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
/PROs:
▪ More efficient approvals, lower costs
CONs:
▪ Negative trials are not addressed
▪ Opens door for industry abuses and chance findings
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...
