Reading of the Week: Antidepressants & Side Effects – the New Lancet Paper; Also, Medical Cannabis & Addiction, and AI Hallucinations

December 18, 2025 /

From the Editor

What are the physical side effects of antidepressants? In a new, impressive Lancet study, Toby Pillinger (of King’s College London) and his co-authors attempt to answer that old question with a new approach: the first systematic review and meta-analysis. They drew on 168 RCTs that measured physical health effects of antidepressants, including almost 59 000 participants and comparisons of 30 antidepressants. “We found strong evidence that antidepressants differ markedly in their physiological effects, particularly for cardiometabolic parameters.” We consider the paper and its implications.

How safe is cannabis for those taking it for medical purposes? Dr. Beth Han (of NIMH) and her colleagues report findings from a US survey in a new JAMA Psychiatry brief report, focusing on cannabis use disorder (CUD). They report that cannabis use wasn’t less addictive when used for medical reasons. “Clinicians should consider addiction risk before recommending medical cannabis and, if they do, should monitor for CUD emergence.”

The BMJ runs humorous articles in its Christmas issue. The journal doesn’t disappoint this year. Dr. Roberto A. Correa Soto (of the Universidad de los Andes) and his co-authors write about AI hallucinations and doctor BS (yes, you read that correctly). Frankly, the paper is worth reading for the profanity alone. “Both doctors and large language models (LLMs) are driven to produce misinformation – ‘bullshit’ and ‘hallucinations’ – owing to a shared pressure to provide answers, prioritising the appearance of competence over accuracy.”

There will be no Readings for the next three weeks. 

DG

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Reading of the Week: Telemental Health Post-COVID – the New JAMA Psych Study; Also, GLP-1 RAs & Antipsychotics, and Depression & MS

December 11, 2025 /

From the Editor

In the first weeks of the pandemic, mental health services underwent rapid transformation. The webcam became an indispensable component of psychiatric practice.

What’s happened since the lockdowns? In a new paper for JAMA Psychiatry, Dr. Mark Olfson (of Columbia University) and his colleagues look at outpatient services in the United States. They drew on US survey data, analyzing the use of telemental health, hydrid, and in-person care. “The findings of this cross-sectional study indicate that telehealth has become a common means of receiving outpatient mental health care in the US, especially for resourced patients with less serious psychological distress who receive psychotherapy from mental health specialists.” We consider the paper and its implications.

Can semaglutide help those with schizophrenia? In the second selection, from JAMA Psychiatry, Marie R. Sass (of the Capitol Region of Denmark) and her co-authors report on an RCT where 104 participants received a glucagon-like peptide 1 receptor agonists or placebo, focusing on individuals with early-stage glycemic dysregulation. “Results of this randomized clinical trial show that adjunctive semaglutide significantly improved glycemic control and weight outcomes in individuals with schizophrenia spectrum disorders.” 

Finally, Drs. David E. Freedman and Anthony Feinstein (both of the University of Toronto) write about multiple sclerosis and depression for The Canadian Journal of Psychiatry. In a practical paper, they discuss therapy, medications, and more. “Depression is a manageable contributor to increased morbidity and mortality in people with MS.”

DG

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Reading of the Week: Cannabinoids for Therapeutic Use – the New JAMA Paper; Also, ECT and Szalavitz on Her Recovery & Substance Use

December 4, 2025 /

From the Editor

Cannabis for chronic pain? What about insomnia or seizures? Patients often ask about the therapeutic use of cannabis. And your patients aren’t the only ones thinking about it; more than one in four Americans have used cannabis for medicinal purposes. But what does the literature actually say?

In an impressive, new review paper just published in JAMA, Dr. Michael Hsu (of the University of California, Los Angeles) and his co-authors seek to answer that question. With 124 citations, they are thorough and thoughtful, drawing on studies, clinical guidelines, and more. They are also clear in their conclusion. “Despite the accumulation of new studies, evidence is insufficient for the use of cannabis or cannabinoids for most medical conditions.” We consider the paper and its implications.

In the second selection from The Lancet Psychiatry, Dr. Richard Braithwaite (of the Sussex Partnership NHS Foundation Trust) and his co-authors comment on ketamine for depression. Though some new studies have reported solid results comparable to ECT, they remain skeptical. “The claim that ketamine is equivalent to ECT is not supported by credible evidence. It is a narrative constructed on a foundation of a small number of inadequately designed trials and flawed meta-analyses.”

Is sobriety required for recovery from substance misuse? In a personal essay for The New York Times, writer Maia Szalavitz argues that it isn’t. She notes her own journey which has spanned 40 years. “In reality, most people who resolve addictions – including me – do not reject all substance use forever.”

DG

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Reading of the Week: Preventing PTSD – the New AJP Study; Also, AI Hallucinations and Dr. Gollapudi on Stethoscopes

November 27, 2025 /

From the Editor

Though years had passed since his peacekeeping service in Bosnia, my patient lucidly described the flashbacks and nightmares that still haunted him. It raises an important question: is it possible to prevent PTSD in the first place?

In a new, important American Journal of Psychiatry paper, Chelsea Dyan Gober Dykan (of Tel Aviv University) and her co-authors attempt to answer that question by drawing on past work showing the effectiveness of response-time-based attention bias modification (RT-based ABM), a cognitive training technique. They describe a three-arm randomized controlled trial involving more than 500 male combat-bound soldiers who, before combat exposure, received one of two cognitive training techniques (RT-based ABM and a variant focused on gaze) or a sham intervention. Participants then reported on PTSD symptoms after it. “Consistent with a previous randomized controlled trial, RT-based ABM reduced risk for PTSD relative to sham ABM when implemented prior to combat exposure.” We consider the paper and its implications.

How common are AI hallucinations? In the second selection, Jake Linardon (of Deakin University) and his co-authors look at hallucinations through the prism of psychiatry, asking ChatGPT to draft writing on several disorders. In their JMIR Mental Health study, hallucinations were frequent. “Citation fabrication and bibliographic errors remain common in GPT-4o outputs, with nearly two-thirds of citations being fabricated or inaccurate.”

Finally, in the third selection from Academic Psychiatry, Dr. Sheba Gollapudi (of the University of Texas) mulls the power of the stethoscope and its psychiatric equivalent. She describes how she developed her listening skills and her use of silence. “Because even though I will not necessarily use a stethoscope in my everyday practice, I know now that the stethoscope is within me.”

DG

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Reading of the Week: Mindfulness for Depression – the New Lancet Psych Study; Also, AI & Med Ed and the Latest in the News

November 20, 2025 /

From the Editor

He tried CBT, yet he remained deeply depressed. What should come next? For the record, my patient wasn’t enthusiastic about trying additional medications. Like many, he favoured psychotherapy to antidepressants. 

In a new Lancet Psychiatry paper, Thorsten Barnhofer (of the University of Surrey) and his co-authors attempt to shed light on the issue. They report on a randomized, controlled, superiority trial involving 234 participants who had depression and completed a dozen or more sessions of therapy – but remained ill. In the study, these participants received either mindfulness or treatment as usual and were followed for 34 weeks. “Our findings suggest that mindfulness-based treatment can be beneficial after non-remission from major depressive disorder following psychological, stepped care treatment.” We consider the study and its implications.

In the second selection, Yilin Ning (of the National University of Singapore) and her co-authors look at the potential of AI for medical education. In a paper for The Lancet Digital Health, they note great opportunities – particularly as low and middle-income nations face shortages of healthcare providers – but they also describe challenges. “AI offers great promise for enhancing the quality and accessibility of medical education and physician training, from personalised learning experiences to the simulation of complex clinical scenarios.”

Finally, we explore the latest news with articles from The New York Times and The Washington Post. The topics: the case for mandatory treatment, glucagon-like peptide-1 agonists for substance, and the life of Dr. Nolan Williams.

DG

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Reading of the Week: DBT vs Meds for BPD – the New AJP Paper; Also, OTC Naltrexone for Alcohol and Climate Change Anxiety in Canada

November 13, 2025 /

From the Editor

She presented to the emergency department with suicidal thoughts but no specific plan. She had been diagnosed with borderline personality disorder, and asked me a simple question: how can I do better?

In a new study published in The American Journal of Psychiatry, Beth S. Brodsky (of Columbia University) and her co-authors attempt to answer that question. 84 people with borderline personality disorder and past suicide attempts and/or self-harm behaviours were randomized and then offered either six months of therapy (DBT) or medications (SSRIs), and compared for the reduction of suicide attempts and self-harm. “DBT appears to work faster and perhaps more effectively in borderline personality disorder for suicide-related outcomes and for nonsuicidal self-injury compared with SSRIs plus clinical management.” We consider the study and its implications.

In the second selection from JAMA Psychiatry, Drs. Olga Terechin, Sofia E. Matta, and Joji Suzuki (all of Harvard University) propose that naltrexone be made available over the counter. Noting the deep problems of unhealthy alcohol use, they argue that greater availability of this medication would be important. “We believe that allowing OTC access to naltrexone would serve as a groundbreaking approach to addressing unhealthy alcohol use, particularly for individuals who are hesitant to seek help or live in areas where access to treatment is limited.”

And in the third selection, S. L. Harper (of the University of Alberta) and her co-authors look at climate change anxiety in Canada. Drawing on a survey with almost 2 500 participants, they analyzed prevalence and demographics in a Nature Mental Health paper. “Mild-to-moderate climate change anxiety in Canada is not uncommon… and certain demographic groups may require additional supports to manage and reduce the symptoms…” 

DG

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Reading of the Week: Novel Depression Care – the New JAMA Psychiatry Study; Also, Psych Beds in the US and ChatGPT & Sensitive Conversations

November 6, 2025 /

From the Editor

He had several antidepressant trials. rTMS was helpful but the improvement faded quickly. Should he try ketamine? My patient had read good things and asked.

In a new paper for JAMA Psychiatry, Ana Jelovac (of Trinity College Dublin) and her co-authors attempt to answer that question. 62 hospitalized patients with depression were randomly assigned to receive either repeated ketamine or midazolam treatment and were followed for 24 weeks afterwards. “Serial adjunctive ketamine infusions were not more effective than serial midazolam infusions in reducing depressive symptoms in inpatients receiving usual psychiatric care.” We consider the paper and its implications.

How has the supply of US psychiatric beds changed with time? In the second selection, from JAMA Psychiatry, Karen Shen (of Johns Hopkins University) and her co-authors drew on US databases, finding a slight reduction in overall beds but perhaps an increase in acute care supply, albeit with an increase in beds from large for-profit hospital chains. “Given reports of safety concerns at large for-profit chains, our findings also underscore the need for research on the effects of growing corporatization of inpatient mental health care on patient outcomes.”

And in the third selection, published on their website, ChatGPT staff write about recent controversies involving those with mental health problems, suggesting that the organization has been moved to action. The essay describes their efforts to make advice safer and more appropriate for users who are psychotic, suicidal, or becoming emotionally reliant on AI. “We worked with more than 170 mental health experts to help ChatGPT more reliably recognize signs of distress, respond with care, and guide people toward real-world support – reducing responses that fall short of our desired behavior by 65-80%.”

DG

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Reading of the Week: Homelessness with Papers from Lancet and JAMA; Also, Kinsella on His Recovery

October 30, 2025 /

From the Editor

The loss of her job. A couple of poorly timed moves, motivated by her need to help care for an ailing parent. Financial woes. These problems converged, and my patient found herself ill and homeless. What were the potential implications for mortality?

In a new paper published by The Lancet Public Health, Sandra Feodor Nilsson (of Copenhagen University) and her co-authors attempt to answer that question. Drawing on Danish data involving more than six million adults, they found that men and women live far fewer years when experiencing homelessness, 15.9 years and 15.3 years, respectively. Though past work has examined the topic, Nilsson et al. offer a more comprehensive look. “Life-years lost exceeded those observed in individuals with schizophrenia, alcohol use disorder (for males), and drug use disorder.” We consider the paper and its implications.

In the second selection, from JAMA, Drs. Kirk B. Fetters and Joshua A. Barocas (both of the University of Colorado) describe recent cuts to Housing First programs in the United States and weigh its impact. They note the evidence for this approach. “Because the health care system is already overburdened and the homelessness crisis is worsening, maintaining and expanding Housing First is not only compassionate but also imperative.”

And in the third selection, Sean Kinsella writes personally about homelessness and addiction. In an essay for the Irish Examiner, he discusses his deep problems – and his recovery. He advocates that we do more for those who are homeless. “I wasn’t seen. I wasn’t heard. I was a file. A risk to be managed.”

DG



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Reading of the Week: Brief CBT for Suicidal Vets – the JAMA Psych Study; Also, Docs & Generative AI, and Lamas on Organ Transplants & Mental Illness

October 23, 2025 /

From the Editor

As psychotherapies have become increasingly more practical and relevant in recent years, we may ask: could a focused therapy help individuals who are suicidal?

In a new JAMA Psychiatry paper, Craig J. Bryan (of the Ohio State University) and his co-authors attempt to answer that question, reporting on a randomized clinical trial involving military personnel and veterans. 108 participants were offered brief cognitive therapy (BCBT) or another psychotherapy, present-centred psychotherapy (PCT), building on past work that has shown the potential of BCBT for those who are suicidal. “This randomized clinical trial found that BCBT reduced suicide attempts among US military personnel and veterans reporting recent suicidal ideation and/or suicidal behaviors compared with an active comparator.” We consider the paper and its implications.

In the second selection, from JAMA Internal Medicine, Dr. Daniel J. Morgan (of the University of Maryland) and his co-authors, ask what physicians can do to prepare for generative AI. They offer several useful suggestions. “All physicians will need to understand the basics of GenAI to practice medicine in the next decade. Those without this understanding may find themselves burdened by archaic workflows or responsible for errors that GenAI could have prevented.”

And in the third selection, Dr. Daniela J. Lamas (of Harvard University), an intensivist, looks at transplantation and those who have mental disorders. In a New York Times essay, she notes an historic bias against such individuals. Still, she wonders about the difficulties of the area. “Transplant is one of the most fraught decisions in medicine…”

DG

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Reading of the Week: Suicide-related Reporting – the New BJP Paper; Also, Cannabis Use & Psychosis, and Mental Health & Working from Home

October 16, 2025 /

From the Editor

The stakes are high: news coverage of suicide can affect suicide rates. So how responsibly do journalists report? How has this changed with time?

In a new paper for The British Journal of Psychiatry, Dr. Mark Sinyor (of the University of Toronto) and his co-authors attempt to answer these questions. Focusing on US network news, they analyzed suicide-related news segments over an 11-year period, including for putatively harmful characteristics. “Coverage of suicide stories by major US cable news networks was often inconsistent with responsible reporting guidelines.” We consider the paper and its implications.

In the second selection from JAMA Psychiatry, Dr. Andrew S. Hyatt (of Harvard University) and his co-authors look at cannabis use after legalization and those individuals with psychosis. In this brief report, they drew from a US database with almost 2 000 participants. “In this study, individuals with psychosis reported a large increase in current cannabis use following legalization and commercialization of cannabis in their state, and by larger amounts than previously reported estimates of the general population.”

Is working from home better for mental health? In the third selection, from Mental Health & Prevention, Jean-Philippe Chaput (of the University of Ottawa) and his co-authors drew on national data to analyze work location and several self-rated measures, including mental health. The dataset is impressive with almost 25 000 participants. “We observed that work location was not related to self-rated mental health, life satisfaction, or life and work stress.”

DG

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