From the Editor

Clozapine is special.

Almost seven decades after its release, that statement – from a new Lancet Psychiatry Editorial – remains true. Clozapine is the best antipsychotic for those who are treatment refractory in their schizophrenia. But there is the risk of potentially life-threatening neutropenia. And so its use is clunky, with much blood work and monitoring, off-putting to some who would benefit from this medication.

Are we too cautious with clozapine? In the first selection, Dr. Korinne Northwood (of The University of Queensland) and her co-authors consider that question in a new Lancet Psychiatry paper. Drawing from a major clozapine database for Australia and New Zealand patients, they analyzed 32 years of data involving 2.6 million blood tests and looked at neutropenic events. “Our results support greater flexibility in prescribing of clozapine and a more balanced approach to risk…” We review the paper and mull its clinical implications.

Australia: cool architecture and good clozapine data

In the second selection, in a letter to the editor, Clement Ma and Dr. Peter Szatmari (both of the University of Toronto) write about the recent MST vs. ECT paper from JAMA Psychiatry. They offer some hesitation on the authors’ wording: “a non-significant result in a superiority trial does not imply that the two treatments are equivalent.”

And in the third selection, actress and former Jeopardy! host Mayim Bialik writes personally about her mental health problems for Trend Magazine. She describes the challenges of getting help and her decision to speak out. She also notes the societal shift in thinking about mental illness. “[S]haring our own personal struggles is not a sign of weakness; it is a sign of strength. We all want to feel better, live better, and experience more joy and less suffering.”


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