Psychiatric Times Editors

 covered a wide variety of psychiatric issues and industry updates, from assessment and management of older age bipolar disorder to the relationship between antidepressants and emotional numbing. Here are some highlights from the week.

Assessment of Individuals With Older Age Bipolar Disorder

The DSM-5 describes bipolar disorder (BD) as a condition that is characterized by recurrent and/or cyclical episodes of mania or hypomania and depression. In the DSM-5, there are 2 subtypes of BD: bipolar I disorder (BD-I) and bipolar II disorder (BD-II). A diagnosis of BD-I is established if an individual experiences at least 1 manic episode with additional major depressive and/or hypomanic episodes. Individuals are diagnosed with BD-II if they experience at least 1 hypomanic episode and at least 1 major depressive episode without any manic episodes. Although BD is not as common among older adults as it is among younger adults, available evidence indicates that the total number of older adults with BD is expected to increase significantly over the next few decades. It has been observed that between 1980 and 1998, the relative frequency of late-onset bipolar disorder increased from 1% to 11%. 

Antidepressants Do Not Work by Numbing Emotions

Recent evidence from randomized, placebo controlled trials (1979 to 2016) has shown that, in about 15% of patients with depression, antidepressant treatment is robustly superior to placebo—contrary to the often-repeated claim that antidepressants are “not much better than a sugar pill.” It is not yet clear what clinical or biological features make this subgroup so antidepressant-responsive, although differences between drug and placebo increased significantly (P<0.001) with greater baseline severity of depression. 

Considering National and Personal Character in Russia’s Invasion of Ukraine

I caught a brief interchange of the September 27th “Late Show” when Stephen Colbert was interviewing the well-known foreign war correspondent Clarissa Ward. She seemed to be concluding that Russia has an unusual propensity to tolerate suffering, so that a long war would not be all that psychologically difficult for the country as a whole.

Her comment reminded me of how long Russia was able to hold out, starvation common by the end, to the siege of Leningrad by the German Nazis in World War II. They ultimately shifted the whole tide of the war. 

The Strength and Value of Organized Psychiatry

Is organized medicine really on the decline? As more nursing and other allied organizations are growing and becoming more politically active, what is happening to membership in physician organizations? Given the increasing stressors of the COVID-19 pandemic, gun violence, physician wellbeing, rising health care costs, the scope of practice issues, and government intrusion on medical decision making, this is a time when physicians, the field, and our patients need help more than ever. Is there still strength in numbers? 

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From older age bipolar disorder to the relationship between antidepressants and emotional numbing, here are highlights from the week in Psychiatric Times.

The Week in Review: September 26-30

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In Case You Missed It: Psychiatric Times Psychedelics Supplement

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Vol. 39, Issue 9 covers the latest in psychedelics research and development in psychiatry.

 covered a wide variety of psychiatric issues and industry updates, from historic USPSTF draft screening recommendations to the need for novel treatments for bipolar depression. Here are some highlights from the week.

USPSTF Makes Historic Anxiety and Depression Draft Screening Recommendations

The US Preventive Services Task Force (USPSTF) just released a draft recommendation stating that adults under the age of 65 should be screened for anxiety. The USPSTF draft recommendation is not final; it will now enter a public comment period.

The USPSTF draft “concludes with moderate certainty that screening for anxiety in adults, including pregnant and postpartum persons, has a moderate net benefit,” although the evidence for older adults (65 and older) is insufficient. The USPSTF has not previously made a recommendation on this topic. 

In the spring, while the year was still young, 

 published a 7000-word essay entitled “Doctors Gave Her Antipsychotics. She Decided to Live With Her Voices.” Some of it recounted the tragic but ultimately heroic story of Caroline Mazel-Carlton, a woman with a long experience of auditory hallucinations who, after much trauma, has become a powerful advocate for humane support and acceptance of those with similar experiences. The story, in the hands of author Daniel Bergner, is not hers alone, but rather the centerpiece of a quasi-editorial calling for a sea-change in psychiatric practice—a “fundamental paradigm shift” in our treatment of mental health. 

The Need for Novel Treatments for Bipolar Depression

Bipolar depression is a condition that proves difficult to treat for many patients. When patients with bipolar disorder (BD) go through a depressive episode, medication adjustment is often the first intervention that clinicians consider. Evidence for standard pharmacologic treatments for bipolar depression shows the strongest support for several dopamine-blocking agents, as well as for lithium and lamotrigine (Lamictal). Recently published treatment guidelines are reflective of this evidence. Pharmaceutical industry support for research on dopamine-blocking medications has contributed to their dominance in the marketplace. Older generic medications are less likely to be included in research trials and thus may not be adopted widely due to a perceived or real lack of evidence. 

Nutritional Treatments: The Next Frontier in Psychiatry

Over the last decade, we have seen an exponential increase in research relating diet quality to mental health. The typical Western diet of ultra-processed foods does not adequately meet the brain’s nutritional requirements and is a proven risk factor for the subsequent emergence of mental disorders in both adults and children. Given the strength of the data supporting the role of optimal nutrition for good mental health, psychiatrists are well positioned to introduce their patients to the topic of diet for mental health and the possible benefit of nutrient supplements for psychiatric conditions. 

From historic USPSTF draft screening recommendations to the need for novel treatments for bipolar depression, here are highlights from the week in Psychiatric Times.

The Week in Review: September 19-23

 covered a wide variety of psychiatric issues and industry updates, from important suicide prevention tips to new insights into ketamine response. Here are some highlights from the week.

Study Explores Effects of Experimenter Sex on Ketamine Response

Does a health care provider’s sex impact how well active agents perform? The answer appears to be a “yes,” according to a new study that examined the antidepressant response to ketamine and its bioactive metabolite (

)-hydroxynorketamine when the drug was administered to mice by men compared to women. 

Suicide Prevention Month Tips and Insights

September is National Suicide Prevention Month. In this Mental Health Minute, Susan J. Noonan, MD, MPH, of McLean Hospital and Massachusetts General Hospital shares the risk factors and warning signs of suicide that clinicians must know. 

A traumatic brain injury (TBI) occurs when brain function is altered due to an external blow to the head or body. National surveillance data indicates there are approximately 3 million new cases of TBI each year in the United States, and that the incidence of TBI has been increasing since 1995. Rates of TBI are increasing in all age groups, but particularly for adults over the age of 65, primarily due to falls. According to some estimates, mild traumatic brain injury (mTBI), or concussion, accounts for as many as 75% to 90% of all traumatic brain injuries. 

NDA for Long-Acting Injectable for Schizophrenia and Bipolar I Accepted

The US Food and Drug Administration (FDA) has accepted the New Drug Application (NDA) for aripiprazole 2-month, ready-to-use, long-acting injectable, a medication administered for the treatment of schizophrenia in adults and for maintenance monotherapy treatment of bipolar I disorder in adults. It is intended for dosing every 2 months via intramuscular injection in the gluteal muscle. 

From ketamine response to differences between mTBI and concussion, here are highlights from the week in Psychiatric Times.

The Week in Review: September 12-16

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