609932 ▪ Mechanism unknown ▪ Worse on higher dose ▪ Dizziness and ataxia = warning signs. #psychiatry #medicine #pmhnp #depression

Do stimulants cause tolerance? ▪ Yes: For mood and rewarding qualities ▪ No: For treating #ADHD From a limited database of 17 trials in new analysis: pubmed.ncbi.nlm.nih.gov/41627718 #psychiatry #pmhnp #ADHDAwareness

Changes in Psychiatric NPs since 2016: ▪ Visits doubled for PMH-NPs, fell by 30% for psychiatrists ▪ 12% run their own practice ▪ Non-whites increased 8% to 16% From new study: pubmed.ncbi.nlm.nih.gov/41621233 I provide #PMHNP consultation/supervision: chrisaikenmd.com/supervision

Psychiatry's future challenges: ▪ Aging population = med-psych disorders ▪ Commodification of health favors the healthy ▪ Immigration, loneliness (& social fatigue), addiction, violence, burnout ▪ EMRs and specialization = dehumanization and fragmentation From: pubmed.ncbi.nlm.nih.gov/41619790

First #Keto trial in treatment resistant #depression (n=88) ▪ Compared it to adding fruit/veg ▪ Barely positive at 6 wk (0.05), not 12 wk pubmed.ncbi.nlm.nih.gov/41637092 Evidence Moderate (6/10) In contrast, Medi diet has large effect in 3 RCTs: chrisaikenmd.com/antidepressa...

Alice in Wonderland Syndrome: ▪ Distortions of visual perception, body image, and time perception ▪ Causes = infections, migraines, epilepsy, meds New paper links it to ▪ Aripiprazole, sertraline, methylphenidate, topiramate However, linking is not causation: pubmed.ncbi.nlm.nih.gov/41448101

Genetic tests did not reduce #depression in new trial: pubmed.ncbi.nlm.nih.gov/41277612 Some secondary outcomes positive, but that is common by chance alone. Secondary outcomes help personalize treatment, but only when primary outcome is positive. Otherwise, ignore them.

Keto helped depression, but not anxiety, in 10 small trials: pubmed.ncbi.nlm.nih.gov/41191382 But they tested it in medical disorders that respond to keto, and mood lifts when health improves. One trial compared it to Mediterranean, which was more effective: pubmed.ncbi.nlm.nih.gov/41197688

FDA fast-tracked centanafadine for #ADHD, a norepinephrine, dopamine, serotonin reuptake inhibitor: ▪ Similar benefit to non-stimulants, but faster onse ▪ 2 phase-III trials adults, 1 in adolescents, none in children Structured interview for diagnosis: www.advancedassessments.co.uk/resources/AD...

Autism-leucovorin trial just retracted: pubmed.ncbi.nlm.nih.gov/41606385 Remaining 4 trials have flaws: Small, poor blinding, not corrected for multiple measures. But plausible mechanism, large effect are promising. FDA approved it for #autism in 2025, but should have funded a phase III trial