Chris Aiken, MD

/To clarify:
▪ 83% of the studies involved students (80% college, 20% high school)
▪ In the large study of adults up to age 49, the rates of diversion and misuse were half these (1 in 10)

Clozapine works in treatment resistant (TR) #schizophrenia, but what about TR schizoaffective?

A new randomized trial supports it there:
www.ncbi.nlm.nih.gov/pubmed/40746...

Anyone using clozapine in schizoaffective?

#psychiatry #pmhnp

How often do prescription stimulants get diverted?

1 in 5 misuse them, and 1 in 5 divert them, concludes new analysis of 12 studies:
www.ncbi.nlm.nih.gov/pubmed/40698...

Is anyone seeing this in #psychiatry practice?

#ADHD #pmhnp

How to Start a Psych Medication Before you cook, oil the pan; before you plant that spring lawn, aerate the soil. Before you start a psych med, these are six things you need to have in place.

The Carlat #Psychiatry Podcast has a new series on How to Start a Psych med.

Our first episode covers 6 tips to engage patients, including how to set expectations for a stop date.
www.thecarlatreport.com/blogs/2-the-...

Ends with a research update on light therapy in #bipolar #depression

Does #ketamine work via opioid system?

This controversial idea finds new support in a randomized trial, where the opioid blocker naltrexone impeded ketamine's #antidepressant and glutamatergic effects:
www.ncbi.nlm.nih.gov/pubmed/40707...

#depression #psychiatry #pmhnp

Light therapy gains official status for #bipolar #depression in new ISBD guidelines:
www.ncbi.nlm.nih.gov/pubmed/40705...

Works regardless of season. ISBD gives practical tips for use, and I’ve updated my product recommendations to include LED-boxes:
chrisaikenmd.com/lighttherapy/

Inflammation is common in late life #depression, concludes new review:
www.ncbi.nlm.nih.gov/pubmed/40709...

We are learning more about how to personalize therapy for inflammation (hs-CRP > 3). Anyone testing CRP in practice?

[Table from my upcoming book on Difficult to Treat Depression]

Yes there’s a positive RCt too

Omega 3 treats #depression, but in treatment resistant cases?

Review finds support from 12 studies, including open-label and randomized controlled trials (tota n= 498):
www.ncbi.nlm.nih.gov/pubmed/40669...

Links to lab-tested products with high EPA:
chrisaikenmd.com/supplements/

#psychiatry

TMS works in late life #depression, with potential cognitive benefits:
www.ncbi.nlm.nih.gov/pubmed/40709...

ECT and lithium are two others with surprising benefits in this age group.

What works for late life depression in your practice?

#psychiatry #pmhnp

NAC lowered mortality 50% in acute #COVID, from 10 RCTs:
www.ncbi.nlm.nih.gov/pubmed/40728...

Antioxidant. Treats trichotillomania and possibly #depression (in #bipolar & MDD if +inflammation or took ≥ 6 mths). May also protect kidneys on lithium.

How to use NAC:
chrisaikenmd.com/supplements/

You can’t win them all, but J&J did the right thing in publishing the negative trial on lumateperone (Caplyta) in #bipolar depression:
www.ncbi.nlm.nih.gov/pubmed/40694...

Negative trials in #depression are not unusual for antipsychotics.

Any tips as I update our table below?

#psychiatry #pmhnp

Clozapine is #1 in treatment resistant #schizophrenia, but what is #2? This analysis suggests high dose olanzapine (25-50 mg):
www.ncbi.nlm.nih.gov/pubmed/40663...

Anyone have experience with it?

#psychiatry #pmhnp

A probiotic found in kimchi reduced hangover symptoms by improving #alcohol metabolism and reducing its oxidative effects in this randomized cross-over trial:
www.ncbi.nlm.nih.gov/pubmed/40732...

It replicates an earlier trial.

#psychiatry #pmhnp #addiction #naturalhealth

Yes, and methylphenidate lowers the risk

www.nichd.nih.gov/newsroom/new....

Saffron improved sleep in randomized trial of 150 (20-30 mg):
www.ncbi.nlm.nih.gov/pubmed/40698...

An old #antidepressant (1st Rx circa 6,000 bce), but only recently crossed the threshold of 3 large trials in #depression (cost = $15-30/mth).

How to use saffron:
chrisaikenmd.com/supplements

Lumateperone (Caplyta) treats #bipolar depression with a medium effect size (0.4-0.5), from new analysis of six trials:
pubmed.ncbi.nlm.nih.gov/40659186

The FDA is currently considering the antipsychotic for major #depression (antidepressant augmentation).

#psychiatry #pmhnp

Here's what happens after stopping GLP-1 weight-loss meds:
▪ Continued #weight loss for 1-2 months
▪ Then regain over next 4 months
▪ The more weight lost, the greater the regain

From new analysis:
pubmed.ncbi.nlm.nih.gov/40691794

Centanafadine is a serotonin-norepinephrine-dopamine reuptake inhibitor (SNDRI) under development for #ADHD.

This large RCT moves it closer to reality:
www.ncbi.nlm.nih.gov/pubmed/40619...

#psychiatry #pmhnp

Very useful thank you

Good point. Some interactions are dose dependent. Much more to clarify with CBD

There are many types of light therapy, so which color is best for depression?

This analysis of 17 trials favors full spectrum white light. The others (green, blue, red) are less effective or no better that usual care.
www.ncbi.nlm.nih.gov/pubmed/40629...

How to use:
chrisaikenmd.com/lighttherapy

Most drug interactions don't matter, but in this chart are meds where small changes in their levels make a big difference. The ones in bold are increased by cannabidiol (#CBD oil).

From new review:
pmc.ncbi.nlm.nih.gov/articles/PMC...

#pharmacist #psychiatry #pmhnp

Should you use naltrexone oral or XR injectable? New analysis finds both work for alcohol and opioid use disorders, but patients are 1.5-2 times more likely to stay in treatment with injectable:
pubmed.ncbi.nlm.nih.gov/40660643

What's you're experience?

New risks/benefits with clozapine in July Carlat, where Dr. Leung of Mayo Clinic shares the rating scale they use to follow patients:
chrisaikenmd.com/clozapinesideeffects

Full issue:
www.thecarlatreport.com/articles/540...

Brexpiprazole (Rexulti) rejected for #PTSD by FDA's advisory panel, voting 10:1. Why?

▪ Only 1 out of 2 phase III trials positive (large phase II trial also positive)
▪ Antipsychotic only tested as first-line, sertraline-combo, but risky meds better reserved for non-response.

There are three diets with #antidepressant potential: Nordic, Japanese, and Mediterranean.

Only the Mediterranean is supported by RCTs, and this new cross-sectional study adds evidence to the Nordic:
ncbi.nlm.nih.gov/pubmed/40620153

An antidepressant diet:
chrisaikenmd.com/antidepressantdiet

High-salt intake is linked to depression. New 15-yr study is best designed yet, following 276,138 people who were free from depression at start;
ncbi.nlm.nih.gov/pubmed/40623639

Doubt we’ll see definitive proof - RCTs would be unethical in humans - but animal studies have provided that.

Last year, TMS beat aripiprazole augmentation in treatment resistant #depression, but what about cognitive symptoms?

The two had similar cognitive outcomes, though TMS was better by a non-significant degree:
www.ncbi.nlm.nih.gov/pubmed/40633...

#psychiatry #pmhnp

More time outdoors = less depression.

It’s a common truism, but this study suggests it is only true for night owls
ncbi.nlm.nih.gov/pubmed/40623646

Nigh owls do benefit from morning light and evening darkness. Learn how to get that with a dawn simulator:
chrisaikenmd.com/dawnsimulator