An Impressive Year: Looking Back on Our 40th Anniversary

FROM THE EDITOR

“This is an impressive, informative, timely, and comprehensive publication for psychiatry.” These were my thoughts after reviewing all the 2025 issues of Psychiatric Times while preparing this editorial. Our 40th anniversary celebration has been a good one, and my favorite quote from all of the cover stories was from Psychiatric Times founder John L. Schwartz, MD, who stated in our January 2025 issue: “Even now, I get the Times in the mail, and as soon as I get it, I sit down and go through it and look at it and think, ‘Gee, that’s interesting.’”¹ Continuing Schwartz’s vision and mission brings great pride to all of us in the Psychiatric Times family, which has grown tremendously over the decades. Let’s take a stroll through the highlights and some of my favorite content from 2025!

Celebrating 40 Years: Looking Forward

Starting Psychiatric Times’ 40th year, Editorial Director Heidi Anne Duerr, MPH, wove a mosaic to frame the gestalt from interviews of the 6 editors in chief (EICs) through the publication’s tenure to date.¹ I began reading Psychiatric Times when the publication began in 1985, during my third year of medical school rotation in psychiatry, and immediately became enamored by it. Reading the perspectives and reflections of the EICs, it was heartening to see the threads of foundational values, a patient-centric focus, the essentiality of lifelong learning, and an eagle-eyed focus on the biopsychosocial-spiritual elements necessary for quality psychiatric treatment that have informed Psychiatric Times. Despite the ever-emerging challenges in the field of medicine, and more so in psychiatry, Psychiatric Times has served as a beacon of light, reminding us of the exciting and dynamic nature of our field, with continued challenges and progress on virtually all fronts.

Brain Trust: Conversations in Psychopharmacology

We are delighted to have debuted our new monthly video series hosted by expert psychopharmacologist Joseph F. Goldberg, MD, in August. These videos are roughly 30-minute casual conversations with thought leaders on topics prescient to psychiatry. Following the July 21 meeting of the FDA expert panel covering selective serotonin reuptake inhibitors and pregnancy, which was immediately fraught as misleading and highly controversial, Goldberg interviewed Marlene P. Freeman, MD.² Freeman, among other titles, serves as the associate director of the Center for Women’s Mental Health at Massachusetts General Hospital. Their fact-filled conversation was a welcome academic exchange following the dysfunction of the FDA’s panel. This exciting monthly series should satisfy any psychiatric provider ready for a deep dive into timely topics and controversies.

Deprescribing

Several articles this year explored the topic of deprescribing psychiatric medications in patients for a wide range of reasons. Considered a routine practice in many medical subspecialties, the term has been viewed as more loaded in psychiatry. On one end of the spectrum, prescribers can be reluctant to modify a patient's complex medication regimen out of concern that they may decompensate; on the other end of the spectrum, a societal movement critical of psychiatry advocates discontinuing all psychiatric drugs, often with little insight regarding the potentially devastating consequences to the patient. As is often the case, the consensus is the middle path, whereby continued assessment of a medication regimen is prudent, and if changes are made, they should be implemented 1 at a time and in a slow, incremental manner. In my opinion, at each psychiatric medication visit, 1 question should always be asked by the end of the appointment: Should I represcribe or deprescribe? At this year’s American Society of Clinical Psychopharmacology Annual Meeting in May, a Task Force Delphi Panel presented their initial findings on this important topic.³

Glucagon-Like Peptide-1 Receptor Agonists

For the past several years, I have been meaning to do a deep dive into understanding the history and mechanism of action of the glucagon-like peptide-1 receptor agonists (GLP-1 RAs). This year, I had the privilege and pleasure of fulfilling this goal, thanks to the education I received on 3 fronts from my friend and colleague, Roger S. McIntyre, MD, FRCPC. McIntyre is a lifelong student of understanding human metabolic function in the brain and the body, as well as how this interfaces with psychiatric disorders. At the American Psychiatric Association Annual Meeting in May, I interviewed McIntyre for our live video series, Talking With Titans, which provided me with a historical overview of this important topic.⁴ McIntyre graciously agreed to write our July cover story, entitled “Transformation 2.0: The GLP-1 RAs as Psychiatric Medications?”⁵ And finally, in September, we featured McIntyre conversing with Goldberg about GLP-1 RAs in a video for our new series, Brain Trust: Conversations in Psychopharmacology.⁶

It is thanks to the Gila monster, a venomous lizard native to the Southwestern United States and Northwestern Mexico, that medical researchers developed the novel medication class of GLP-1 RAs, which has revolutionized the treatment of type 2 diabetes mellitus, obesity, and cardiovascular disease. McIntyre explained our evolving understanding of the central beneficial effects of GLP-1 RAs, which hypothetically include increasing neurogenesis and neuroplasticity, reducing inflammation and oxidative stress, and reducing the accumulation of amyloid-β plaques and the formation of tau neurofibrillary tangles. Currently, GLP-1 RAs are being prescribed to mitigate weight gain resulting from many psychiatric drugs. The future is hopeful with current clinical trials investigating the potential role of GLP-1 RAs in a range of psychiatric, neurological, and substance use disorders.

Schizophrenia: A Huge Unmet Need

Unsurprisingly, a frequent topic percolating throughout all the various platforms of Psychiatric Times is the unmet needs in arguably our most challenging disorder: schizophrenia. Described as both a neurodevelopmental and a neurodegenerative disorder, schizophrenia has an estimated prevalence in the United States of 0.7%. Over the past century, a tremendous amount of research has and continues to advance our understanding of this often-disabling disorder, with incremental gains and serious setbacks. Ultimately, it is a complicated disorder with likely thousands of variables that can contribute to, or protect from the emergence of, the feared “first psychotic episode,” which often, but not always, marks the beginning of this lifelong disorder.

In 2024, the first non–dopamine-2 receptor antagonist medication to treat schizophrenia, xanomeline/trospium chloride (Cobenfy), was FDA approved⁷ and has provided a long-overdue new mechanism of action that we are continuing to learn from. Additionally, maximizing treatment outcomes through improved access, earlier diagnosis, alliance building, psychosocial support, adherence, and adverse event mitigation/management has gained momentum, leading to several advances (Table). Psychiatric Times' October cover story reviews a recently published must-read article elucidating international guidelines for the algorithmic treatment of schizophrenia (INTEGRATE).⁸

However, we have a long way to go. Arguably, the biggest unmet needs are effective treatments for the negative and cognitive symptom subdomains that are the hallmark of schizophrenia and strongly contribute to the functional disability so commonly seen in this disorder.

Social Media and Artificial Intelligence

Human appetites are essential for us to survive as individuals and a species, but each appetite, in deficit or excess, can lead to a broad array of suffering. Obvious examples are food, material possessions, sex, feeling safe, love, and social connectedness. The tremendous progress in computer science and information technology during the 1980s and 1990s revolutionized access to information and social networking to a degree that no one could have predicted. By 2010, the dark side of this technology appetite was deeply integrated into human culture, and a plethora of books and documentaries have codified this phenomenon, including a significant increase in depression and anxiety, especially in adolescents and young adults. The psychiatry of today has borne witness to the psychological harm resulting from the initially benign-appearing algorithms of “like” and “share” that have fueled the well-documented increase in anxiety and depression in adolescents and young adults. Additionally, addiction to screen time has inadvertently created information silos that have served to divide populations rather than unite them. Finally, artificial intelligence has metastasized into every aspect of life, and we await the verdict on its ultimate impact on human society. We must work together to mitigate the harm and maintain the great benefits that these technologies provide.

Lorazepam (Ativan) Injectable Shortage

As if the daily demand of our clinical work is not stressful enough, every once in a while we get thrown an unexpected curveball. In the case of lorazepam (Ativan), one of the most utilized benzodiazepines in all of medicine, and especially in psychiatry, the same curveball just keeps coming. Shortages of lorazepam date back over 10 years, with waxing and waning shortages impacting different formulations at different times. Currently, we are in the middle of a significant shortage of injectable lorazepam, which has impacted routine health care delivery nationally.

With so many benzodiazepines available to us in the United States, one might ask why a shortage of lorazepam is such a big deal. Understanding the pharmacokinetics of lorazepam provides the answer. Lorazepam bypasses phase 1 biotransformation, thereby reducing drug-drug interactions and making it safer to use in patients with hepatic disease. It undergoes a single-step metabolic process called glucuronidation, which is a phase 2 biotransformation that involves conjugation with glucuronic acid to produce a single inactive metabolite that is primarily renally excreted. For the various conditions in which injectable lorazepam is used, it has an ideal half-life of approximately 15 hours. Clinicians also have significant experience using injectable lorazepam in hospital settings for a wide range of indications in which an injectable benzodiazepine is the preferred treatment. A concise editorial by Whitledge et al nicely reviews the recurrent challenge of benzodiazepine shortages and concludes⁹:

“Suppliers are ultimately responsible for addressing manufacturing issues, but regulatory and legislative action on transparency and quality metrics can facilitate this process.”

Concluding Thoughts

The 40th anniversary of Psychiatric Times was a great one! We remain committed to our mission of delivering timely, practice-oriented, evidence-based, and peer-reviewed information that has defined us. We are proud and appreciative of the generosity of our authors, whose eclectic experiences and wide-ranging credentials maintain the flow of articles to keep us all informed about our broad and complex profession of psychiatry. With excitement, we are jumping into the next 40 years and are proud and committed to continue as your primary source of all that is important in psychiatry. Thank you for your patronage!

References

1. Duerr HA. Celebrating 40 years: looking forward. Psychiatric Times. Jaunary 6, 2025. https://www.psychiatrictimes.com/view/celebrating-40-years-looking-forward

2. Goldberg JF, Freeman MP. Getting to the truth about SSRIs and pregnancy with Marlene Freeman, MD. Psychiatric Times. August 15, 2025. https://www.psychiatrictimes.com/view/getting-to-the-truth-about-ssris-and-pregnancy-with-marlene-freeman-md

3. Goldberg JF, Swartz HA, Mago R, et al. What is meant by the term "deprescribing," and does it belong in our lexicon? J Clin Psychiatry. 2025;86(4):25ac15936.

4. Miller JJ, McIntyre RS. Insulin is an antidepressant: a conversation with Roger McIntyre, MD, FRCPC. Psychiatric Times. May 22, 2025. https://www.psychiatrictimes.com/view/insulin-is-an-antidepressant-a-conversation-with-roger-mcintyre-md-frcpc

5. McIntyre RS. Transformation 2.0: the GLP-1 RAs as psychiatric medications? Psychiatric Times. July 7, 2025. https://www.psychiatrictimes.com/view/transformation-2-0-the-glp-1-ras-as-psychiatric-medications

6. Goldberg JF, McIntyre RS. A better understanding of GLP-1s: in conversation with Roger S. McIntyre, MD, FRCPC. Psychiatric Times. September 16, 2025. https://www.psychiatrictimes.com/view/a-better-understanding-of-glp-1s-in-conversation-with-roger-s-mcintyre-md-frcpc

7. FDA approves drug with new mechanism of action for treatment of schizophrenia. News release. September 26, 2024. Accessed November 11, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-drug-new-mechanism-action-treatment-schizophrenia

8. McCutcheon RA, Pillinger T, Varvari I, et al. INTEGRATE: international guidelines for the algorithmic treatment of schizophrenia. Lancet Psychiatry. 2025;12(5):384-394.

9. D Whitledge J, Fox ER, Mazer-Amirshahi M. Benzodiazepine shortages: a recurrent challenge in need of a solution. J Med Toxicol. 2023;19(1):4-6.