Chris Aiken, MD

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

GLP1's for #alcohol use? Here's what controlled trials show:
• Best study: exenatide failed (n=127)
• Semaglutide worked in a lab setting, with mixed-results in real-world (n=48)
• Dulaglutide "worked," but a secondary outcome and barely positive (n=151)

pubmed.ncbi.nlm.nih.gov/41273789

Study of over a million medicaid patients reveals neglect of a common cause of death:
▪ Only 30% with new onset #opioid use disorder received a med for it

Which could have reduced risk of overdose death by
▪ 86% w/methadone
▪ 77% w/buprenorphine
▪ 30% w/naltrexone
pubmed.ncbi.nlm.nih.gov/41276914

Light therapy treats many disorders, but not brain fog post-breast cancer surgery in a new trial:
pubmed.ncbi.nlm.nih.gov/41275449/

It can augment antidepressants, and it's among the top CAM therapies for Difficult to Treat #Depression in new textbook:
www.audible.com/pd/Difficult...

Forest therapy improves
• Depression
• #Anxiety
• Anger
• Fatigue
• Cognition

Best when sessions last >1 hour. From new review:
pubmed.ncbi.nlm.nih.gov/41256089

It's among the Top 7 Lifestyle interventions in my next book on Difficult to Treat #Depression:
www.audible.com/pd/Difficult...

Zuranolone (Zurzuvae) barely worked in new, large trial of MDD from Japan:
pubmed.ncbi.nlm.nih.gov/41251319

Zuranolone is iffy in MDD, but works in postpartum #depression. It is one of 8 rapid acting meds; learn how to combine them with therapy in:
amzn.to/4aeSpbA

Glucagon-Like Peptide 1 Receptor Agonists and Mental Health This systematic review and meta-analysis examines data for patients with diabetes and/or obesity from trials of GLP1-RA treatment to evaluate psychiatric, cognitive, and quality-of-life outcomes compa...

Yes, some positive pre-clinical data, or data in diabetes, but new analysis found no difference in depressive symptoms on GLP-1s (despite improvement in quality of life)
jamanetwork.com/journals/jam...

Trials are underway, mostly in substance use disorders

Practical guide to benzo taper from JAMA:
pubmed.ncbi.nlm.nih.gov/41247740

CBT helps, maybe Silexan, and small trials support:
▪ Carbamazepine (200–800 mg/d)
▪ Pregabalin (200–400 mg/d)
▪ Propranolol (60–120 mg/dd)

More in the deprescribing chapters of new book:
www.audible.com/pd/Difficult...

There’s an old folk song “Rip Van Winkle was a lucky man”

Oh and to answer your question- they got worse long term in antidepressant arm because the med was withdrawn at 16 weeks.

Thank you. I’ve adapted the a few systems to rate evidence, but this is new. INSPECT seems to be about detecting fraud which is much needed.

A good place to meditate

Exercise improves child #ADHD, but this is the first trial to test it in adults:
▪ Large effect (0.9)
▪ Strength/aerobic 30-40 min/day
▪ Brief mindfulness component

pubmed.ncbi.nlm.nih.gov/41244864

Evidence: Moderate (6/10, high drop-outs, small, single-blind)

#mentalhealth #psychiatry #pmhnp

Are energy drinks "legal cocaine"?

▪ Similar cardiotoxic mechanisms, not just from caffeine
▪ Heart disease with chronic use, even in young & healthy

pubmed.ncbi.nlm.nih.gov/41266869

Stick to coffee, or even better, tea, this TG:
chrisaikenmd.com/coffeetea

In Borderline Personality Disorder, DBT = less suicide events than SSRI in 6-month, small RCT:
pubmed.ncbi.nlm.nih.gov/41190740

SSRI group got 30-min sessions every 2 weeks. DBT group not on SSRI. Open question: DBT helpful, SSRI harmful, or both?

Evidence: Moderate (6/10)
chrisaikenmd.com/ebm

Difficult to Treat #Depression is now in audio (with tables):
www.audible.com/pd/Difficult...

Top tips:
• Only a few treatments offer reliable prevention
• Subtypes guide the way: vascular, inflammatory, mixed, etc
• #Therapy is essential; lifestyle just as important

#psychiatry #pmhnp #medicine

Here's what to know about SNT #TMS:
▪ Brought full recovery to 80% with refractory #depression (avg 5 med failures)
▪ Works within a week
▪ Double blind was intact

More in podcast:
www.thecarlatreport.com/blogs/2-the-...

And new depression textbook (audio version out soon):
amzn.to/4p7hc6e

#Probiotics improved sexual health in women:
pubmed.ncbi.nlm.nih.gov/40136541

Mainly sexual function on SSRIs, but also menopause, PCOD, and endometriosis.

Also improve depression, cognition, anxiety, and metabolic health in varied populations.

How to use:
chrisaikenmd.com/supplements

▪ 10 causes of ADHD symptoms that are NOT classic ADHD
▪ 3 new med combos*
▪ 5 generic swaps for branded meds
▪ 5 research updates

All in the new Carlat Report:
www.thecarlatreport.com/ext/resource...

*eg atomoxetine-trazodone in sleep apnea, lurasidone-cycloserine in bp-depression

Possible lithium interaction with semaglutide (Ozempic) raising #lithium levels (possibly through dehydration or increased absorption).

BOTTOM LINE: Check lithium labs before starting semaglutide, and monitor lithium level more frequently during therapy

pubmed.ncbi.nlm.nih.gov/40999647

More tea = less #depression, with peak benefits at 6 cups/day (in large epidem studies).

This new analysis finds a similar trend for cognitive benefits, peaking at 5 cups/day.
pubmed.ncbi.nlm.nih.gov/41222998

Tea has more neuroprotectants than coffee:
chrisaikenmd.com/coffeetea

Sleep is essential to health, but health is no better with most sleep meds.

By avoiding benzos, z-hypnotics, trazodone after age 50, people will live a little longer, have fewer falls, better cognition:
pubmed.ncbi.nlm.nih.gov/41209816

Natural ways to improve sleep:
chrisaikenmd.com/brochures

Guanfacine improved #depression and cognition in uncontrolled trial of patients with prominent cognitive symptoms (it is a non-stimulant used for #ADHD) (2 mg qhs).
pubmed.ncbi.nlm.nih.gov/41211529

Evidence grade: Low (5/10, dramatic results)
chrisaikenmd.com/ebm

Does smoking cause irritability in #bipolar?

Possibly, concludes Mendelian randomization study, where it accounts for 12% of the irritability:
pubmed.ncbi.nlm.nih.gov/41221021

Other studies suggest a smoking --> depression cause, perhaps through vascular health.

Evidence grade: Low (4/10)

Curcumin (turmeric) is one of the top supplements for #depression, and in the analysis of 9 #diabetes trials it led to 3.6 lb weight loss.
www.ncbi.nlm.nih.gov/pubmed/41211...

Caution: rare liver injury, though also has liver protective effects.

How to use:
chrisaikenmd.com/supplements

Neuromodulation =
1. TMS
2. ECT
3. Transcranial direct current stim (tDCS)
4. Deep brain stim (DBS)
5. Vagus nerve stim (VNS)
6. Magnetic stim therapy (MST) and more

Only one works in treatment resistant #schizophrenia: TMS.

From new analysis:
www.ncbi.nlm.nih.gov/pubmed/41210...

#psychiatry

L-theanine improved insomnia and quality #sleep initiation in analysis of 11 RCTs (100-225mg BID):
www.ncbi.nlm.nih.gov/pubmed/41176...

It's a glutamatergic extract of tea with positive trials in depression, OCD, anxiety, and cognition. How to use:
chrisaikenmd.com/supplements

Art Y Wang

The GLP-1 semaglutide (#Ozempic) failed to improve mood and executive functioning in this, the first RCT of a GLP-1 for major #depression:
www.sciencedirect.com/science/arti...

Weight loss was significant (all subjects were overweight/obese).

Evidence grade Moderate (8/10):
chrisaikenmd.com/ebm

Thank you. What other red flags did you find?