From the Editor
Welcome 2025.
It’s our tradition that we begin the New Year by reviewing the best work of the past one. So, this week, we consider the best papers of 2024.

Let’s remember that this list is neither exhaustive nor definitive. The 10 selected papers are interesting and relevant to clinical practice, though many others could have been included.
These papers address topics ranging from artificial intelligence to antidepressant withdrawal. The common thread: their clinical relevance.
Additionally, I name a person of the year.
DG
“Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis”
Jonathan Henssler, Yannick Schmidt, Urszula Schmidt, et al.
The Lancet Psychiatry, July 2024
“Don’t you get severe withdrawal when you try to quit?” Many patients hesitate to start antidepressants because of the fear of withdrawal.
How common is it? In this systematic review and meta-analysis, Henssler et al. analyzed 79 studies involving over 21 000 people. They also compared withdrawal symptoms between antidepressants and placebo – a nice and important touch.
They found that some withdrawal symptoms were common (about 15%) but severe withdrawal was rare (2.8% – and perspective: placebo was 0.6%).
“Acupuncture for Combat-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial”
Michael Hollifield, An-Fu Hsiao, Tyler Smith, et al.
JAMA Psychiatry, June 2024
PTSD is common, and it’s challenging to treat. Not surprisingly then, many patients look for treatments that aren’t well established but seem helpful, like acupuncture. As clinicians, what should we think? In this paper, Hollifield et al. report on an RCT where venum acupuncture was compared to a sham treatment. The paper examined both a clinical response (measured with a PTSD scale) and a biological one (measured with the startle response) – nice.
“[V]erum acupuncture had a large pretreatment to posttreatment effect and was statistically superior to sham needling for reducing PTSD symptoms and enhancing fear extinction.”
“Cannabis-Related Disorders and Toxic Effects”
David A. Gorelick
The New England Journal of Medicine, 14 December 2023
Technically, this paper was published two weeks before the start of 2024 – but we considered it in a Reading in 2024. And, hey, with so many of our patients using cannabis, this review is very relevant and any excuse to highlight good work on cannabis is worthwhile.
Dr. Gorelick analyzed the literature. Here are three key take-aways:
- Cannabis itself has changed. “The potency of cannabis has doubled over the past 2 decades.”
- Screening can be helpful. Even a short questionnaire can but useful; in contrast, drug testing isn’t.
- CBT works. Yes, psychotherapy helps and patients may find apps for that purpose, especially if they have milder presentations.
“Clinical Outcomes of Magnetic Seizure Therapy vs Electroconvulsive Therapy for Major Depressive Episode: A Randomized Clinical Trial”
Zhi-De Deng, Bruce Luber, Shawn M. McClintock, et al.
JAMA Psychiatry, March 2024
It’s the most effective treatment for treatment-refractory depression – but the side effects are problematic. And, of course, there is the stigma associated with ECT. Could MST be an alternative?
In this RCT published in JAMA Psychiatry, Deng et al. did a comparison, finding “the efficacy of MST was indistinguishable from that of ultrabrief pulse [right unilateral] ECT, the safest form of ECT currently available.”

A note of caution: the study wasn’t powered as an equivalence or noninferiority trial. Still, a promising result.
“Closing the accessibility gap to mental health treatment with a personalized self-referral chatbot?”
Johanna Habicht, Sruthi Viswanathan, Ben Carrington, et al.
Nature Medicine, 5 February 2024
There is more and more interest in AI – but few real-world experiments.
In this Nature Medicine study, the authors looked at the use of a chatbot for self-referral against the standard option in the UK’s NHS when patients seek psychological care; the resulting study is impressive, involving almost 130 000 people. (Yes, you read that correctly.)
For the record, AI increased referrals – especially, in terms of those who self-identified as being ethnic minorities. “∼33,000 additional patients have found their way into treatment owing to this technical solution.”
“The effectiveness of smartphone app-based interventions for insomnia and sleep disturbances: A meta-analysis of randomized controlled trials”
Jake Linardon, Cleo Anderson, Zoe McClure, et al.
Sleep Medicine, October 2024
This isn’t a great paper; there are clear problems with it. Why, then, include the Sleep Medicine study in my top ten list? It’s the one paper here that will probably change your practice today.
Linardon et al. conducted a meta-analysis of apps to treat insomnia. “Findings suggest that stand-alone app-based interventions can effectively address insomnia and sleep disturbances, and may play an important role in the management of these symptoms.” Given how common sleep disturbances are for our patients, this paper is very practical and relevant.
Looking for an app to incorporate into your practice based on this study? CBT-I Coach, developed by US Veterans Affairs and included in the meta-analysis, is free and offers many features.
“Brief Cognitive Behavioral Therapy for Suicidal Inpatients: A Randomized Clinical Trial”
Gretchen J. Diefenbach, Kayla A. Lord, Jessica Stubbing, et al.
JAMA Psychiatry, December 2024
Inpatient admissions offer the opportunity for safety and a reassessment of medications. Can they also provide patients with life-saving psychotherapy? Diefenbach et al. argue yes, describing a randomized clinical trial involving 200 inpatients who received either the usual care or a focused CBT, tailored for short admissions.
“Relative to treatment as usual (which in this study included safety planning and caring contacts), the addition of CBT-inpatient reduced the odds of suicide attempt by 60% over 6 months post-discharge. The rate of psychiatric readmissions was also reduced by over 70%…”
“Clinical effectiveness and cost-effectiveness of a brief accessible cognitive behavioural therapy programme for stress in school-aged adolescents (BESST): a cluster randomised controlled trial in the UK”
June Brown, Kirsty James, Stephen Lisk, et al.
The Lancet Psychiatry, July 2024
Could we prevent major mental health problems in adulthood with school-based initiatives for adolescents? The concept is much discussed these days. To date, many experiments have been too broad and expensive (including all students) or too narrow and stigmatizing (including only those with problems).
Brown et al. offer a middle ground, focusing on those who self-refer. They report on a randomized controlled trial involving 900 UK students, with CBT or treatment-as-usual. “[T]he DISCOVER intervention is modestly clinically effective and economically viable and could be a promising early intervention in schools.” It’s a nice contribution to the literature and a step in the right direction.
“Efficacy of a culturally adapted, cognitive behavioural therapy-based intervention for postnatal depression in British south Asian women (ROSHNI-2): a multicentre, randomised controlled trial”
Nusrat Husain, Farah Lunat, Karina Lovell, et al.
The Lancet, 12 October 2024
How can we better engage patients in care? In Canada, only about half of patients with depression receive any treatment; the percentage is much lower in certain subpopulations.
In their study, British south Asian women with postnatal depression were randomized to a culturally-adapted form of CBT or treatment as usual. The Lancet paper is fascinating – and hopeful. “Participants in the [intervention] group were estimated to be almost twice as likely to have recovered at 4 months than those in the control group.”
“When Atypical Antipsychotics Were New”
Susan Weiner
Schizophrenia Bulletin, 26 September 2024
Weiner, an accomplished poet, writes about her first break psychosis, her struggles getting the care she needed, and her ultimate recovery. Despite the paranoia, the multiple hospitalizations, and the suicide attempts, she connects with one psychiatrist – who helps her find an antipsychotic that truly helps.
“The right medicine for the right person can produce sanity like a miracle drug, and all is once again bright.”
The paper is exceptionally well written; Weiner is a talented writer with a dry sense of humour. The paper also reminds us of, well, why we clinicians do what we do.
The Person of the Year
As president of the Canadian Medical Association, Dr. Joss Reimer has used the platform to discuss administrative burden in healthcare, advocate for more family physicians, and promote Reconciliation. She has also spoken openly about depression. Dr. Reimer draws on her clinical experience, but also on her lived experience.
In selecting a Person of the Year, I consider people who have made contributions to scholarship or clinical work or academic life. Past selections have included a former Minister of Finance, the CEO of a major hospital, and the former chair of a university department of psychiatry.
This year, I choose Dr. Reimer who has been a visible and effective advocate.
She has been candid about her personal history. She first had a depressive episode during her training. “Doing grocery shopping, every errand, every task was too great and something I wasn’t capable of doing,” she commented in an interview.

She also has spoken about her recovery. “You can have a significant mental illness that would be debilitating at one point and you can still flourish in your personal life, your career – it is possible to achieve. You can even be a physician practicing and the chief medical officer of an organization or even the president of the CMA with depression.” This is an important message for everyone to hear – including for us physicians.
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For those interested in reading more of the “best papers of the year,” you can find choices from 2023 and 2022, here:
https://davidgratzer.com/reading-of-the-week/reading-of-the-week-the-best-of-2023/
and here:
https://davidgratzer.com/reading-of-the-week/reading-of-the-week-the-best-of-2022/
Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.
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