Carlat Psychiatry

Probiotics failed in the first randomized trial to test them for substance-induced depression. Full details of this small study are here, along with supplements that have a role in substance use disorders: psych-partners.com/probiotics-fai…

Do diabetes meds protect kidneys on lithium? Li-renal function improved on SGLT2 Inhibitors in new cohort study (they are known to protect the kidneys) Evidence grade: Low (4/10) cohort study NAC is another possibility; details at: psych-partners.com/protecting-the…

Antipsychotics by efficacy in schizophrenia, from new analysis: 1. Clozapine 2. Amisulpride, olanzapine, risperidone Cobenfy also high efficacy, and lacks long-term risks, but short-term high drop-out rates due to GI SE. See ranks across 7 side effects: psych-partners.com/antipsychotics…

We put Jeffery #Epstein on the couch in the Carlat #Psychiatry Podcast as we explore... ▪ Narcissism ▪ Psychopathy ▪ Machiavellianism ▪ The "Warrior" gene And a new psychodynamic therapy for antisocial personality: thecarlatreport.com/blogs/2-the-ca… #psychology #psychiatry #pmhnp

Zolpidem (Ambien) linked to arrthymias in large, 15-year matched cohort study. While it doesn't prove causation, a plausible mechanism is known. More details and practice implications: psych-partners.com/ambien-cardiac/

Light therapy improved anhedonia in new small trial of #depression, but only when delivered in morning. Evidence grade moderate (7/10) More details and practical tips on timing light therapy: psych-partners.com/light-therapy-… #psychiatry #pmhnp #therapy #naturaltherapy #mentalhealth

Dextromethorphan augmented clozapine in new randomized trial of schizophrenia with a large effect. With few options in clozapine-resistant cases, even a small trial is a worthy addition. More details: psych-partners.com/clozapine-dext…

New review highlights 7 supplements for depression ▪ Most studied: Omega-3 ▪ Less evidence: Probiotics, saffron ▪ Effective but interactions: St. John's wort ▪ Best for deficiencies: Vitamin D, folate, zinc, magnesium More detail & lab-tested products psych-partners.com/seven-suppleme…

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-heads…

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: thecarlatreport.com/blogs/2-the-ca… Search for "Carlat" in your podcast app.

New consensus on deprescribing features many pearls, like ▪ 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

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

Update on a RCT that greater quetiapine > lithium as augmentation in treat-resist #depression. Re-analyzed, quetiapine's superiority was limited to those with severe anxiety: pubmed.ncbi.nlm.nih.gov/41762225 But both had similar anxiolysis, so ?greater severity marks quetiapine response

High rate of autism 39% in transgender youth seeking psych 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.

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: thecarlatreport.com/blogs/2-the-ca…

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

#Lithium (195 mg) failed to prevent decline (but raised creatinine) in older pts w/ mild cognitive impairment in 2-yr RCT: ncbi.nlm.nih.gov/pubmed/41770546 ▪ Earlier trial was positive in pts w/dementia markers ▪ Maybe underpowered, but if a benefit it is small Evidence Moderate 8/10

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

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