Chris Aiken, MD @chrisaikenmd Twitter profile

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Chris Aiken, MD

@chrisaikenmd

2 years

A daily dose of practice-changing research from the editor of the Carlat Psychiatry Report

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Chris Aiken, MD

@chrisaikenmd

8 months

New study pulls together 198 symptoms of early psychosis from 14 rating scales Surprisingly, first line treatment for early "prodromal" #psychosis = psychotherapy/omega-3, not antipsychotics. Learn more:

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Chris Aiken, MD

@chrisaikenmd

7 months

Aripiprazole (Abilify) has a warning about causing impulsive hedonic activity like #gambling , and new meta-analysis adds fellow dopamine D3 agonists cariprazine (Vraylar) and brexpiprazole (Rexulti) to that list: #psychiatry #mentalhealth

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Chris Aiken, MD

@chrisaikenmd

1 year

All mood stabilizers lowered mortality risk in #bipolardisorder , but the benefit was greatest with lithium - against suicide and other deaths - in new study of 25K followed over 5 years.

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Chris Aiken, MD

@chrisaikenmd

4 months

#Lithium reduced suicidality 49% in this new analysis of 13 randomized controlled trials: Caveat: Suicide was not the primary outcome in those studies Don't avoid lithium to prevent suicidal overdose; the data suggests the opposite. #suicideprevention

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Chris Aiken, MD

@chrisaikenmd

1 year

Think your patient won’t stick with clozapine or lithium? Those 2 meds had the highest rate of adherence in this super-sized study of #bipolar . Full recovery outweighs side effects. #psychiatry #lithium #bipolardisorder

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Chris Aiken, MD

@chrisaikenmd

5 months

#Lithium lowered mortality in #bipolar , from suicide and other deaths, more than other mood stabilizers in this study of 25k followed for 5 years: Join me @APApsychiatric May NYC, I'll present on lithium w/ R Post and J Rybakowski:

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Chris Aiken, MD

@chrisaikenmd

7 months

Hospitalization prevents suicide, but only if the patient made a suicide attempt within the past day, suggests a new big-data study from the VA: Hospital care did not lower the #suicide risk for those with ideation only or attempts in the past 2-7 days

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Chris Aiken, MD

@chrisaikenmd

4 months

#WorldBipolarDay reminds us why mania peaks in the Spring. Sudden increases in sunlight destabilizes mood. Darker parts of map have sharper spring spikes. People raised in those "solar flux" regions also have a younger age of onset of #bipolardisorder :

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Chris Aiken, MD

@chrisaikenmd

12 days

New paper gathers updates on #lithium from past 7 years: > Beat aripiprazole, valproate, quetiapine in mania > Better prevention than valproate > Better cognitive protection than quetiapine > Safe/effective in child #bipolar More:

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Chris Aiken, MD

@chrisaikenmd

9 months

#Lithium had same rate of chronic kidney disease as valproate and lower risk of acute kidney injury in 10 yr study of 10,946, as long as level <= 1.0: A surprise? Well, valproate injures the kidneys in animal models. #psychiatry #bipolar

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Chris Aiken, MD

@chrisaikenmd

5 months

An update on treatment-resistant #depression in the elderly from @NEJM Look for vascular causes, rule out psychosis/bipolar, consider psychotherapy, ECT, TMS, add-on lithium, aripiprazole, ketamines. Chart has target doses for elderly.

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Chris Aiken, MD

@chrisaikenmd

5 months

Asians have more side effects to antidepressants. On reason: 20-40% metabolize them slower in the liver. Desvenlafaxine (Pristiq) isn't metabolized there, which may explain why it was better tolerated than duloxetine (Cymbalta) in this large 2023 trial from China:

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Chris Aiken, MD

@chrisaikenmd

3 months

Among #ADHD treatments, amphetamines had a slightly greater risk of causing psychosis than methylphenidate, and atomoxetine (Strattera) had no risk in this new large study, confirming an earlier report from NEJM: #psychiatry #mentalhealth

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Chris Aiken, MD

@chrisaikenmd

2 months

First long-term study confirms safety and efficacy of high-dose SSRIs in #OCD : Doses went up to 650mg sertraline, 80mg escitalopram, 120mg fluoxetine, 600mg fluvoxamine (21 months, retrospective, n=105) #psychiatry

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Chris Aiken, MD

@chrisaikenmd

8 months

New study identifies #depression with excessive fatigue and insomnia as a more severe subtype, with more suicidality, social impairment, weight changes, and a predominant winter pattern: #psychiatry #sleep #mentalhealth

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Chris Aiken, MD

@chrisaikenmd

3 months

Silexan (lavender extract approved for anxiety in Europe) is more effective than SSRIs in head-to-head trials & worked better for more severe #anxiety in new analysis of 5 RCTs: Podcast: How to use:

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Chris Aiken, MD

@chrisaikenmd

4 months

Bupropion is no more likely to cause anxiety than an SSRI. I argued that earlier: And this study backs that up with rating scales from a large EMR databank:

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Chris Aiken, MD

@chrisaikenmd

8 months

ADHD meds associated with a 4% increased risk of heart disease per year, mainly hypertension/arterial dz (dose-dependent), from new case-controlled study of 278,027 people followed 14 yrs: However, untreated #ADHD has a high mortality risk

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Chris Aiken, MD

@chrisaikenmd

9 months

The largest trial of amitriptyline in irritable bowel syndrome ( #IBS ) just published. Low doses of this antidepressant (10-30mg) were more effective than placebo and good tolerability (based on drop out rates) #psychiatry #guthealth #IBD

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Chris Aiken, MD

@chrisaikenmd

5 months

Mania is a common complication of corticosteroids, particularly in doses >40mg prednisone equivalent, finds new review Most cases occurred in peopled without a psychiatric history, and steroid tapers can also trigger mood symptoms #bipolar #psychiatry

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Chris Aiken, MD

@chrisaikenmd

7 months

New metaanalysis of meds in #bulimia finds few winners. Topiramate looks good, along with the FDA-approved fluoxetine (Prozac, 60mg) Topiramate dose = 100-200mg, sometimes 600, start 25mg/d and raise slowly every 7 days) #psychiatry #eatingdisorders

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Chris Aiken, MD

@chrisaikenmd

7 months

Clinicians who followed CANMAT #depression guidelines had better outcomes in new large 6-year study: Uncontrolled, so doesn't prove causation, but the CANMAT is free and full of useful pearls:

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Chris Aiken, MD

@chrisaikenmd

2 months

High potency #cannabis doubled the risk of #psychosis in this large study of UK teens, while low-potency was safer: But most of today's #marijuana is high-potency More updates in Carlat #Psychiatry News

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Chris Aiken, MD

@chrisaikenmd

9 months

#CBD oil (Cannabidiol) failed to treat #bipolar #depression in this new, small randomized controlled trial of #bipolardisorder This healthier ingredient of #marijuana also failed in a recent study of #anxiety

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Chris Aiken, MD

@chrisaikenmd

4 months

FDA just cleared Neurostar TMS for ages 15-up as antidepressant augmentation. 78% of teens responded to TMS in 1169 real-world cases. 18 controlled trials support #TMS in youth #depression (ages 8-up): #psychiatry #mentalhealth #pediatrics

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Chris Aiken, MD

@chrisaikenmd

10 months

How to stop an antidepressant? New review finds longer tapers worked better And gives a shout out to the “hyperbolic” taper: How to microdose tapers: #antidepressant #deprescribe #mentalhealth #depression

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Chris Aiken, MD

@chrisaikenmd

8 months

#Lithium and IV #ketamine rose to top for both efficacy and tolerability in treatment-resistant #depression in new network metaanalysis of 22 trials, surpassing esketamine (Spravato) and aripiprazole (Abilify) More updates:

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Chris Aiken, MD

@chrisaikenmd

5 months

Treatment of #ADHD (with stimulants) was not linked to later stimulant misuse in a new large study of 11,066 teens followed for 5 years into early adulthood: #psychiatry #addiction #mentalhealth

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Chris Aiken, MD

@chrisaikenmd

8 months

Melancholic #depression = lower recovery with SSRI citalopram in new STAR*D analysis (27% vs 54%). Perhaps tricyclics work better for these features (low appetite, muscle slowing, non-reactive mood, guilty rumination) but this study did not test that

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Chris Aiken, MD

@chrisaikenmd

9 days

People w/ #schizophrenia lived longer on clozapine vs other meds in large retrospective study from Brazil, building on many similar trials: Confounders are possible, but clozapine brings fuller recovery, and better #mentalhealth usually = longer life.

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Chris Aiken, MD

@chrisaikenmd

8 months

ECT is more effective than TMS for psychotic depression, and in this study of 138 it had 2.5x higher response in general #depression , consistent with earlier metaanalyses Crossover design (each patient got both treatments) has some pros/cons

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Chris Aiken, MD

@chrisaikenmd

2 months

Don’t stop an #antidepressant within 3 months of recovery, and continue it at least 6 months to minimize risk of relapse, concludes analysis of 36 trials: Confirms the findings of earlier studies, that at least 6 mth of #depression recovery is needed

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Chris Aiken, MD

@chrisaikenmd

4 months

Psychosis is common in #Parkinsons , but antipsychotics worsen the muscle stiffness. Review of 16 trials finds 2 antipsychotics are favorable: 1. FDA-approved pimavenserin (Nuplazid) 2. Clozapine Quetiapine didn't worsen PD much, but also didn't work

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Chris Aiken, MD

@chrisaikenmd

2 months

Clonidine 4-times more effective than placebo at reducing tics (Tourette's) in new RCT of 127 children with #ADHD : Clonidine treats ADHD & tics, while stimulants can worsen tics. They used patch (1-2 mg/wk), sometimes better tolerated than oral clonidine.

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Chris Aiken, MD

@chrisaikenmd

7 months

An update on #cannabis and #anxiety . THC raises anxiety, especially in new users. #CBD was once thought to lower anxiety, but newer studies suggest it doesn’t do much at all: Both are in #marijuana , and THC levels are on the rise in modern weed

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Chris Aiken, MD

@chrisaikenmd

10 months

New review of #cannabis and #depression concludes “ #Marijuana can be helpful in elevating mood and [lowering anxiety] initially, but it is subsequently followed by a rise in depressive symptoms, which manifest as mental distress and frustration.”

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Chris Aiken, MD

@chrisaikenmd

3 months

First case of ketamine tolerance from Mayo Clinic: To stay well, the patient required increasing frequency of #ketamine , until it no longer worked after 5 years. #depression #psychiatry

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Chris Aiken, MD

@chrisaikenmd

3 months

4 antipsychotics stand out for combined dopamine-serotonin effects: Aripiprazole, cariprazine, brexpiprazole, lumateperone Of these, the first 3 improved negative symptoms of #schizophrenia in new analysis of 20 trials: I'd add clozapine to list

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Chris Aiken, MD

@chrisaikenmd

1 month

#Benzo tapering guide open for comment 'til 7/19: >Taper by 5-25% every 2-4wk >Benzo risks: falls, car accidents, cognitive impairment, overdose >Higher risk: older, pregnant, sub u d/o, or on #opioid >Covers diversion, threats to providers #psychiatry

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Chris Aiken, MD

@chrisaikenmd

9 months

The #ADHD med atomoxetine (Straterra) improved sleep apnea when paired with the antimuscarinic aro-oxybutynin in new RCT If FDA approved, this combo pill would be the first medication to directly treat the nocturnal symptoms of #sleepapnea #cpap

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Chris Aiken, MD

@chrisaikenmd

8 months

4 steps to explain #borderline diagnosis (dx) from new study >Explain diagnostic process >Assess thoroughly >Explore how the features are active in everyday life >Link dx to evidence-based treatments/hope More in podcast

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Chris Aiken, MD

@chrisaikenmd

2 months

Nearly half of patients with treatment resistant #depression take long-term benzos, and this large observational study finds reasons to question that practice: Benzo use associated with low physical activity and worse cognition #psychiatry

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Chris Aiken, MD

@chrisaikenmd

2 months

What works for acute #anxiety (unrelated to a specific disorder)? 1st, therapy. New analysis finds only 3 effective meds: > Benzos > Quetiapine (Seroquel) > Pregabalin (Lyrica) All have risks that caution against their use. Safest? I'd say pregabalin.

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Chris Aiken, MD

@chrisaikenmd

8 months

Pearls for treating late-life #depression in new review. Go to full dose (but start low/slow), use psychotherapy, avoid benzo/anticholinergics/antihistaminergics, and consider aripiprazole augmentation, ketamine, or ECT if no response:

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Chris Aiken, MD

@chrisaikenmd

9 months

New challenge to #ketamine 's benefits. Stanford MDs gave the drug to depressed patients while they were unconscious and undergoing surgery Ketamine was no different than a saline placebo, and both gave a big boost to depression, raising questions...

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Chris Aiken, MD

@chrisaikenmd

6 months

Generic antipsychotics ranked in non-psychotic d/o: Top > Quetiapine: #sleep , #anxiety , #depression > Aripiprazole: mania, Tourette's From best to worst tolerated > Paliperidone, risperidone, lurasidone, quetiapine, aripiprazole, olanzapine, ziprasidone

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Chris Aiken, MD

@chrisaikenmd

1 year

First guidelines on catatonia released, recommending benzos (lorazepam) or ECT 1st line; amantadine or memantine 2nd; and judicious use of #antipsychotics which can worsen the condition (they prefer atypicals with low D2 dopamine blockade) #psychiatry

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Chris Aiken, MD

@chrisaikenmd

8 months

New review identified medical disorders to rule-out before diagnosing #ADHD , including sleep apnea, diabetes, thyroid disorder, absence seizures, concussion, inflammatory bowel disease, iron deficiency, and anemia:

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Chris Aiken, MD

@chrisaikenmd

2 months

Only one med rose to top for sleep in #PTSD in new analysis of 99 trials: Prazosin. “Evidence is scarce and indicates lack of efficacy for SSRIs, mirtazapine, z-drugs and #benzodiazepines , which are widely used in daily practice.” #psychiatry #trauma

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Chris Aiken, MD

@chrisaikenmd

7 months

New review replaces #lithium myths with facts, suggesting: 1. 1st line in #bipolardisorder 2. Works in many #bipolar types 3. Prevents suicide 4. Drug interactions/pregnancy = manageable 5. Controlled release = better tolerated #depression #psychiatry

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Chris Aiken, MD

@chrisaikenmd

9 months

No meaningful benefit w/ aripiprazole+SSRI vs. SSRI alone as a FIRST-LINE intervention in #depression in new trial of 70 Cognition improved faster in the combo group on THINC-it test, but was the same by 2 mths; depression/anxiety the same throughout.

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Chris Aiken, MD

@chrisaikenmd

3 months

Magnetic Seizure Therapy (MST) equaled #ECT for #depression in new RCT of 73 patients, with fewer cognitive side effects: MST is not TMS (transcranial magnetic stimulation). Both use magnets, but MST (like ECT) works by inducing seizures with the magnet.

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Chris Aiken, MD

@chrisaikenmd

8 months

Tricyclics are the most effective antidepressants for #panic disorder in this new Cochrane analysis, particularly desipramine: Learn how to use tricyclics in our podcast: Art: Implosion by Cotards Chamber #anxiety

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Chris Aiken, MD

@chrisaikenmd

1 month

#Psilocybin was no better at treating #depression than an SSRI #antidepressant in a large trial, but did this #psychedelic have more psychological benefits? Not according to this analysis of personality changes in that landmark trial:

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Chris Aiken, MD

@chrisaikenmd

5 months

Transcranial magnetic stimulation (TMS/iTBS) made a meaningful, lasting difference in cognition, negative symptoms, and social abilities in #schizophrenia in 2 small RCTs from the past year: #psychiatry #mentalhealth #mentalillness

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Chris Aiken, MD

@chrisaikenmd

10 months

Esketamine's remission rates 1.5x greater than quetiapine's in large @NEJM trial of treatment resist #depression 32 wks, n=676, randomized, single blind, no placebo, industry sponsored, both used as augmentation after >= 2 failed #antidepressant trials

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Chris Aiken, MD

@chrisaikenmd

5 months

Industry funding was common in DSM-5 (60% of US contributors) and most of it went undisclosed because @APApsychiatric did not require disclosure of research funding, concludes new study from @BMJ_latest : #psychiatry

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Chris Aiken, MD

@chrisaikenmd

4 months

Choosing that first antidepressant is largely guided by side effects. But there are many ways to personalize antidepressant augmentation and this piece is full of rare pearls, like nimodipine for vascular #depression . From Drs Anbarasan Deepti and David Liebers

Carlat Psychiatry

@CarlatPsych

4 months

New on our site: The best augmentation strategy varies by patient. Learn which features help personalize the plan. #mentalhealth

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Chris Aiken, MD

@chrisaikenmd

10 months

Remarkable study created criteria for 3 types of "At-Risk" #bipolardisorder . After a decade of follow-up, 1 in 3 at-risk patients converted to full bipolar compared to none of the control patients: #psychiatry #depression

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Chris Aiken, MD

@chrisaikenmd

5 months

Estrogen protects against #schizophrenia , delaying its onset in women, but does an estrogen patch augment antipsychotics? "Yes," concludes new meta-analysis in women with schizophrenia:

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Chris Aiken, MD

@chrisaikenmd

1 year

27 years after its release, we learn about a new use for paroxetine (Paxil): erythema of rosacea. It improved multiple outcomes in this well designed, 12 week randomized controlled trial of 97. #psychiatry #clinicaltrials #dermatology

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Chris Aiken, MD

@chrisaikenmd

8 months

I use to think bupropion did not work for meth/amphetamine use disorder, but this new analysis of 8 RCTs has me reconsidering this antidepressant Benefits were modest, and better with longer term treatment #addiction #sobriety #mentalhealth #psychiatry

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Chris Aiken, MD

@chrisaikenmd

3 months

#Esketamine worked on day #1 , but was no better than placebo after a month in this large, randomized, industry-sponsored trial in treatment resistant #depression from China. Surprising? Several unpublished trials showed a similar fade.

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Chris Aiken, MD

@chrisaikenmd

10 months

Lithium raises neutrophils, but can it reverse neutropenia on clozapine? New review suggests it's worth trying, and finds no evidence that #lithium simply "masks" the problem, preventing it from being detected: Complicated issue, in need of more data

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Chris Aiken, MD

@chrisaikenmd

2 months

63% of people with #depression respond to pramipexole, concludes this metaanalysis in bipolar & unipolar disorder: Good safety at 6 months, nausea and somnolence the main side effects. How to use it in #psychiatry :

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Chris Aiken, MD

@chrisaikenmd

10 months

DSM-5 just got an update, and it’s free at: 2023 updates are minor, but includes 2022 gems like > New: Prolonged Grief d/o; Impairing Emotional Outbursts > Gone: “Commit" suicide > Changed: Neurocognitive d/o #psychiatry #psychology

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Chris Aiken, MD

@chrisaikenmd

6 months

What works when clozapine fails in #schizophrenia ? Not ECT in this new randomized trial of 40 patients: An earlier RCT was also negative, dampening the uncontrolled hopes of observational findings. ECT is a clearer choice for catatonia and psychotic dep

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Chris Aiken, MD

@chrisaikenmd

9 months

/Finally a study looks at high dose stimulants in #ADHD . No additional benefit with high-dose amphetamines, and the small benefit for high dose methylphenidate was outweighed by its risks #psychiatry #mentalhealth

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Chris Aiken, MD

@chrisaikenmd

3 months

Stroke causes depression, but #depression also raises the risk of #stroke , about 1.5 times, finds this case-control study of 26,877: Interesting, but the association may be due to other risk factors that are shared by both illnesses #neurology

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Chris Aiken, MD

@chrisaikenmd

5 months

Silexan is a European med with a large effect in #anxiety (GAD), confirmed by this metaanalysis of 1,213 subjects: This lavender extract is over-the-counter as "CalmAid" in the US, learn how to use it

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Chris Aiken, MD

@chrisaikenmd

1 year

#Esketamine was no better than placebo after a month of treatment in new, large, randomized trial in treatment resistant depression in China, though it worked @24 hours. Surprising? Well, an earlier metaanalysis arrived at a similar conclusion.

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Chris Aiken, MD

@chrisaikenmd

7 months

Atomoxetine (Strattera) reaches its peak benefit in childhood #ADHD at a dose of 1.4 mg/kg, according to new analysis of 12 RCT: Caution: it can reach 10x higher levels in poor CYP2D6 metabolizers, causing severe fatigue. #psychiatry #mentalhealth

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Chris Aiken, MD

@chrisaikenmd

3 months

How much does placebo account for #ketamine and #esketamine benefits? 72%, from new analysis: Similar to placebo contribution for antidepressants (62-82%). Meds make a real difference, but the power of the placebo is welcome news for the human spirit.

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Chris Aiken, MD

@chrisaikenmd

14 days

Predictors of conversion to bipolar: 1. Earlier onset #depression 2. Frequent depressions 3. Cyclothymia 4. Family history #bipolar 5. Substance use, unemployment, suicide attempts From large study. 7% converted over 12 yr (0.5%/yr), most to BP-II:

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Chris Aiken, MD

@chrisaikenmd

8 months

Pairing atomoxetine ( #ADHD med) with a sleep dose (50mg) of trazodone improved sleep apnea in small study Builds on other work atomoxetine, which improves upper airway muscle tone and is being developed as a combo pill with aro-oxybutynin for #sleepapnea

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Chris Aiken, MD

@chrisaikenmd

5 months

Exercise treated #depression with an impressive effect size (0.9; effectively treating 1 of 2 by NNT) in this metaanalysis of 41 trials: Best evidence for supervised and group #exercise #mentalhealth #psychiatry

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Chris Aiken, MD

@chrisaikenmd

4 months

Last month I posted a large trial where omega-3 prevented psychosis in vulnerable children. Now an analysis of 21 earlier studies backs that up: Reduction is small (7-16%); greater as the studies go longer. How to use omega-3:

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Chris Aiken, MD

@chrisaikenmd

8 months

Another study finds esketamine prevents postpartum #depression when used as Cesarian anesthesia, this time in women with no mental disorders (rates of PPD lowered: 18.5% vs 5.2%) One hypothesis: esketamine lowers pain levels after delivery.

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Chris Aiken, MD

@chrisaikenmd

9 months

Lithium doesn't cause weight gain, concludes 1) A meta-analysis of 29 trials 2) A study of severe weight gain on mood stabilizers Trends yes, but not statistic sign. Analysis of short-term trials found weight LOSS on #lithium

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Chris Aiken, MD

@chrisaikenmd

8 months

#Asthma improved when #depression was treated with an SSRI antidepressant (escitalopram or citalopram) in this new analysis of 3 randomized trials #mentalhealth

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Chris Aiken, MD

@chrisaikenmd

17 days

Breakthrough for migraine and #depression : Venlafaxine (Effexor) worked just as well as the more established treatment nortriptyline at reducing migraine frequency/intensity in this large RCT: (and with fewer side effects) #psychiatry #neurology

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Chris Aiken, MD

@chrisaikenmd

10 months

Large study ranked lifestyle factors to prevent #depression : 1 Sleep (7-9 hr) 2 Never smoking 3 Social connection 4 Moderate alcohol 5 Regular physical activity 6 Low-to-moderate sedentary activity 7 Healthy diet Tips for patients:

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Chris Aiken, MD

@chrisaikenmd

4 months

Duloxetine (Cymbalta) reduced post-surgical #opioid use in this analysis of 8 randomized controlled trials: The antidepressant is FDA approved in 3 #pain conditions: • Diabetic peripheral neuropathic pain • Fibromyalgia • Chronic musculoskeletal pain

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Chris Aiken, MD

@chrisaikenmd

8 months

Childhood #ADHD can turn into #schizophrenia , and new study of 211,705 identifies who is at risk. Those with multiple comorbidities, particularly #autism , intellectual disability, tics, #depression , and #bipolar Stimulants and psychosis don't mix

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Chris Aiken, MD

@chrisaikenmd

1 month

Jonathan Meyer has a great new book out on lithium And here you can catch his webinar on the book: #psychiatry #bipolardisorder #bipolar #mentalillness #depression

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Chris Aiken, MD

@chrisaikenmd

9 months

What would the STAR*D #depression trial look like if done today? A STAR*D for adolescents is underway; med algorithm just published: Starts w/ fluoxetine (which has best evidence in youth) or CBT; augment options: aripiprazole, olanzapine, lithium

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Chris Aiken, MD

@chrisaikenmd

5 months

Caffeine has a strong link to #anxiety in this new review, particularly at high doses above 400mg (that's 6 shots espresso) Can't give it up? Tea balances caffeine with anxiolytic compounds like theanine: #coffee #mentalhealth

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Chris Aiken, MD

@chrisaikenmd

1 month

INDICTED: Clinical and business leaders at the telehealth company Done face up to 20 years in prison for scheming to “provide easy access to stimulants to patients who didn’t need them” 40 million pills. $100 million revenue.

California telehealth execs charged in ADHD prescription scheme amid nationwide med shortage

Two executives at Done — Ruthia He and David Brody — allegedly schemed to provide easy access to Adderall and other meds to patients who didn't need them, then bill insurance companies.

www.latimes.com

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Chris Aiken, MD

@chrisaikenmd

2 months

#Bipolar disorder comes with a lot of comorbidities, especially: > #Anxiety d/o 40% > #ADHD 19% > #OCD 10% > Substance use d/o 31% From new analysis: Treat bipolar first, and minimize antidepressants. Most comorbidities respond to #psychotherapy .

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Chris Aiken, MD

@chrisaikenmd

6 months

New therapy treats #depression by regulating sleep and circadian rhythms. Large effect (d=1.1) compared to usual treatment in trial of 152: It's similar to the steps in my self-help book for #bipolar and depression:

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22

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Chris Aiken, MD

@chrisaikenmd

9 months

Alprazolam (Xanax) is thought to have a large effect size in panic disorder, but its potency fell 42% when the unpublished trials were dug up by this new analysis #anxiety #psychiatry #benzos

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Chris Aiken, MD

@chrisaikenmd

5 months

In #schizophrenia , the longer the long-acting injectable lasts, the longer the patient stays well, concludes this industry sponsored comparison of 1, 3, and 6-mth paliperidone (Invega) #psychiatry #mentalillness

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Chris Aiken, MD

@chrisaikenmd

9 months

Clonidine treats opioid WD and ADHD, and this new study reminds us it reduces #pain as well. A controlled trial of 70 patients with a history of #opioid use disorder who presented to the ED with orthopedic fractures:

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22

96

Chris Aiken, MD

@chrisaikenmd

10 months

1 in 32 have #adultADHD , concludes review of 57 studies: Diagnosis difficult, improved by structured test like "Adult onset" #ADHD is a myth, so trace symptoms to childhood: #mentalhealth #adhdawareness

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Chris Aiken, MD

@chrisaikenmd

20 days

Antidepressants did not cause mania (or prevent #depression ) in this 1 year observational study of 979 people with #bipolar : However, they only looked at hospitalized cases, and did not separate bipolar I from II.

10

26

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Chris Aiken, MD

@chrisaikenmd

3 months

A new use for paroxetine (Paxil): Erythema of rosacea. The SSRI #antidepressant improved multiple outcomes in this well designed, 12 week randomized controlled trial of 97: #psychiatry #clinicaltrials #dermatology

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Chris Aiken, MD

@chrisaikenmd

2 months

A 2023 study by @NassirGhaemi et al found high rates of cyclothymia among those diagnosed with adult #ADHD : Amphetamines helped their cognition a little, but often made their mood worse. Learn how to tell #bipolar /ADHD apart:

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Chris Aiken, MD

@chrisaikenmd

5 months

What makes an antipsychotic work for #bipolar #depression ? This paper looks for common ingredients, concluding > Serotonin reuptake inhibition > 5HT-2A blockade > Alpha-1 norepi blockade > D1 blockade The D2 blockade likely prevents switching into mania

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Chris Aiken, MD

@chrisaikenmd

2 months

#Depression makes it hard for people to take meds regularly. This novel study tested whether pairing an antidepressant with a rewarding substance (methylphenidate) would improve adherence: It did not.

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