Month: April 2026

Reading of the Week: Psychedelics vs Antidepressants – the New JAMA Psych Paper; Also, US Psilocybin Use and Hahn on the Work of Mental Illness

April 30, 2026 / / 0 Comments

From the Editor

“Trump signs order to accelerate access to psychedelic drug treatments”

– Reuters, 18 April 2026

Last week, the U.S. president signed an executive order easing the way for more research on psychedelics for mental illness. It’s another example of the enthusiasm that many – policymakers, politicians, patients, families, members of the public – have for these drugs. Past work has indicated some effectiveness in treating depression. But how much of it can be explained by placebo? Psychedelics are, after all, challenging to study, in part because of difficulties with blinding (people can figure out whether they receive a psychedelic or placebo).

Dr. Zachary J. Williams (of the University of California, Los Angeles) and his co-authors attempt to shed light on this issue with a new, smart study published in JAMA Psychiatry. In it, they did a meta-analysis, comparing the effectiveness of psychedelic-assisted therapy (PAT) and open-label traditional antidepressants (TADs) for the treatment of major depression, drawing on 24 studies. “These findings suggest that PAT is no more effective than TADs under equal-unblinding conditions for the treatment of depression and highlight the potential role of blinding integrity.” We consider the paper and its implications.

And, on the topic of psychedelics, Dr. Kevin H. Yang (of the University of California, San Diego) and his co-authors look to quantify the number of people using psilocybin in the United States. In a priority data letter for The American Journal of Psychiatry, they used data from the National Survey on Drug Use and Health, a survey with more than 59 000 respondents. “With approximately 8 million individuals estimated as having used in the past year, naturalistic psilocybin use is sufficiently prevalent that psychiatrists are likely to encounter patients who use it outside of clinical settings.”

And in the third selection, an essay from The Globe and Mail, Brandon Hahn writes personally about his experiences with mental illness, noting public intolerance and tolerance – and meaningful gestures. “Sometimes support looks like red tape and a pile of forms. Sometimes it looks like a chair that faces the window while holding a hand.”

DG

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Reading of the Week: MST vs ECT – the New Lancet Psychiatry Paper; Also, the First AI Drug Prescriber and Dr. Taglienti on Her Cancer & Her Career

April 23, 2026 / / 0 Comments

From the Editor

He began to respond to ECT and felt less depressed than he had in many years. But as the treatments continued, my patient noticed gaps in his memory including family vacations when his children were young. “Those memories are precious.” He stopped ECT and, soon after, was deeply depressed again. 

Smaller studies suggest that Magnetic Seizure Therapy (MST) – where alternating magnetic fields induce seizures – offers relief to patients without the cognitive problems of ECT. In a new study published by The Lancet Psychiatry, Dr. Daniel M. Blumberger (of the University of Toronto) and his co-authors add to the literature with the largest randomized trial comparing these convulsive therapies conducted and the first non-inferiority clinical trial to address efficacy. The study involved 239 participants with depression. “MST showed non-inferior efficacy relative to… ECT in achieving remission of depression, and a more favourable cognitive safety profile.” We consider the paper and its implications.

Should patients receive prescriptions from an AI prescriber? In the second selection, from JAMA, Dr. Daniel G. Aaron (of the University of Utah) and Christopher Robertson (of Boston University) look at a new Utah program allowing AI to prescribe medications without physician involvement. They are cool to the idea. “Although AI offers the promise of increased efficiency and expanded access, the evasion of legal obligations by early movers raises profound concerns. Incorporating AI into modern health care must be evidence based and responsible.”

And in the third selection, Dr. Jenna Taglienti (of Hofstra University) writes personally about her cancer in JAMA. As a psychiatrist and a residency program director, she finds meaning in her work – but illness helps her gain perspective. “Medicine can have extraordinary meaning. But it cannot substitute for being present in your own life.”

DG

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Reading of the Week: Mirtazapine for Methamphetamine – the New JAMA Psych Study; Also, Patients & AI and Delgaram-Nejad on His Meds

April 16, 2026 /

From the Editor

He occasionally used cannabis in his 20s and did not try crystal methamphetamine until after his 35th birthday. He readily admits to problematic use, undermining his relationship and leading to the loss of his job. In my office, he describes his desperation and asks: Is there a medication that could help?

In the first selection, a new paper published in JAMA Psychiatry, Rebecca McKetin (of the University of New South Wales) and her co-authors attempt to answer that question. In an impressive new study, they report the results of a phase 3, parallel-group, double-blind, placebo-controlled RCT involving 344 people with moderate or severe methamphetamine use disorder and a trial of mirtazapine or placebo. “The results of this randomized clinical trial confirm that mirtazapine can be used in routine clinical practice to facilitate a reduction in methamphetamine use among people with a moderate to severe methamphetamine use disorder.” We consider the paper and its implications.

In the second selection, Shaddy K. Saba and Dr. William B. Weeks (both of New York University) write on AI and patients. In a commentary for JAMA Psychiatry, the authors observe that an increasing number of patients are turning to AI and argue that clinicians need to become actively involved. “The question is not whether AI is good or bad for mental health: like many other patient behaviors, it can be both and depends on context. The question for clinicians is whether to help patients navigate its use.”

Finally, in the third selection from Schizophrenia Bulletin, Oliver Delgaram-Nejad – who has schizophrenia – discusses his decision to stop medication. Reviewing his episodes of psychosis, he argues that antipsychotics are too problematic for him. “I have weighed the benefits and risks, and navigated the rather painful tension, of remaining on an antipsychotic and living with the side effects versus accepting the risk of relapse and reclaiming my energy.”

DG

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Reading of the Week: Cannabis – the New Lancet Psych Paper; Also, the Skepticism of Joel Paris and Mania & the Law

April 9, 2026 /

From the Editor

What do you say to your patient when he insists that cannabis is helping him with his mental disorder? What is the evidence?

Of course, many papers have been published on the topic. That said, Jack Wilson (of The University of Sydney) and his co-authors contribute nicely to the literature with their new systematic review and meta-analysis – arguably the most comprehensive to date – published in Lancet Psychiatry. 54 RCTs were included, involving almost 2 500 participants, including those with depression and PTSD. “Given the scarcity of evidence, the routine use of cannabinoids for the treatment of mental disorders and substance use disorders is currently rarely justified.” We discuss the paper and its implications.

What happens to your view of our field after five decades spent treating tens of thousands of patients, leading major institutions, and authoring dozens of books and papers? In a new episode of Quick Takes, Dr. Joel Paris, former chair of the Department of Psychiatry at McGill University and a self-proclaimed skeptic, discusses the past, present, and future of psychiatry. Never one to shy away from sharing his controversial views, Dr. Paris dives into his thoughts on the DSM system (he’s not a fan) and what he sees as “fads and facilities” – such as the overdiagnosis of adult ADHD, trauma, and autism. “Over time, my perspective on psychiatry has changed in the direction of greater skepticism.”

Finally, in the third selection from The Canadian Journal of Psychiatry, Drs. Kenya A. Costa-Dookhan and Andrew Lustig (both of the University of Toronto) discuss what to do when a patient doesn’t meet criteria for an involuntary admission but isn’t well. Drawing on a case involving a patient experiencing a manic episode, they offer three strategies. “When mania outruns the law, our task is to accompany our patients with clarity, compassion, and collective integrity, not toward cure, but toward the next opportunity for care.”

DG

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Reading of the Week: Psychotic Prompts & AI – from JAMA Psych; Also, Lithium Landscape and Dr. Cooke on Growing Up

April 2, 2026 /

From the Editor

Patients, including those with psychosis, may turn to AI chatbots for advice. What are they told? And are they encouraged to seek care?

In a research letter that was recently published in JAMA Psychiatry, Dr. Elaine Shen (of Columbia University) and her co-authors attempt to answer these questions. Using three versions of ChatGPT, they provided 79 statements indicative of positive psychotic symptoms and 79 that were neutral. The responses were then rated by two reviewers. With the free version of ChatGPT – what most people use – psychotic prompts had 43-fold higher cumulative odds of receiving a less appropriate rating than control prompts. We consider the study and its implications.

Lithium has fallen out of fashion; a recent Canadian paper found declining prescriptions in Alberta. In a new American Journal of Psychiatry commentary, Dr. Robert M. Post (of George Washington University) and his co-authors make the case for the old mood stabilizer. They offer several arguments, including that it is a disease-modifying agent. “Clinicians, patients, and the public should be educated about the unique assets of lithium, such that conventional treatment paradigms of bipolar disorder emphasize the greater and earlier use of the drug to achieve a more benign course of illness and less cognitive dysfunction.”

Finally, in the third selection from JAMA, Dr. Emma M. Cooke (of Harvard University) writes about medical school rotations. Now an internist, she remembers the common med school question: “what do you want to do when you grow up?” She mulls her responses – and the simplicity of the question. “For everyone in medicine, not just medical students, our choice of specialty is just a single data point in what makes us who we are.”

DG


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