Chris Aiken, MD

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-...

Yes that would be important. But most doctors do not agree yet that it works (only 2 small trials before this) so placebo still needed to prove efficacy.

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

Which antipsychotics work fastest for agitation in the hospital?

> Orally disintegrating options (asenapine, olanzapine), 30 min
> Faster than inj (36-48 min), and less often refused
> Quetiapine = least effective

Large, naturalistic study:
pubmed.ncbi.nlm.nih.gov/41609240

Evidence grade: Low

Magnesium L-Threonate is a patented form of Mg that readily enters the brain. It improved cognition in a new RCT in young adults with insomnia (n=100), consistent with earlier RCTs in older adults:
pubmed.ncbi.nlm.nih.gov/41601871

Evidence grade: 9/10

#psychiatry #neurology #pmhnp

Gluten-free diet improved negative symptoms of schizophrenia in small, blinded randomized trial in patients with gluten antibodies (AGA IgG+), which are more common in #schizophrenia (35% vs 10%):
pubmed.ncbi.nlm.nih.gov/41544406

Replicates earlier trial.

Creativity may be linked to #bipolar, but it is a strength, not a cause of mental illness.

It predicts response to #therapy, and in this new study, better outcomes in social #anxiety disorder:
pubmed.ncbi.nlm.nih.gov/41497067

Stimulants for cognition in schizophrenia?
1. It's contraindicated
2. It failed in 22 trials, worsening psychosis in 50-70%

This new trial tests it again, but has too many flaws to move the needle:
pubmed.ncbi.nlm.nih.gov/41582768

Raspberries improved cognition, neuroinflammation, and insulin in older, overweight adults in single meal:
pubmed.ncbi.nlm.nih.gov/41536265

Evidence grade Moderate 6/10.

Similar findings with blueberries, both short- and long-term:
www.psychiatrictimes.com/view/blueber...

#therapy Art: T Jones

Recreational drugs that interact w/MAOIs:
pubmed.ncbi.nlm.nih.gov/41546846

▪ Alcohol if unpasteurized
▪ Dextromethorphan
▪ Meperidine, tramadol, methadone
▪ Kratom
▪ Cocaine, Meth
▪ Some psychedelics: ibogaine, psilocybin, DOI, mescaline, 2CB, PCP, toad serum, MDMA

More in:
amzn.to/45gbBTg

Light at night raised the risk of insomnia 27% in a new meta-analysis of 691,851:
pubmed.ncbi.nlm.nih.gov/41500302

It also worsens obesity, #depression, #bipolar, and impedes learning. How to get the room dark:
chrisaikenmd.com/darktherapy

#psychiatry #pmhnp #therapy #psychology