Takeaways From the 2025 Southern Florida Psychiatry Conference

CONFERENCE REPORTER

The inaugural 2025 Southern Florida Psychiatry Conference took place November 21-22, 2025, in West Palm Beach, Florida. Psychiatric Times was on the ground providing live coverage, updates, and exclusive interviews. Here are some highlights.

Vagus Nerve Stimulation for Treatment-Resistant Depression: A Durable Option

Up to 35% of patients with major depressive disorder do not respond to less than or equal to 4 treatment trials. This high global disease burden necessitates alternative neuromodulation treatment options, shared Todd Broder, MD. He suggests vagus nerve stimulation (VNS).

VNS is an implantable pulse generator placed in the chest, with a lead that wraps around the left cervical vagus nerve. It provides afferent modulation of limbic circuits, enhances neurotransmitters, and facilitates neuroplasticity with potential anti-inflammatory effects.^1,2

“If we can harness this and send impulses up the nerve, we can impact various circuitry in the brain,” said Broder.

In a 5-year, prospective, open-label, nonrandomized observational study, VNS demonstrated a significantly higher 5-year cumulative response rate (67.6% vs 40.9%) and a significantly higher remission rate (43.3% vs 25.7%) compared with standard of care.³

“Durability is a big problem in psychiatry. Is it a big deal if patients get well if we don’t keep them well?” asked Broder. “I think VNS’s claim to fame is its durability.”

The most common adverse effects include surgical risks (especially infection), changes in voice, and hoarseness. Some patients can develop chronic cough, noted Broder, but he believes adverse effects are often more related to the implantation surgery than to the treatment itself.

The implantation process, as described by Broder, looks like this:

• Titration protocol post implantation: The initial stimulation takes place 2 to 3 weeks after surgery to allow the incision to heal.
• Ramp-up begins: Increase the current by 0.25 mA per week, while monitoring for adverse effects. Most patients will reach a maintenance dose of 1.5 to 2.25 mA.
• Individualization: If the patient starts to demonstrate vocal cord sensitivity or sleep apnea, the current may need to be lowered or have a longer off time.
• Magnet mode: Some patients may benefit from on-demand stimulation if experiencing acute distress.

An audience member asked whether there were any instances in which a VNS device required replacement. Broder shared that there are instances when the device malfunctions and must be replaced, sometimes related to battery life, but he believes these are rare.

VNS is also more available than people think, said Broder, as it is covered by insurance. “We just don’t talk about it enough,” he said.

“VNS is invasive but shows significant long-term durability data and efficacy in treatment-resistant depression,” concluded Broder.

References

1. Dorr AE, Debonnel G. Effect of vagus nerve stimulation on serotonergic and noradrenergic transmission. J Pharmacol Exp Ther. 2006;318(2):890-898.

2. Kamel LY, Xiong W, Gott BM, et al. Vagus nerve stimulation: an update on a novel treatment for treatment-resistant depression. J Neurol Sci. 2022;434:120171.

3. Aaronson ST, Sears P, Ruvuna F, et al. A 5-year observational study of patients with treatment-resistant depression treated with vagus nerve stimulation or treatment as usual: comparison of response, remission, and suicidality. Am J Psychiatry. 2017;174(7):640-648.

What Psychiatrists Need to Know About the Pharmacologic Management of Stuttering

“We can help people who stutter with the tools we have today, but we hope to get better tools yet and discover the cures of tomorrow,” said Gerald A. Maguire, MD. “It is a very exciting time for neuropsychiatry...and when you leave this room today, you’ll know more about stuttering than 99% of clinicians.”

Stuttering is a neurodevelopmental disorder that affects 5% of all children and persists to affect over 1% of all adults. It is a condition that dates all the way back to ancient history (the Egyptians had a hieroglyphic for stuttering, shared Maguire). There are no approved therapies for this condition.

It has a high comorbidity with depression and social anxiety and can be associated with a significant negative impact on quality of life across several aspects (social, academic, occupational). It has been largely ignored by the medical and scientific communities, said Maguire: “We need to change that.”

As stuttering is not frequently listed or recognized in medical histories, it is often misunderstood. Comorbid conditions of stuttering are obsessive-compulsive disorder, attention-deficit/hyperactivity disorder (ADHD), and tic disorder, based on their neurologic underpinnings.

“Stuttering is not 1 condition like schizophrenia is not 1 condition, like major depressive disorder is not 1 condition,” emphasized Maguire. “Let’s begin to change this paradigm.”

Maguire explained the neural structures and neurologic pathways involved in stuttering. The medial system—through a part of the basal ganglia known as the striatum—helps control the natural timing and initiation of speech. The amygdala is activated in individuals who stutter and plays a central role in their reaction to stress. The lateral system can be activated through an external timer, such as singing, which bypasses the striatal circuit.¹

Stuttering has several etiologies,² but it has a strong genetic component involving multiple genes. Individuals who stutter may also have greater iron deposition, according to new research from Germany.

According to his research, dopamine agonists can improve stuttering, shared Maguire. Younger individuals appear to respond better.

Agents that may have an impact on stuttering include the following:

• Haloperidol
• Pimozide
• Risperidone
• Ecopipam
• Gemlapodect (NOE-105)

Off-label agents in stuttering include the following:

• Olanzapine
• Risperidone
• Aripiprazole

Notably, there is a lack of standardized approaches to stuttering. We need to improve the metrics to assess the severity of stuttering over time, per the FDA, said Maguire.

Maguire offers the Brief Stuttering Assessment, a validated metric to measure stuttering severity.

1. How much time while in conversation over the past week did you think about your stuttering?
2. How often did you change, substitute, or avoid words over the past week when you anticipated you might stutter?
3. To what extent did you feel physical tension while you were speaking over the past week?
4. How much energy did you expend over the past week focusing on how you were speaking rather than focusing on what you wanted to say?
5. Over the past week, how often did you avoid or want to avoid a conversation because of the fear of stuttering?
6. Over the past week, how would you rate your level of anxiety while stuttering?
7. How would you rate your speech overall over the past week?
8. Over the past week, how would you rate the impact of stuttering on your school or work?
9. Over the past week, how would you rate the impact of stuttering on your social life?
10. Over the past week, how would you rate the global impact of stuttering on your quality of life?

What does stuttering treatment look like today? Maguire suggests the following:

• Treating comorbidities such as social anxiety and ADHD.
• Intervening early with speech therapy or medications.
• Removing offending pharmacologic agents.
• Utilizing cognitive behavioral therapy when necessary.
• Targeting trauma, as patients who stutter have some elements of trauma, and targeting these could improve symptoms.

In order to improve outcomes, cross-specialty collaboration is essential. Neurology, neuroscience, and psychiatry need to collaborate with speech therapists to optimize outcomes, shared Maguire.

References

1. Maguire GA, Riley GD, Yu BP. A neurological basis of stuttering? Lancet Neurol. 2002;1(7):407.

2. SheikhBahaei S, Millwater M, Maguire GA. Stuttering as a spectrum disorder: a hypothesis. Curr Res Neurobiol. 2023:5:100116.

Timely, Psychiatric Care for New Mothers: Treatment of Postpartum Depression

“It is critical that we screen all patients,” said Patricia Junquera, MD. “I say all because some women feel a lot of pressure to be happy when they are pregnant.”
In their presentation on addressing postpartum depression (PPD), Junquera; Erin Crown, MHS, PA-C, Psych-CAQ; and Shulamit Bossewitch, NP, discussed how best to provide timely psychiatric care to new mothers.

Ideally, decisions about psychiatric medication use during and after pregnancy should be made before conception. The use of a single medication at a higher dose is preferred over multiple medications. Medications that are used should have fewer metabolites, higher protein binding, and fewer interactions with other medications.¹

Women with bipolar disorder have a significantly higher risk of postpartum hospitalization, a rate 20 to 30 times higher than that in the general population. Additionally, the postpartum period is a high-risk time for the first onset or relapse of bipolar disorder.² Mothers diagnosed with postpartum psychosis may actually have bipolar spectrum disorder, shared Junquera.

In the peripartum and postpartum periods, women face increased stigma around body image and weight. This weight stigma is associated with elevated depressive symptoms, stress, and unhealthy behaviors. Approximately 12.7% of women are diagnosed with major depressive disorder during pregnancy; body dissatisfaction is one of the leading causes. This poor body image can be an early predictor of PPD.³

In terms of evidence-based solutions, Junquera recommended the following:

• Promoting body appreciation and acceptance
• Identifying and mitigating weight stigma
• Implementing emotion regulation interventions like cognitive reappraisal
• Supporting a realistic postpartum narrative that values function over form

“Words do matter,” stressed Crown. Encouraging the healthiest choices possible is important for mothers, but it must be done without shaming, which can lead to increased guilt, fear, and anxiety in mothers.

Bossewitch highlighted nonpharmacologic interventions. These include the following:

• Psychotherapy, such as cognitive behavioral therapy, interpersonal therapy, and supportive counseling.
• Peer support and group therapy, which can help prevent mothers from feeling isolated.
• Exercise, as regular physical activity can improve mood by boosting endorphins.
• Mindfulness-based interventions, such as breathwork. Although there are only limited direct studies, anecdotal and clinical reports highlight benefits.
• Sleep, which can be especially difficult. Sleeping when the baby sleeps, establishing a nighttime routine, and avoiding screen time can help improve sleep hygiene for new mothers.
• Nutrition and supplements, as a balanced diet rich in ω-3 fatty acids, vitamins, and minerals can support mood regulation. Limiting caffeine and alcohol and staying hydrated can help stabilize energy and mood.
• Environmental interventions can maintain structure for new mothers. Building quiet time, reducing noise and clutter, and reminding her that she has interests outside of just the baby can help mothers feel normal.
• Engage with the partner and family. Educating partners and family encourages emotional and practical support.
• Bright light therapy can help stabilize mood, improve sleep, and reduce fatigue.
• Electroconvulsive therapy, while not FDA approved for PPD, is particularly effective for PPD with psychotic features or catatonia.
• Repetitive transcranial magnetic stimulation, also not FDA approved for PPD, shows some evidence of reducing PPD symptoms in small studies.

“There are many effective nondrug options for these moms. They often work best in combination. There is no one-size-fits-all [treatment] for PPD, as in all mental health,” said Bossewitch.

Crown shared more information on pharmacologic options. In terms of antidepressant selection for PPD, the typical antidepressants, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, are limited by slow onset of action and may not address pathophysiologic mechanisms in PPD. Suicide risk is important to screen for in this patient population.

Brexanolone is the first drug specifically approved for the treatment of PPD. It has a novel treatment approach as a neurosteroid and analogue of allopregnanolone. However, brexanolone was discontinued in 2025, and FDA approval was withdrawn.

Zuranolone is now the first and only oral medication FDA approved for the treatment of PPD in adults. It is a neuroactive steroid that acts on GABA_A receptors. For dosing, appropriate absorption requires 50 mg taken orally once daily alongside a high-fat meal in the evening. If the evening dose is missed, patients should take the next dose at the regular time the following evening. It is important not to take extra capsules on the same day to make up for the missed dose. There are no contraindications per the FDA label. However, new mothers should note impaired ability to drive or engage in other potentially hazardous activities. It should also not be used during pregnancy, only after.

“Now, I have a friend who was trained in forensic psychiatry, and he once taught me that we have a moral and legal responsibility to inform all of our patients about all of their treatment options, regardless of what we think about them, as long as they are appropriate treatment options, and to allow them an opportunity to make informed choices. So this piece of patient preference is particularly important to consider when we’re talking about [PPD],” shared Crown.

References

1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 87 November 2007: use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2007;110(5):1179-1198.

2. Masters GA, Brenckle L, Sankaran P, et al. Positive screening rates for bipolar disorder in pregnant and postpartum women and associated risk factors. Gen Hosp Psychiatry. 2019:61:53-59.

3. Riesco-González FJ, Antúnez-Calvente I, Vázquez-Lara JM, et al. Body image dissatisfaction as a risk factor for postpartum depression. Medicina (Kaunas). 2022;58(6):752.