Supporting a loved one with bipolar disorder can be emotionally hard, difficult, and often overwhelming. Families frequently find themselves managing unpredictable mood swings, ranging from manic highs to depressive lows, while attempting to preserve everyday stability. Understanding the disease and understanding how to respond successfully are critical not just for the individual diagnosed, but also for the overall well-being of the family system. Bipolar disorder is a chronic mental health disorder marked by severe mood swings, including mania, hypomania, and depression. These events have the potential to influence behavior, decision-making, sleep patterns, and interpersonal relationships. What is The Emotional Impact on Families Caring for someone with bipolar disorder can trigger a wide range of emotions, including concern, irritation, guilt, and even burnout. During severe episodes, family members may feel helpless and unsure of how to provide appropriate support. It is critical to recognize that these responses are valid. Supporting a loved one with a chronic illness necessitates patience, adaptability, and resilience. However, neglecting your own mental health during the process might result in caregiver weariness, limiting your ability to provide effective support. Common Early Warning Signs of Bipolar Disorder Each individual with bipolar disorder has a unique set of triggers. Stress, sleep disruption, substance abuse, and major life changes are all possible causes. Families that recognize these factors can help prevent crises from escalating. Typical early warning signals include: Sleep patterns change. Increased irritation or restlessness. Sudden fluctuations in energy or motivation Withdrawal from social interactions Recognizing these symptoms early enables for timely response, such as changing routines or seeking professional help. While support is necessary, it is also critical for families to set boundaries. Supporting someone with bipolar disorder should not imply accepting damaging conduct or ignoring your own needs. Boundaries promote a balanced dynamic in which assistance does not lead to over-dependence or emotional exhaustion. Are Early Symptoms Different in Men and Women? Early symptoms of bipolar disorder can change between men and women, but the basic diagnostic markers stay the same. Men are more likely to develop the illness younger, usually in late adolescence or early adulthood, and it begins with more obvious manic or hypomanic episodes. These may include increased energy, risk-taking behavior, impatience, and impulsivity, all of which can be mistaken as personality qualities rather than symptoms of a mood disorder . On the other hand, women are more likely to appear with depressive symptoms at first, such as chronic sorrow, exhaustion, changes in sleep and food, and feelings of guilt or worthlessness. Women are also more likely to experience rapid cycling patterns, in which mood episodes change more frequently, and they may be more sensitive to hormonal effects such as menstrual cycles, pregnancy, or menopause. Furthermore, co-occurring conditions like as anxiety disorders are more common in women and can disguise or overlap with early bipolar symptoms. These gender-related patterns are not absolute, but they are clinically significant because they affect how quickly the illness is diagnosed and treated. Hope and Long-term Stability Although bipolar disorder is a lifelong diagnosis, it can be managed with the correct combination of medication, support, and lifestyle changes. Many people have secure, prosperous lives thanks to their informed and supportive families. Progress may not always be linear, and setbacks are possible. Long-term stability, however, is within reach with patience, perseverance, and competent assistance. Supporting a loved one with bipolar disorder requires a careful balance of empathy, structure, and self-knowledge. Families play an important part in the rehabilitation process, but they must also realize their own limitations and seek help as needed.

Erectile dysfunction, premature ejaculation, and hypogonadism are common clinical diagnoses. Beyond established guidelines, however, there is a group of rare sexual disorders in men that are often overlooked or prematurely classified as psychogenic disorders. For affected individuals, this can lead to prolonged evaluation across multiple specialties and substantial impairment of their quality of life, intimate relationships, and mental health. A review published in Nature Reviews Urology summarizes the current evidence on seven of these conditions. Post-finasteride syndrome (PFS) Restless genital syndrome (ReGS) Postorgasmic illness syndrome (POIS) Post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction (PSSD) Hard flaccid syndrome (HFS) Sleep-related painful erections (SRPE) Post-retinoid sexual dysfunction (PRSD) The evidence is derived mainly from case series, observational studies, and pharmacovigilance data, with the absence of randomized trials. Therefore, the etiology, diagnosis, and management of these conditions remain incompletely defined. 1. Drug-Induced Syndromes Several of these conditions share a defining feature: Sexual symptoms persist even after discontinuation of the causative agent. These findings have direct implications for diagnosis and management. PFS PFS refers to persistent sexual, physical, and psychological symptoms after the discontinuation of 5-alpha reductase inhibitors, such as finasteride or dutasteride. Clinical features include reduced libido, erectile dysfunction, decreased genital sensitivity, and orgasmic dysfunction. Depressive symptoms, anxiety, and cognitive impairment may also occur. Proposed mechanisms include alterations in neuroactive steroids in the cerebrospinal fluid and plasma, changes in androgen receptor expression, structural changes in the corpus cavernosum observed in animal models, and genetic polymorphisms of androgen receptors. Alterations in the gut microbiota have also been reported. Pharmacovigilance data are prone to reporting and selection bias, and media coverage may influence how and when individuals seek care. This condition is diagnosed by exclusion. Persistent sexual dysfunction lasting for at least 3 months after discontinuation is a core criterion. Preexisting sexual or psychiatric conditions should be considered in the differential diagnosis. No evidence-based treatment exists, although individual case reports have described hormonal or symptom-directed approaches. Diagnosis should not be made in individuals with prior exposure to isotretinoin or SSRI. PSSD Adverse sexual effects associated with SSRI therapy are well recognized. PSSD describes persistent dysfunction after drug discontinuation. The reported symptoms include genital anesthesia, reduced libido, anorgasmia, erectile dysfunction, and altered ejaculation. Symptoms are not necessarily dose-dependent and may occur after brief exposures. In 2019, the European Medicines Agency recommended updating product information for SSRI and serotonin-norepinephrine reuptake inhibitors to include warnings about persistent sexual dysfunction after discontinuation. Proposed mechanisms include sustained serotonergic dysregulation, alterations in 5-HT receptors, and epigenetic changes. Serotonin inhibits sexual function, whereas dopamine plays a stimulatory role. Animal studies suggest that early SSRI exposure may have long-term effects on sexual behavior. Diagnosis requires a thorough medical history, with careful assessment of the temporal relationship to medication use and exclusion of depression-related sexual dysfunction. Treatment options remain limited and are based on individual cases, such as switching to dopaminergic antidepressants or vortioxetine. Although spontaneous improvement has been reported, recovery may take several years. PRSD Isotretinoin is widely used to treat severe acne vulgaris. Adverse sexual effects, particularly erectile dysfunction and loss of libido, have been reported as possible side effects, with symptoms persisting even after treatment discontinuation. In some individuals, symptoms appear or worsen after discontinuation of the medication. Animal studies demonstrated the effects of retinoids on the male reproductive system, including changes in testosterone levels and spermatogenesis. Hormonal alterations in humans may normalize after discontinuation. A serotonergic mechanism has been proposed but remains unproven. Diagnosis relies on clinical history and exclusion of other causes. No specific treatment exists, and management is symptom-directed. 2. Neuropathic and Functional Syndromes ReGS ReGS is characterized by persistent, unpleasurable genital dysesthesia, often described as a sensation of impending orgasm without sexual desire. Symptoms may worsen with sitting and are associated with significant psychological distress. Evidence suggests the involvement of small fiber neuropathy affecting the dorsal penile or pudendal nerves. Several dopaminergic mechanisms have been proposed. This condition is not primarily associated with preexisting psychiatric disorders. Treatment approaches include paroxetine, diazepam, pregabalin, transcutaneous electrical nerve stimulation, and pramipexole, with varying outcomes. Differential diagnoses include urologic, neurologic, and psychosomatic conditions. HFS HFS is characterized by a penis that remains in a firm, semi-rigid, or shriveled state, accompanied by sensory changes, cold sensation, pain, erectile dysfunction, and urinary symptoms. Preceding trauma, often during sexual activity or masturbation, is commonly reported in the literature. Proposed mechanisms include pudendal neuropathy, local hypoxia, inflammation, and pelvic floor muscle spasms. Psychological factors, such as anxiety and depression, may contribute to symptom persistence and to chronic pain. Imaging studies, such as Doppler ultrasonography or MRI, are often normal, which may lead to misdiagnosis as a psychogenic disorder. Management includes pelvic floor physiotherapy, psychological support, and symptom-directed pharmacotherapy, although the evidence remains limited. 3. Ejaculatory Syndromes POIS POIS is characterized by flu-like or allergy-like symptoms that occur within seconds to hours after ejaculation and persist for 2-7 days. Common features include fatigue, myalgia, difficulty in concentrating, rhinorrhea, and feverishness. An immune response to components of semen has been proposed, supported by positive skin testing using autologous semen in some cases. Other hypotheses include neuroendocrine dysregulation, cytokine changes, and an opioid-like withdrawal response after the orgasm. Diagnosis is based on a specific pattern of symptoms, their rapid onset relative to ejaculation, and their lasting persistence. Treatment approaches, such as desensitization therapy, nonsteroidal anti-inflammatory drugs, and silodosin, have been reported in individual case reports. There is currently no standardized therapy for this condition. SRPE SRPE is a rare form of parasomnia characterized by painful erections during REM sleep that awaken the individual. Daytime erections remain normal and painless. Episodes often last approximately 15 minutes and may result in sleep disruption, fatigue, and increased irritability. The probable causes include pelvic floor hypertonicity, autonomic dysregulation, and neurovascular factors. An ischemic mechanism similar to that of priapism is unlikely to occur. Polysomnography often results in reduced sleep efficiencies. Baclofen is the most studied treatment, with variable and often temporary benefits. Other pharmacologic options have been described on a case basis. However, invasive approaches are not recommended for this condition. Clinical Implications These conditions share several features, including low prevalence, absence of validated biomarkers, limited high-quality evidence, and substantial psychological burden. Many affected individuals reported that their symptoms were not taken seriously or were prematurely attributed to “psychogenic” causes without adequate evaluation. A structured sexual and medication history is essential, particularly for individuals exposed to 5-alpha reductase inhibitors, SSRI, or retinoids. Clinicians should document baseline sexual function and discuss potential adverse effects before initiating treatment. Persistent symptoms after discontinuation require careful differential diagnosis rather than a hasty referral to psychosomatic care. Multidisciplinary collaboration across urology, endocrinology, neurology, and psychosomatic medicine is required to address this issue. Recognizing these syndromes as potential organic conditions reflects the current evidence and supports more appropriate clinical management. Further prospective studies and coordinated registries are needed to better define the prevalence, risk factors, and treatment strategies of this condition. Clinicians who encounter these conditions in practice can contribute through systematic documentation and participation in research. Note: This article originally appeared on Medscape .

I wiped away tears and stared down at a deep gash in my arm as I typed. What I wrote would eventually become a blog post about my struggles with postpartum psychosis and suicidality. Even though I was in immense pain, I was hopeful that somehow my words might make someone else feel less alone. At least one in seven new parents develop postpartum depression and nearly 80% will suffer some form of depressive episode immediately following the birth of their child. Yet we continue to perpetuate the myth that new parenthood is universally the happiest time imaginable. For me, new parenthood was anything but. I nearly died. It was one of the hardest times of my life, and just when I was seeing light at the end of the tunnel, CPS came knocking at my door. In the saddest of ironies, the person who read my blog seven years ago and was responsible for Child Protective Services being called on me is currently writing publicly about the loss of her husband to suicide. She is telling the world that ultimately, it is a suicidal person’s responsibility to save themselves and that “personal accountability” is paramount for preventing suicide. She is a mental healthcare professional. She is also my sister-in-law. She caused tremendous harm to me and my family and is now causing further damage to anyone who is suicidal that might come across her writing. This is because what she is saying about her husband’s death is that it could have been prevented if only he had tried harder. Not only is this victim-blaming, but by leveraging her position as a mental health professional, she is perpetuating what has been dubbed “suicidism.” Alexandre Baril coined the term “suicidism” to describe the unique discrimination and marginalization suicidal people face. Suicidism intersects with ableism and sanism in important ways, insofar as most suicidal people are deemed “mentally unwell,” despite research indicating that while mental illness is a major risk factor, other precipitating causes, such as Adverse Childhood Experiences, psychological abuse, and marginalization play equally important roles. Suicidal persons are often criminalized as well. Saying someone “committed” suicide, for example, implies they perpetrated a crime, but against whom? Thieves victimize others but those who die by suicide are victims , not criminals. Thus, suicidologists have argued this terminology should not be used. Another important movement in suicide research is “ postvention .” Rather than focusing on prevention strategies, many of which Baril rightly notes are suicidist, we need to pay more attention to how we frame suicide after it’s happened. Postmortem speculations about what led a person to suicide tend to pathologize victims. The person was “out of their mind” or must have been mentally unwell to do such a thing. As many advocates have argued, this is harmful, because it assumes no person could rationally contemplate dying: no “sane” person chooses to die, their “mental illness” did that to them. These sorts of statements subtly imply a suicidal person is a patient rather than an agent, and thus is incapable of authorship over their actions. But perhaps the most harmful ‘help’ offered is insisting that suicidal people reach out and “save themselves” without also recognizing how unsafe it can be to do so. Often, when people reach out — by calling a hotline or confiding in someone — they are punished. Suicidologists have warned against the commonly touted ‘solutions’, such as the 988 hotline, and have noted the likelihood of police intervention when contacting these services. Imagine calling a hotline hoping it would save your life, only to find yourself involuntarily hospitalized and drugged. Or worse, the police show up, and if you happen to be in crisis while also not being white, your chances of being shot dead are alarmingly high. For those who are hospitalized against their consent, their chances of dying by suicide after being released actually increase. In short, many intervention strategies are violence disguised as help. The irony in my case is that I did reach out. I blogged and shared that blog with a close-knit group of supposedly trustworthy family and friends. During my pregnancy, I knew I would need significant support to remain mentally healthy, so I proactively put those supports in place. I was doing everything right, according to my sister-in-law’s recent recommendations, namely, “recognizing my vulnerabilities” and holding myself accountable for my well-being. I told the truth: that I wanted to die. Rather than reach back toward me to help, she set off a chain of events that resulted in CPS knocking on my door. My family was terrorized by this for nearly two months until it was finally settled that I posed no risk to my child. To this day, I have panic attacks and nightmares, and when the doorbell rings, I often shriek in fear or drop my coffee all over the floor. This is textbook post-traumatic stress. My suicidality did not begin with my first pregnancy. I can remember planning to kill myself at age 16 and taking active steps to do so. I’ve also struggled with anorexia most of my life, which I later learned is the most lethal mental illness. Nevertheless, I’ve always managed to find coping mechanisms that keep me alive and in a mostly healthy relationship with food. I do triathlons and open water marathons and generally focus on goals I can see myself fulfilling in the future. But it’s not an exaggeration to say that most of my life is spent finding ways not to think about killing myself. This battle with suicidality reared its ugly head after the birth of my first child. The birth was incredibly long and traumatic, 60 hours in total, and ended in an emergency C-section, which I had desperately tried to avoid. I knew being sliced open would only exacerbate my body issues. Then there was the sleep deprivation. Three days of labor that resulted in a thankfully incredibly healthy new baby boy, did not result in much-needed sleep, as any new parent will know. A few weeks after his birth, I found myself hallucinating, having intrusive thoughts, and cutting myself. Even when I had a chance to sleep, I didn’t. I would sit in the dark in the living room alone, while my baby slept in the bedroom with my partner. I would sit there with a drink in hand, rocking back and forth, trying everything I could to shake it: the thought that I would be better off dead. One night like this, I penned a letter to my child and began making my plans. My partner found me early the next morning at my computer, with blood on my arm from a deep wound I’d inflicted. He encouraged me very strongly to go see someone. Suffice it to say, I’m a hard sell when it comes to entrusting my mental well-being with mental health professionals. Mostly, it’s the lack of scientific rigor in psychology that makes me skeptical, but this is not the essay for that discussion. There are plenty of books and articles out there that delve into all that. I’ve always been ambivalent about assuming any labels, primarily because I’ve received so many. Depending on the doctor, it can range from OCD, to generalized anxiety disorder, to bipolar, and I have even been diagnosed by one therapist as autistic. A psychologist once told me to pick a diagnosis so she could properly code for insurance. In short, I have a healthy dose of skepticism regarding the mental healthcare profession. Nevertheless, I begrudgingly went to see a psychiatrist and even more begrudgingly took the meds she prescribed. Immediately, I was able to sleep. My hypervigilance abated. With help, I eventually weaned myself off the SSRI I was taking, and looking back, I am glad I did. Research consistently links SSRIs with all sorts of complications, not least of which is a risk for suicide. I say all this with the very important caveat: if these drugs help you, by all means, take them. I did. I am pretty sure I would not have survived without them. There is no one-size-fits-all model for mental health and there certainly is not a consensus about the effectiveness of most psychotropic drugs. So there I was, feeling like myself again, looking at my beautiful child. I had just successfully taken a trip with him to a friend’s wedding. My partner and I were amazed to find that our nine-week-old slept through the night for the first time, in a hotel, seven hours from our home. We didn’t question it. We slept. Glorious, back-to-back hours of sleep. We danced at the reception. The pictures are some of my favorite images of our family. Our son was dressed in a little conductor outfit since the wedding was in an old train station. We were all so happy. Life finally seemed like it was worth living again. I was reminiscing about this great weekend while nursing him upstairs in the bedroom and that’s when I heard the doorbell ring. A few minutes later, my partner was in the doorway telling me I had to get down there. What followed was a nightmare that I am forced to relive whenever it chooses to push itself to the forefront of my thoughts. If CPS has never invaded your life, you are fortunate. Apparently all suicidal people are doing illegal drugs, because I was forced to pee in a cup, in my own bathroom, in front of the caseworkers. They told me they had 45 days to substantiate or drop the charges against me. After they riffled through my belongings and demanded to see how much milk I had pumped for my baby, I asked them who called. They told me that information is confidential, but they said it was because of a blog. I knew someone very close to me had filed the report. As expected, the allegations were unsubstantiated. But DCFS took the full 45 days to officially close the case, even though all they had to do was call my psychiatrist and it would have been settled. I was at a conference two days before their deadline, chairing a session, and my phone was buzzing incessantly. I had to leave the room to take the call because I knew it was them. They were trying to get a hold of my psychiatrist, on a Friday afternoon, and wanted me to help. I was flabbergasted. “So you are telling me you are just now trying to interview her?” I asked, exasperatedly. We requested a copy of the report once the case was closed and we were appalled by the sheer incompetence of the Arkansas DCFS. The colleagues I had suggested as references were all listed on the report as having been interviewed. Their responses sounded bizarre to me, so I called each of them and found out that they were never actually interviewed. The report also listed an interview with someone else, a person neither my partner nor I knew, and she claimed she was worried about her “friend’s” blog. It turns out she was a social worker employed in the same office as my partner’s sister. This is how we found out that my sister-in-law had a hand in causing the terror of CPS invading our lives. There isn’t really a word to convey how angry we were. I made vague comments on social media about being betrayed by family and how enraged I was, but never mentioned anyone by name. I needed an outlet for my feelings. Rather than try to understand this, my partner’s family began a smear campaign against me. His mom jumped in to tell me I was unfairly judging their “loving” family. This is the same woman who, weeks prior, had written an angry post directed at whoever did this: “Just let me get my hands on you. Nothing meaner than an angry grandma. You had no grounds or sensibility. Shame on you — hope it comes right back at you!” When she found out it was her daughter, however, I became the enemy. She even had the gall to tell me that “CPS only investigates the most serious cases,” which is patently false — CPS investigates every call they receive — but also, this contradicted her earlier claim that there were no grounds for the call in the first place. I could write a novella about the gaslighting and moving of goalposts that transpired in an attempt to frame me as the unhinged bitch who deserved what happened to her, but there is no point. I will forever be the scapegoat in the story they tell themselves in an attempt to avoid the truth. But I know truth. And I have receipts. Today, I realize my anger was a perfectly normal reaction to completely abnormal and abusive treatment, but back then, I saw my partner suffering, and it broke my heart. His sister did apologize, but her story about how my blog landed in the hands of that social worker never sat well with us, and today, seeing what she writes, her apology seems as hollow as the platitudes she invokes. Nevertheless, I genuinely wanted to allow my children to have relationships with aunts and uncles and cousins. I am an adoptee, and the product of a closed adoption, so I was involuntarily estranged from my own genetic family for most of my life. It is not a situation I would inflict on anyone, unless it was the only way to ensure their safety. Thus, I tried to bury it, for my partner and my children. But dust swept under a rug doesn’t magically disappear. It’s just hidden temporarily. It’s now been eight months since my sister-in-law’s husband died by suicide. When I learned it happened, my heart broke, for her, for her kids, but most of all, for him. A fellow suicidal person who did not survive. It is a tragedy and I would like to think it was preventable, but I cannot say this with confidence. I know that when I was at the height of my postpartum crisis, I was not delusional or irrational. Hopeless, yes, but my mind was clear and I had a well-reasoned path to end my pain. I did not want to be rescued or saved. I wanted to stop hurting. I have no idea what my brother-in-law was feeling in those moments, days, or weeks leading up to his death. But I know he died alone, with no one holding his hand, with no proper goodbyes, and likely believing his family would be better off without him. My sister-in-law states that if her husband had taken early steps to prevent his own spiraling into despair, then maybe he would never have reached such a helpless state. This is victim-blaming. For one, he was on medication, so he was trying to do something about his mental health, but also, it’s not entirely clear that depression is what caused this. Their marriage was acrimonious, and by her own admission, they were headed for divorce. I don’t want to speculate beyond what I know to be true, but it’s not wild conjecture to assume that there were discussions of custody and other anxiety-inducing and depressing conversations. To say it was “his” depression that caused this overlooks the material conditions that might have contributed to his desire to die. I also cannot help but think about how he knew what happened to me when I reached out. He saw what his wife, a clinical psychologist, did when I told the truth about wanting to die. It’s not unreasonable to think he might not have felt safe reaching out. Nevertheless, she touts her credentials in the wake of his death, stating false or outdated claims, such as that “the majority of people who die by suicide never ever communicate their intentions.” In reality, many suicidal people communicate their intent before dying, with some studies suggesting as many as 68% of victims do so. Moreover, we have to consider that communicating intent can take many forms, and hence, many researchers note that there are likely far more cries for help than their studies indicate. Regardless, this misinformation she is sharing, coupled with her insistence that there is no way she could have seen this coming, is troubling, and frankly, harmful. Causing harm and refusing to be held accountable for it seems to be a theme in my partner’s immediate family. When I was at my lowest, not one of them checked in on me to see if I was managing okay. Knowing I had tried to kill myself, none of them said “I’m so glad you are still here, because you matter.” It’s easy to tell a dead person they mattered. Humans are great at writing eulogies. But we are shit at making people feel like they matter while they are alive. I’m not saying I think my brother-in-law was made to feel like he didn’t matter, but to leave that unexplored as a possibility is to do a disservice to him as a human being. He deserved to be heard. He still does. To publicly proclaim that suicidal persons are responsible for their own rescue is to completely disregard what real despair feels like. Perhaps this is why, as Baril and others argue, it’s time we stop centering non-suicidal persons in discussions of suicidality. If you have never known what it’s like to want to die and to actively seek that out in earnest, then maybe you don’t have much insight into what a person in that state ought to be doing. Maybe, if folks quit talking about experiences they have never lived, others who are actually living those things would have space to share their stories, without shame, and without the interventions of policing systems. Perhaps, ironically, lives could be saved if we started truly hearing the ones who say they don’t want to be saved. I didn’t want to be saved. I believed it was better to save my family from me . Whenever I’ve struggled with thoughts of ending my life, the ideas running through my mind are not “ help! ” or “ I wish someone would save me from myself! ” It’s mostly relief, knowing that if I go, my children will not have to suffer because of my incompetence as a mom. Where on earth would I get that idea, you ask? It didn’t just spring forth from a deep well within me, I assure you. The world is fucking rough, and it’s especially rough on new moms, as I began this essay discussing. Today, as I write, it is hard to imagine looking at my children and thinking they’d be better off without me, but I vividly remember having those feelings in the moment. And guess what? Struggling with thoughts of suicide doesn’t make you selfish, or delusional, or a bad parent. Ironically, the last lines of the letter I wrote to my son seven years ago read: “ I love you so much and want nothing but your happiness. Finally, I found a reason to be unselfish. Thank you for that. I love you, my little Bigfoot. Be kind. Be thoughtful. Be happy.” I am not sorry I blogged about being suicidal. I am sorry that those who should have supported me most chose instead to turn their backs on me and allow me and my family to suffer even more at the hands of the family-policing industrial complex. I am sorry they continue to perpetuate suicidist marginalization by speaking for a victim of suicide without his consent and by washing over the damage they have done and continue to do. Suicidal people exist, and yet we do not. This is because, in the minds of non-suicidal people, we are either dead, or we are one of them . Suicide has either claimed us, or we are “cured,” the thought of dying never again entering our mad minds. But we are here. We live in underground networks of secrecy, because we don’t want to be found out, lest we be subjected to suicidist violence. However, we must be heard. It is time to stop rendering living suicidal people voiceless, and to center them in discussions of what it’s like to experience suicidality. Proximity to it does not count, either. Much like adoption, unless you are adopted, you simply do not understand what it’s like to be adopted. Suicide rates have not declined over the last decade. In fact, they are on the rise among various demographics. All the different approaches to prevention, from the biological and social models, to the social justice approach, suffer from a common problem: silencing suicidal people. Thus, suicidism prevails. Suicide prevention regimes are steeped in it because people who have no lived experience with suicidality talk over those of us who do. I hope, for my brother-in-law’s sake, and for all others out there, both living and deceased, who have experienced suicidality, that the mic gets passed one day soon. You deserve to speak. But more importantly, you deserve to be listened to with care. *** Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own. *** Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site. Related Article: Suicide Prevention Suicide Prevention Must Expand Beyond Crisis Intervention

National Suicide Prevention Month is upon us again. This month represents hope: hope as we create more awareness around suicide; hope found in the resources available; and hope as we see the stigma around addressing suicide decrease. This month also can represent pain for those who have been touched by suicide. Whatever you are feeling this September, there are things you can do to create hope in your family and your community. Learn the warning signs and risk factors for suicide , or attend a training (many trainings are now offered online) to learn how to intervene and refer if someone is considering suicide, and help spread the word about the 988 Suicide & Crisis Lifeline . SAMHSA is committed to suicide prevention year-round. Our commitment is evident in our leadership, our funding opportunities, and our partnerships. Many of our funding opportunities help address groups that are disproportionately affected by suicide. American Indian and Tribal Communities : American Indian and Alaska Natives (AI/AN) experience disproportionately high rates of suicide. According to the Centers for Disease Control and Prevention (CDC) 2022 Morbidity and Mortality Weekly Report (MMWR), from 2015-2020 , suicide rates among AI/AN individuals increased almost 20 percent. While provisional estimates of suicide rates among this population decreased in 2022, their suicide rates are still much higher than the national average. Incorporating culture as a protective factor has been shown to help AI/AN individuals, especially youth, have an increased sense of purpose and belonging and can reduce suicidal ideation. At SAMHSA, we have developed a program called Native Connections that supports a model of increasing community readiness to address suicide. Black Youth : Black youth have been experiencing rapidly increasing rates of suicide deaths and attempts. According to CDC data, suicide deaths of Black youth and young adults between the ages of 10-24 increased significantly from 2018-2021. Connecting Black youth with culturally supportive suicide prevention and mental health supports can help reduce suicidal ideation and attempts among Black youth. At SAMHSA, we’ve created a Black Youth Suicide Prevention Initiative to help develop strategies to support Black youth. To learn more about supporting this population, check out the HHS Report to Congress on African American Youth Suicide (PDF | 1.3 MB) . LGBTQ+ Youth : Youth who identify as lesbian, gay, bisexual, transgender, or queer/questioning are more than four times as likely to attempt suicide than their peers because of the stigma and mistreatment they experience in society.. LGBTQ+ youth who have even one supportive adult in their life (e.g., a parent, a coach, a teacher, mentor, friend’s parent, etc.) are 40% less likely to report a suicide attempt. You can check out the Suicide Prevention Resource Center’s (SPRC) newly released Mental Health and Suicide Prevention for LGBTQIA2S+ Youth Resource Guide as well as SAMHSA’s Family Counseling and Support for Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex+ Youth and their Families grant for more information. Older Adults : Data released by the CDC indicated a significant increase in suicide deaths among older adults aged 64 and over in 2022. Understanding challenges that older adults face — such as increased chances of developing a chronic illness, which can be connected to a sense of burdensomeness and perhaps suicidal thoughts and behaviors — can help create meaningful supports for this population. Screening for suicide risk among older adults is another strategy to identify older adults at risk for suicide. To learn more about supporting the mental health of older adults, SAMHSA’s E4 Center of Excellence for Behavioral Health Disparities in Aging can be helpful. Persons with Lived Experience : Whether you have had thoughts of suicide yourself, have loved or supported someone who has survived a suicide attempt, or lost someone to suicide, it is important to take extra care of yourself and to be mindful of your needs for support and self-care. Some of the ways you can do this are learning how to support someone considering suicide , browsing resources for suicide attempt survivors or suicide loss survivors , and taking care of your own mental health and well-being. The SPRC’s Lived Experience Advisory Committee is working to engage the field around integrating lived experience in suicide prevention activities. Persons with Substance Use Disorders : Substance use disorders (SUDs) are associated with significantly increased risk of suicide in the United States, especially among individuals experiencing multiple SUDs. Share facts on substance use and misuse and connect people in your social and professional communities to evidence-based prevention information and tools, such as: SAMHSA’s “Talk. They Hear You.” campaign, including its new mobile app , which helps parents and caregivers start conversations about substance misuse prevention; SAMHSA’s Student Assistance Program which provides schools and educator resources to help teachers, administrators and other school professionals play a role in preventing underage substance use and abuse; harm reduction ; and other SAMHSA resources on substance misuse and opioid overdose . We all play a role in suicide prevention. When you start a conversation with a loved one who may be struggling with thoughts of suicide and offer support and model self-care, you are providing hope to those who may need it most. If you are a part of one of the groups highlighted above or have a loved one who is, we encourage you to build from the momentum this month to incorporate additional support and learning opportunities in your community. Related Articles: - Suicide Prevention

The direct and indirect costs of schizophrenia cause a sizable societal burden. Key points Schizophrenia is a chronic disorder affecting over 1 percent of the U.S. population. The annual societal costs per affected individual range from about $111,000 to $126,000 annually. Twenty percent of these costs result from direct expenses like health care, housing, and disability benefits. Costs can be lowered by investing in research that will lead to prevention and better treatments. Schizophrenia is a severe, chronic, and disabling mental illness. It is characterized by “positive” symptoms such as hallucinations and delusions, and “negative” symptoms such as decreased motivation, difficulty with social relationships, and diminished ability to experience pleasure. Cognitive symptoms, including problems with attention, memory, and executive function, are also a hallmark of this disorder. These symptoms make it hard for people with the disorder to attend school, maintain employment, and otherwise lead productive lives. Over 3 million individuals in the United States, or about 1 percent of those between the ages of 18 and 64, have this disorder. An important paper published in JAMA Psychiatry by Holly Krasa and colleagues discusses the economic costs resulting from schizophrenia. The authors analyzed data from a variety of sources including the Medical Expenditure Panel Survey, a comprehensive set of annual surveys gathering health care information about the U.S. population. They examined direct medical and non-medical expenses incurred by individuals with schizophrenia for example, health care utilization, disability benefits, and supportive housing costs. They also investigated indirect costs such as unemployment, underemployment, lower quality of life, and caregiver expenses. Living Situations for Individuals with Schizophrenia The research team reported that approximately 68 percent of individuals with schizophrenia reside in independent households, and almost 19 percent live in supportive housing. Another 5 percent live in long-term care facilities. Almost 5 percent are incarcerated, and about 3 percent are unhoused. Societal Costs of Schizophrenia The investigators found that annual costs resulting from schizophrenia were $366.8 billion in 2024 dollars. The annual cost per person living with the illness was $119,436. Seventy-five billion dollars of that total cost resulted from direct expenses, while about $292 billion was from indirect expenses. About 41 percent of direct costs were related to healthcare expenditures, 40 percent to supportive housing costs and expenses related to homelessness, 13 percent to justice system expenses, and 6 percent to Social Security disability payments. The $292 billion in indirect costs included 18 percent from lost wages, 14 percent from diminished quality of life, 15 percent from decreased life expectancy, 34 percent from unpaid wages for caregiving, and 20 percent from costs associated with diminished caregiver health and out-of-pocket expenses. Costs varied depending on the state where a person resided. The state with the least expensive costs was Utah at $110,975 annually. Alaska was the most expensive at $126,225 annually. Reflections Schizophrenia is often diagnosed during adolescence and young adulthood. Although severity varies over time, it is usually chronic and impacts individuals and their caregivers over many decades. Early treatment may help alleviate some symptoms and lessen some of the associated costs. New and better treatments may decrease an individual’s symptoms and lower both direct and indirect costs. However, the most effective way to diminish suffering and lower associated costs is to elucidate the causes of this disorder and develop preventative strategies. Schizophrenia research is grossly underfunded, but investments in research offer the best chance of long-term success in alleviating patient and caregiver suffering and lowering societal costs. Note: This article originally appeared on Psychology Today .

Two years ago, US Surgeon General Vivek Murthy, MD, called for warning labels on social media platforms, citing concerns about the potential mental health risks associated with heavy use, especially among children, adolescents, and young adults. The debate has intensified as researchers investigate how heavy social media use affects brain development, mood, and cognition and whether patterns of heavy social media use resemble behavioral addictions. That scrutiny reached a turning point on March 25, when a Los Angeles jury found Meta and Google liable in a landmark case, concluding that the companies' platforms were negligently designed and contributed to a young user’s mental health harms. The verdict, which is reportedly the first of its kind, could shape thousands of similar lawsuits alleging that social media companies knowingly engineered addictive products. Why the Hype? Concerns about social media addiction have grown along with rising rates of anxiety, depression, and suicidal behavior among young people. Recent research suggests that it may not be total screen time that matters most but patterns of addictive use. For example, a large longitudinal cohort study that tracked more than 4000 US adolescents for 4 years found that about 31% developed increasing trajectories of addictive social media use beginning around age 11, and those with high or increasing addictive use had more than double the risk for suicidal behaviors or ideation compared with peers with low addictive use. However, baseline screen time alone did not predict mental health outcomes. Instead, behaviors associated with addiction such as compulsive checking or distress when unable to use social media were more strongly linked to adverse outcomes. “What matters clinically is that simply spending more time on screens at age 10 was not associated with worse suicide-related and mental health outcomes; it was the addictive use patterns that predicted risk,” Yunyu Xiao, PhD, assistant professor, Department of Psychiatry and Population Health Sciences, Weill Cornell Medicine/NewYork-Presbyterian, who led the study, told Medscape Medical News . Yet, in another large cohort study of adolescents, time spent on social media did seem to matter. Researchers found that spending more than 3 hours per day on social media was associated with an increased risk of reporting high levels of internalizing and externalizing problems, even after adjusting for mental health problems. A separate study showed that a 1-week social media “detox” intervention among young adults was associated with significant reductions in symptoms of depression, anxiety, and insomnia. How Does Social Media Use Affect the Developing Brain? Social media platforms are built around intermittent rewards likes, comments, notifications that activate the brain’s reward system. Research suggests that these cues stimulate dopamine release in neural circuits involved in motivation and reinforcement, similar to mechanisms seen in other behavioral addictions. “Social media activates the same reward pathway as drugs and alcohol, releasing dopamine in the nucleus accumbens and creating neural networks that constitute the habit loops that have us clicking, checking, scrolling, and swiping, far beyond what’s healthy or even what we want,” Anna Lembke, MD, professor of psychiatry and addiction medicine, Stanford University School of Medicine, California, and author of Dopamine Nation, told Medscape Medical News. At the cellular level, said Lembke, the youth brain is a “vulnerable brain because from age 5 to age 25, we’re cutting back on the neurons we’re not using and myelinating the neurons we use most often. “Hence, early exposure to addictive substances and behaviors fosters a neurological scaffolding built upon these unhealthy habit loops. The earlier a child is exposed to social media, the more likely they are to get addicted to social media.” Is It Really an Addiction? Despite growing concern, social media addiction is not currently recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). There is disagreement about whether problematic social media use constitutes a distinct addiction or whether it should be classified under broader categories such as internet addiction, behavioral addictions similar to gambling disorder, or compulsive digital media use. Some experts argue that many patterns of heavy use resemble behavioral addictions, with key features such as loss of control over use, continued use despite negative consequences, withdrawal-like symptoms (irritability when unable to access platforms), and increasing time spent using the platform. Others caution that labeling excessive use as “addiction” may oversimplify a complex behavioral phenomenon, noting that problematic social media use may reflect coping strategies or underlying conditions rather than true addiction. Lembke said she is “decidedly in the camp that views social media as addictive for some users, with behavior patterns that mirror those seen in other addictions.” She added that, in her view, what is often called social media addiction referred to more formally as “social media use disorder” probably will be incorporated into future diagnostic frameworks such as the DSM and ICD-11. She expects it would fall under substance-related and addictive disorders , alongside conditions like gambling or gaming disorder, and be defined using the same core criteria which she described as the “Four C’s” loss of control, compulsive use, craving, and continued use despite consequences with tolerance and withdrawal considered optional. “In other words,” said Lembke, “it makes the most sense to build on existing categories and definitions of addiction when talking about social media addiction. Although there may be some nuanced differences between social media addiction and say, internet gaming disorder, there are more similarities than differences.” Xiao said that whether it is ultimately classified as a standalone addiction or a subtype of behavioral addiction, the empirical evidence is clear. “These compulsive use patterns follow addiction-like trajectories; they are measurable, escalate over time in substantial subgroups, and are associated with significant mental health consequences,” he said. Can Social Media Be Positive? Despite concerns, social media can also offer meaningful benefits to young people. Studies have shown that online platforms can help adolescents maintain friendships and social support networks, provide access to mental health resources and peer communities, and help marginalized groups to find identity affirmation and social connection. However, experts agree that the relationship between social media use and mental health is complex and highly individualized, with both risks and benefits depending on patterns of use and personal vulnerabilities. For adolescents, open family discussions about online behavior and expectations can help establish healthy habits. Encouraging balanced, intentional social media use such as setting screen-free times during meals or before bedtime, for example; turning off nonessential notifications; prioritizing active engagement over passive scrolling; and paying attention to emotional responses to online interactions can also help keep social media use positive. How Do Clinicians Identify At-Risk Patients? Clinicians increasingly face questions from patients and parents about whether problematic social media use constitutes an addiction and how to recognize and treat it. “Clinicians need to screen patients for social media addiction the same way they would for any addiction; that is, ask patients what digital media platforms they use, how much and how often, and then ask about the Four C’s, tolerance, and withdrawal,” said Lembke. Several validated instruments may help clinicians assess problematic use. They include the Social Media Disorder (SMD) Scale, a nine-item scale that measures problematic social media use among adolescents. There is also the Bergen Social Media Addiction Scale (BSMAS), a self-report questionnaire designed to measure dependence on social media, as well as the Digital Media Overuse Scale (dMOS) which assesses broader patterns of problematic digital engagement. While these scales are not diagnostic, they can help identify patients who may benefit from behavioral interventions, Lembke noted. Xiao noted that children who initially show low or moderate levels of addictive social media use are not typically considered at risk. However, ongoing follow-up can help identify concerning trends, such as progression to more severe patterns of use over time. “Clinicians should consider repeated, longitudinal screening for addictive use patterns, not just a one-time snapshot, particularly during the transition into adolescence,” Xiao advised. Who Is at Greatest Risk? Females are more likely to have high or increasing addictive use of social media and mobile phones, while males are more likely to show high addictive use of video games. Critically, said Xiao, disparities extend beyond overall use. Youth who are Black or Hispanic, from lower-income or less-educated households, or who have unmarried parents were more likely to follow high addictive-use trajectories a pattern consistent with broader childhood developmental outcomes influenced by social determinants of health. “Factors like exposure to racism and adverse childhood experiences can make children from underserved communities more susceptible to these adverse outcomes,” Xiao added. Note: This article originally appeared on Medscape .

Key Takeaways Individuals with SSDs experience significant disability, compounded by treatment-resistant symptoms and physical health multimorbidity, leading to a premature mortality gap. Physical activity offers dual benefits for physical and mental health, improving cardiorespiratory fitness, muscular strength, and mental health outcomes in individuals with SSDs. Barriers to PA engagement include individual and environmental factors, but fostering autonomous motivation and integrating exercise into psychiatric care can enhance participation. Psychiatrists are encouraged to promote PA as an adjunctive treatment for SSDs, incorporating routine screening and advocating for equitable access to exercise programs. Individuals living with schizophrenia spectrum disorders (SSDs) experience significant disability, underpinned by functional impairment in almost every domain of life. Treatment resistance to first-line antipsychotic medications can be as high as 30%. Negative and cognitive symptoms typically respond poorly to medications and, together with positive symptoms, contribute to limited personal and functional recovery. These challenges are further compounded by physical health multimorbidity (co-occurrence of multiple, serious, largely preventable physical health conditions in parallel) that develops from a much younger age and leads to cumulative health risks and a premature mortality gap of approximately 15 to 20 years compared with the general population. Modifiable lifestyle risk factors such as low levels of moderate to vigorous physical activity (MVPA), low cardiorespiratory fitness, and high levels of sedentary behavior compound the cardiometabolic adverse effects of antipsychotic medications, contributing to high cardiometabolic risk. Emerging evidence also suggests that low muscular strength may be an independent risk factor for premature mortality. The cardiorespiratory fitness and muscular strength of individuals living with SSDs are comparable to those of individuals decades older in the general population and can be seen as signs of premature aging. Practically, this can result in difficulties with mobility and activities of daily living, further exacerbating global functional impairment. Physical activity (PA) is defined as “any bodily movement produced by skeletal muscles that results in energy expenditure.” PA may offer dual benefits for physical and mental health; in line with this, there is growing recognition of its potential to improve health outcomes among individuals with SSDs. Physical Health Although weight loss is the most commonly reported motivation for individuals with SSDs to engage in PA, PA alone has not consistently produced significant weight loss. A small number of studies have found that MVPA may contribute modestly to weight reduction; however, the most robust evidence for this outcome comes from multimodal lifestyle interventions (combinations of nutritional counseling, weight management programs, physical activity, health education, and motivational interviewing). Thus, we believe that lifestyle interventions should be offered from the onset of illness and antipsychotic treatment, tailored to both the individual and the illness, and integrated into routine psychiatric care. Cardiorespiratory fitness is a strong predictor of mortality, independent of adiposity or other risk factors. Thus, for individuals with SSDs, improving cardiorespiratory fitness may be a more achievable target than weight loss from PA alone. A large meta-review of patients with SSDs found PA can improve cardiorespiratory fitness, with the greatest improvements observed following interventions of at least moderately vigorous intensity, and when delivered by qualified exercise professionals, such as exercise physiologists and physiotherapists. Emerging research from a small number of studies suggests resistance training can improve muscular strength. Case Study 1 “Alan” is a 47-year-old single, unemployed man living with SSD who had an undergraduate degree in business and a pre-illness history of amateur competitive cycling. He was admitted to a residential psychiatric rehabilitation facility with remitted positive symptoms but a profound negative syndrome, lying in bed for 23 hours per day. His elderly mother provided all daily care for him. At the rehabilitation facility, Alan began to engage in a moderate-intensity whole-body resistance training program, 3 times per week under the supervision of an exercise physiologist, delivered onsite and integrated into usual care. Over 8 weeks, his lower and upper body strength gradually improved until he was able to start exercising independently, and he began biking to the store for his own groceries. In addition to the restoration of physical and daily functioning, he described a significant improvement in self-confidence: “It was very helpful to my physical health and my core strength that I use just for getting around every day, and I think it did help in some small way to my emotional state; I feel like I’ve done something, or that I’m capable of doing something…[with] confidence in myself.” Mental Health and Functioning There has been consistent evidence of the benefits of PA for individuals with SSDs on mental health outcomes, including negative and cognitive symptoms, global functioning, and quality of life. The findings relating to negative and cognitive symptoms are particularly relevant, as they show a promising impact on outcomes that do not respond well to medications, thus highlighting the role of PA as an important augmentation strategy for mental health. Most of the current evidence is derived from aerobic studies, with greater benefits when intensity is at least moderate. However, yoga has been found to have some promising benefits for positive and negative symptoms, although a greater number of high-quality trials in a broader range of settings are required to make definitive recommendations. Case Study 2 “Brandon” is a 24-year-old single man with treatment-resistant schizophrenia with a partial response to clozapine. Despite assertive augmentation of the clozapine with other medications, electroconvulsive therapy, and cognitive behavior therapy for psychosis, Brandon continued to present with persistent distressing auditory hallucinations. After Brandon started engaging in aerobic MVPA 3 times per week, supervised by an exercise physiologist, he reported acute improvements in mood, a significant reduction in the auditory hallucinations for several hours after a session, and an increase in overall quality of life. Over time, sessions were increased to 5 days per week, but he struggled to continue with PA without supervision. Support workers were sought, and he was able to continue the PA therapy in the community in the longer term. “On the days that I do training, I’m in a good mood all day; even the voices, they don’t really bother me, I can ignore them,” he said. Physical Activity Type In terms of type, aerobic exercise has been the most widely studied; however, preference for exercise engagement is vital. Evidence from systematic reviews demonstrates benefits from a range of PA types, including sports, resistance training, yoga, walking, and high-intensity interval training in individuals with SSDs. Encouraging individuals with SSDs to engage in the type of PA they enjoy and are most likely to sustain engagement is important. How Much Physical Activity? The World Health Organization (WHO) recommends at least 150 minutes of MVPA per week for general health benefits. For patients with SSDs, even small amounts of PA (ie, less than 150 minutes of MVPA) may confer benefits and are better than none. Achieving WHO guideline levels may be challenging and potentially discouraging for individuals who have been recently inactive. Recent work has highlighted the value of promoting open goals (eg, nonspecific, exploratory, graded outcomes) for those who find behavior change difficult. Hence, in the initial phase of PA adoption, encouraging people for example, to “see how many steps you can do today” may be preferable to setting specific targets that may feel unattainable. Implementation in the Real World While the feasibility of PA interventions evaluated in structured research trials is comparable with psychological therapies and medications, sustaining engagement for PA in the real world can be challenging for individuals with SSDs. Numerous individual factors (eg, obesity, pain, negative symptoms, low support) and environmental factors (eg, cost, stigma, access, opportunity) can be barriers to participation. Neurobiologically mediated impairments in reward processing also underpin motivational deficits for PA one of the most commonly cited barriers to PA in this population. Autonomous motivation for PA has been associated with greater engagement in patients with SSDs and should be actively fostered. For example, this may mean supporting intrinsic reasons, such as “I do physical activity for fun” or because “I personally value the benefits,” rather than more external types of motivation, such as “I need to do physical activity to please others” or “because I feel guilty.” According to self-determination theory, the necessary conditions for autonomous motivation are relatedness, autonomy, and competence. In addition to choice of PA type or intensity where resources permit, providing options for the format (ie, individual or group) is also optimal. Mobilizing emotional and practical support is vital and may include input from mental health clinicians, family, carers, and nonclinical or peer supports. At a systems level, structural changes in mental health service delivery such as enhancing access to and integration of exercise programs and gyms into mental health services, as well as incorporating exercise professionals into multidisciplinary teams have recently gained traction. Such models are likely to help translate the promising efficacy seen in clinical trials into real-life effectiveness. Adverse events from PA interventions appear to be low; however, routine screening can detect those who require medical assessments for suitability: Most patients with SSDs without specific risks can readily engage in light to moderate-intensity PA. In line with international guidelines, psychiatrists and mental health clinicians are encouraged to incorporate routine screening of PA into usual care, which can be done using simple self-report tools, such as the physical activity as a vital sign questionnaire, or an internationally validated self-report screening tool, the simple physical activity questionnaire. Psychiatrists can play an important role in the promotion of PA to individuals with SSDs by considering an “exercise is medicine” approach, and are well positioned to provide advice about health and behavior change. At a policy level, there is also a role for psychiatrists in advocacy for equitable access to services and qualified professionals to support the integration of PA interventions into psychiatric services . Acknowledgements We would like to thank the individuals living with SSDs who provided consent for the deidentified use of their clinical information and comments. Note: This article originally appeared on Psychiatric Times .

There is no clear evidence that acetaminophen use during pregnancy causes autism spectrum disorder or attention-deficit/hyperactivity disorder (ADHD) in children, a comprehensive review of existing research has concluded. The findings, drawn from nine systematic reviews covering 40 studies, suggested that any apparent association observed in earlier research may be explained by shared genetic and environmental factors within families rather than by the analgesic itself. “Given that alternative classes of drugs for relief of pain and fever, such as nonsteroidal anti- inflammatory drugs, are known to adversely affect the fetal vascular system and can cause complications such as oligohydramnios and premature closure of the ductus arteriosus, and considering the harmful effects of pyrexia on pregnancy, women should be advised to take paracetamol when needed to treat pain and pyrexia in pregnancy,” the investigators, led by Jameela Sheikh, MBChB, with University of Liverpool, England, wrote. The study was published online on November 10 in the BMJ. Unfounded Concerns Acetaminophen, which is also known as paracetamol in the UK, remains the most commonly used pain and fever medication during pregnancy and is widely recommended by health agencies worldwide. Concerns over its use during pregnancy intensified in September 2025, when the US government officials publicly advised against in pregnant people, citing autism risks — a claim that sparked global anxiety among expectant mothers and parents of children with autism. In response, regulators in the UK, EU, and Australia reaffirmed that paracetamol remains safe for use in pregnancy. Previous systematic reviews and observational studies offered inconsistent findings on whether prenatal exposure to the analgesic increases the risk for autism or ADHD. Many lacked proper adjustment for confounding factors such as maternal health, genetics, and environmental influences all known to shape neurodevelopmental outcomes. To investigate further, the researchers conducted an umbrella review of nine systematic reviews of randomized trials and observational studies reporting maternal acetaminophen use during pregnancy and diagnoses of autism or ADHD in offspring. All nine reviews reported some degree of positive association between maternal paracetamol use and neurodevelopmental outcomes. However, the authors of seven reviews cautioned against inferring causation, citing a lack of data, bias in the primary studies, and unmeasured or inadequately controlled confounders. In the four reviews that included meta-analyses, pooled estimates for ADHD ranged from 1.2 to 1.4, with smaller but still positive associations for autism. Authors of two analyses cautioned, however, that bias and unmeasured confounding in the primary studies likely influenced these results. In the single review that incorporated two sibling-comparison studies accounting for shared familial and genetic factors by comparing exposed and unexposed children within the same families the observed associations weakened and approached a null effect. For autism, the hazard ratio for ever use of acetaminophen in pregnancy dropped from 1.05 in the general cohort to 0.98 among siblings. Likewise, for ADHD, it declined from 1.07 to 0.98 in one study and from 2.02 to 1.06 in the other. These findings suggest that “shared family factors, such as parental mental health, genetic predisposition, and socioenvironmental background, explain much of the observed risk,” the authors wrote. Methodologically, the overlap of primary studies included in the reviews was “very high” (23% corrected covered area), suggesting that many reviews drew on the same core studies, the investigators noted. Overall, confidence in the results was rated as “critically low” in seven of the reviews and “low” in the remaining two reviews. The investigators noted that, to date, no well-established biological mechanism in humans links prenatal exposure to acetaminophen with autism or ADHD in childhood . A review of animal studies likewise “found no consistent evidence that developmental exposure to paracetamol at therapeutic or nontoxic doses results in neurodevelopmental harm.” A Welcome, High-Quality Analysis Outside experts praised the quality of this review in a statement from the UK nonprofit Science Media Centre. “This paper is a welcome and careful assessment which rightly concludes the evidence does not clearly link use of paracetamol in pregnancy with autism of ADHD in the offspring,” said Gráinne McAlonan, MBBS, PhD, professor of translational neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, England. “The methods are robust and clearly laid out. The emphasis on the importance of family history in increasing the likelihood of outcomes like autism and ADHD is appropriate,” McAlonan added. “The high-quality methodology used in this new umbrella review confirms what experts around the globe have been saying,” added Dimitrios Siassakos, professor of obstetrics and gynecology, University College London, England. “The evidence that links paracetamol use in pregnancy to autism is tenuous and those studies which do report an association are confounded by the association of autism or ADHD with factors shared by families such as genetics, lifestyle etc.,” Siassakos said. Note: This article originally appeared on Medscape .

A drug that stimulates neuronal growth decreases PTSD symptoms. Key points Current treatments for PTSD have limited effectiveness. Some research suggests that MDMA (Ecstasy) together with psychotherapy may reduce PTSD symptoms. Methylone is produced by modifying the chemical structure of MDMA. Methylone, without psychotherapy, led to clinically meaningful improvement of PTSD symptoms. by Eugene Rubin MD, PhD and Charles Zorumski MD Posttraumatic stress disorder (PTSD) is a disabling illness. It follows exposure to significant traumas such as military violence, sexual abuse, child abuse, major traffic accidents, and other violent events. As outlined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), symptoms include intrusive symptoms associated with a traumatic event for example, recurrent, involuntary, and distressing memories, flashbacks, and recurrent distressing dreams; avoidance behaviors; negative changes in thinking and mood; and heightened arousal or reactivity for example, hypervigilance. Currently approved pharmacologic treatments for PTSD include two selective-serotonin reuptake inhibitors sertraline and paroxetine. These medications often have limited effectiveness. Various psychotherapies have also been utilized to treat PTSD, but they often do not result in major improvement. Prior research suggests that 3-4 methylenedioxymethamphetamine (MDMA, Ecstasy) together with psychotherapy may be helpful in alleviating symptoms of PTSD . However, issues with the design of MDMA clinical trials have led to concerns about the results. Recently, Amanda Jones and colleagues published the results of a clinical trial of methylone for treatment of PTSD in the journal JAMA Psychiatry . Methylone is a synthetic compound produced by modifying the chemical structure of MDMA. According to the authors, methylone “increases the release of serotonin, norepinephrine, and dopamine, leading to rapid and long-lasting effects on neuroplasticity in brain areas affected by PTSD, including increased neurotrophic support as well as direct effects on neurite outgrowth.” Study Design This study was a multicenter, double-blind, placebo-controlled, randomized clinical trial. It took place at 16 sites in the U.S., U.K., and Ireland between November 29, 2023, and February 19, 2025. Participants were 18 to 65 years old and met DSM-5 criteria for current PTSD with at least six months of symptoms. The investigators assessed symptoms with the Clinician-Administered PTSD Scales for DSM-5 (CAPS-5). This instrument evaluates twenty symptoms categorized into four clusters. Total scores range from 0 to 80, with higher scores indicating worse symptoms. To be enrolled in the trial, an individual had to have a CAPS-5 total score of at least 35 at screening and at least 28 at baseline. All participants had received previous treatment with pharmacotherapy, psychotherapy, or both at least once. Criteria for exclusion included a primary diagnosis of another DSM-5 disorder, current use of antidepressants or other treatment for PTSD (including psychotherapy), moderate or severe substance use disorder, active suicidal ideation, and use of a psychedelic drug within 12 months of screening. Individuals were randomized to one of two groups: those receiving methylone or placebo. To minimize increases in blood pressure, the dose of methylone was divided into an initial 150 mg dose followed by a 100 mg dose 90 minutes later. Similarly, people in the control group received split administration of placebo. Participants were observed for at least eight hours during the dosing session; however, no psychotherapy was administered. They received weekly dosing sessions for four weeks and then entered a 6-week follow-up period. Participants were evaluated two days after each dosing session and at regular intervals during the 6-week follow-up, up to day 64. The CAPS-5 total scores as well as symptom cluster scores were determined at each visit. The cluster scores measured intrusion, avoidance, negative alterations in cognitions and mood, and arousal and reactivity. Sixty-five individuals (average age 44 years; 60 percent women) participated in the study. The average duration of their PTSD symptoms was 19 years. Two-thirds had been treated with medications, and over 75 percent had received psychotherapy. Forty-five percent had experienced sexual trauma, 8 percent military-related trauma, and 47 percent other types of traumas, including traffic accidents, abuse, or other kinds of violence. Key Findings At the end of the study (day 64), the CAPS-5 total score improved by over 23 points in the methylone group and less than 14 points in the placebo group. This difference was both statistically and clinically significant. Improvement was noted by day 10. Improvement was also evident for each of the four CAPS-5 symptom clusters. A treatment response (defined as 50 percent or greater improvement in total scores) occurred in over 57 percent of those receiving methylone compared to 19 percent of those receiving placebo. Remission (defined as a total score of 11 or less) occurred in 32 percent of those in the methylone group versus 11.5 percent in the placebo group. At the end of the study, 61 percent of those receiving methylone no longer fulfilled criteria for PTSD versus 31 percent of those receiving placebo. Side effects of methylone were generally mild or moderate and transient, usually occurring on the day of dosing and resolving within a day. Common side effects included headache, decreased appetite, nausea, dizziness, increased blood pressure, dry mouth, and insomnia. About 53 percent correctly guessed they had received placebo. About 70 percent guessed correctly that they had received active drug. Thoughts Severe PTSD is disabling and often does not respond well to current treatments. The results of this study suggest that methylone may be effective in alleviating symptoms of this disorder. Importantly, the beneficial effects were still present six weeks after the last dose of medication. It is important to note that no psychotherapy was administered in conjunction with the drug. Study staff monitored participants during dosing days, but their roles were to be available in case of adverse effects and briefly answer questions. PTSD resulting from military-related trauma may be particularly treatment-resistant. In this study, only 8% of participants had experienced this type of trauma and therefore the results cannot address the effectiveness of methylone in this group of individuals. Methylone’s side effects resembled those of a mild stimulant. Seventy percent of the methylone group correctly guessed they received active medication, and more than 50 percent correctly identified being treated with placebo. This is at the upper end of the range of individuals in antidepressant trials who guessed correctly that they were in active treatment and is a limitation in drawing conclusions from clinical trials of this type. This clinical trial was a phase 2 study. Such studies evaluate a relatively small group of participants to test a drug’s efficacy and safety. To our understanding, the pharmaceutical company developing methylone is planning to launch a large, phase 3 study, which is critically important if the drug is to gain approval for clinical use because phase 3 studies often fail to reproduce the results of smaller, phase 2 studies. If methylone proves effective in larger studies, it is possible that an effective treatment for PTSD will become available within the next five years. Studies of the misuse/abuse potential of methylone will also be important going forward. Note: This article originally appeared on Psychology Today .

New research challenges the assumption that long-term cannabis use improves symptoms or functioning in post-traumatic stress disorder (PTSD). On the contrary, researchers found that abstaining from cannabis for 3 months was associated with significantly greater reductions in PTSD symptoms in adults with PTSD and comorbid cannabis use disorder (CUD). The data suggest that continued cannabis use could limit recovery in some domains — underscoring the need to routinely assess cannabis use during PTSD treatment and to educate patients on the potential consequences of continued use, the researchers said. The study, was published online February 18 in the Journal of Clinical Psychiatry . Helpful or Harmful? PTSD is a debilitating psychiatric condition marked by intrusive memories, avoidance, negative changes in mood and cognition, and hyperarousal. Many patients turn to cannabis to ease symptoms. In one recent study, roughly 28% of individuals with PTSD reported past-year cannabis use and 9% met criteria for CUD. Although some studies have suggested PTSD symptom reduction with cannabis or cannabinoid-based treatments, others have identified potential risks, such as disrupted fear-extinction learning and worse clinical and treatment outcomes. A recent systematic review found mixed evidence overall, with six studies suggesting benefits, five reporting worsening of symptoms, and three showing no significant impact of cannabis use in the setting of PTSD. Led by Ahmed Hassan, MD, University of Toronto, Ontario, the researchers recruited adults aged 18-65 years with confirmed PTSD and CUD through the Centre for Addiction and Mental Health in Toronto and asked them to discontinue cannabis for 12 weeks. Abstinence was defined as a urine 11-nor-9-carboxy-tetrahydrocannabinol level of 50 ng/mL or lower with no self-reported use, verified at multiple timepoints. Participants received escalating cash incentives for remaining abstinent at weeks 4, 8, and 12. Eleven (52%) of the 21 participants who completed the 12-week protocol achieved biochemically verified abstinence, while 10 did not. Those who achieved abstinence reported significantly greater reductions in total PTSD symptom severity and symptom count compared to those who did not. Total severity scores on the Clinician-Administered PTSD Scale for DSM-5 dropped from 36.2 at baseline to 10.5 at week 12 among abstainers vs 34.6 to 21.8 among those who did not maintain abstinence (P = .001). A similar pattern emerged for total symptom count, with abstinent participants dropping from 14.3 symptoms at baseline to 4.1 at week 12, compared to a decrease from 13.5 to 8.9 among non-abstainers. Notably, the investigators observed that individuals who remained abstinent showed greater reductions in several core symptom clusters, including avoidance, negative alterations in mood, cognition, and hyperarousal domains that are often cited as targets for cannabis-based self-medication among individuals with PTSD. “However, in this comorbid PTSD and CUD sample, sustained cannabis abstinence was associated with symptom improvement, thereby challenging assumptions about its clinical utility in this population,” they wrote. Interestingly, they added that there were no differential effects on re-experiencing symptoms such as flashbacks, intrusive memories, and nightmares. Both abstinent and non-abstinent participants reported similar improvements in re-experiencing, suggesting that factors unrelated to cannabis use may have contributed to symptom change or insufficient power, the authors said. The researchers called for larger randomized trials to “replicate and extend” these preliminary findings and to investigate mechanisms through which abstinence may relate to symptom changes in PTSD with CUD. The study had no commercial funding. The authors had no relevant disclosures. Note: This article originally appeared on Medscape .

TOPLINE: Digital media use in children and adolescents was associated with poorer developmental outcomes, with social media showing the most consistent adverse links to depression, behavioral problems, and substance use. Video gaming was linked to aggression and externalizing behaviors. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of longitudinal studies examining the associations between the use of digital media and health and developmental outcomes in individuals from infancy to 18 years of age. They included 153 studies representing 115 cohorts, with participants aged 2-19 years (mean age, 12.81 years; 53.8% girls) and a mean follow-up duration of 2.48 years. Exposure categories were balanced across social media, video games, and other forms of media, covering digital devices, messaging and communication platforms, digital learning, health and fitness applications, and general internet use. Outcomes comprised specific developmental subdomains, grouped into 16 social-emotional, three cognitive, and seven physical and motor subdomains, based on established child development frameworks. Meta-regressions examined moderators, including age at exposure (infancy, early childhood, preschool age, school age, early adolescence, and late adolescence), sex, year of first exposure (pre-2012 vs post-2012), and other variables. TAKEAWAY: Social media use was associated with depression (correlation coefficient [r], 0.09; 95% CI, 0.06-0.12), externalizing behaviors (r, 0.13; 95% CI, 0.07-0.19), internalizing behaviors (r, 0.14; 95% CI, 0.03-0.25), self-harm thoughts and behaviors (r, 0.11; 95% CI, 0.01-0.27), and problematic internet use (r, 0.21; 95% CI, 0.13-0.29), reflecting broader socioemotional difficulties. In the cognitive domain, social media use was linked to lower academic achievement (r, -0.07; 95% CI, -0.11 to -0.02; I², 34%), and in the physical domain, it was linked to substance use (r, 0.14; 95% CI, 0.08-0.19; I², 96%). Video gaming was associated with aggression (r, 0.16; 95% CI, 0.09-0.23) and externalizing behaviors (r, 0.17; 95% CI, 0.07-0.26), with high heterogeneity noted; however, it was also associated with better attention and executive functioning (r, 0.10; 95% CI, 0.03-0.16; I², 52%). Social media’s effect on depression was weaker in children aged 6-11 years than in early adolescents aged 12-15 years. Moreover, social media showed a stronger link to substance use after vs before 2012. IN PRACTICE: “Promoting healthier digital engagement will require coordinated efforts across ecological levels, including family practices (eg, co-viewing media), school-based digital literacy, regulatory oversight of industry, and attention to cultural values and the evolving platforms,” the authors wrote. SOURCE: The study was led by Samantha Teague, PhD, of the Department of Psychology, College of Healthcare Sciences at the James Cook University in Townsville, Australia. It was published online on March 9, 2026, in JAMA Pediatrics. LIMITATIONS: Causality could not be determined. The follow-up period was usually around 1 year, which limited understanding of long-term effects. Most studies focused mainly on social media and video gaming, with social-emotional outcomes being overrepresented compared with cognitive, physical, or motor domains. Early childhood exposures, trajectories into adulthood, and objective measures of exposure were not well covered. DISCLOSURES: One author disclosed support from the Australian Government National Health and Medical Research Council Investigator Grant during the conduct of the study, and another author reported receiving an Investigator Grant from the Australian National Health and Medical Research Council and a Medical Research Future Fund grant. Note: This article originally appeared on Medscape .

A new expert consensus statement from the American Society of Clinical Psychopharmacology offered clinical guidance on when and whether to discontinue psychiatric medications. The statement, developed by a 45-member international task force, reached consensus on 44 of 50 recommendations addressing when deprescribing is warranted. Among the key points: clinicians should periodically reassess all medications, always verify adherence before concluding a drug isn’t working, and engage patients in shared decision-making about discontinuation. The recommendations address what authors said is a long-neglected aspect of psychopharmacology practice. “Prescribers in mental health are often taught how to start medicines but not how to end them, or how to recognize an endpoint,” lead author Joseph F. Goldberg, MD, MSc, clinical professor of psychiatry at the Icahn School of Medicine at Mount Sinai, New York City, told Medscape Medical News. The study was published online on February 25 in JAMA Network Open . Much-Needed Guidance Psychiatric training and research have historically focused on selecting, dosing, and combining medications, with far less attention paid to when and how to stop psychotropic drugs. That has left many patients on complex regimens without clear guidance on treatment duration or regular reassessments to determine whether a medication should be continued. The task force sought to address this disconnect by establishing principles for deciding whether and when to stop a medication safely, distinguishing from prior literature that focused mainly on the mechanics of tapering off a drug. “There’s been a lot in the popular media about the term deprescribing. It’s been seized by certain groups to mean inappropriateness of medicines in psychopharmacology the idea that medicines are hazardous and dangerous and shouldn’t be used,” Goldberg said. “We were very alarmed by the lay public messaging. We wanted to say some things for the professional record,” he added. For the project, panelists conducted a review of existing literature and developed and completed a Delphi survey between January and May of 2025. Each survey item underwent multiple rounds of review, and consensus on each statement was defined as agreement or disagreement by 75% or more of the panelists. Key Recommendations Several recommendations achieved unanimous agreement. Panelists agreed that the usefulness of every psychotropic medication should be reassessed periodically at minimum, annually and that a risk-benefit analysis should be conducted before any deprescribing decision. There was also unanimity that when patients take multiple psychiatric medications , only one deprescribing change should be made at a time. “The most fundamental takeaway is to not passively re-prescribe and renew without periodically stopping to assess the regimen,” Goldberg noted. The task force strongly endorsed assessing medication adherence before drawing conclusions about efficacy. Given that approximately 50% of patients with chronic mental health conditions don’t adhere well to a treatment regimen, the panelists agreed that decisions about deprescribing for perceived lack of efficacy shouldn’t be made until the patient’s adherence has been carefully evaluated. “All clinicians in psychiatry understand and recognize that adherence is a tremendous problem it’s arguably the leading cause of relapse in mood disorders and in schizophrenia,” said Goldberg. “But I think most don’t know how to assess it.” Clear communication about the rationale for deprescribing achieved 98% consensus. As to benzodiazepine use among specific populations, the task force reached 100% agreement that it should be carefully reassessed as patients become older adults, and that medication lists in older patients should be routinely evaluated for cumulative anticholinergic burden. Areas of Disagreement Not all recommendations achieved consensus. When asked whether valproate should be routinely deprescribed in women of childbearing potential regardless of whether pregnancy is planned only 67% of panelists agreed, falling short of the 75% threshold. This was notable given valproate’s well documented teratogenic risks and a World Health Organization (WHO) statement advising against its use in that population. Goldberg acknowledged the finding was surprising. “You never say never,” he said. “There may be circumstances where the pros do outweigh the cons. Some people thought the WHO recommendation was taking it a bit far they’d go along with avoiding it in pregnant women or sexually active women, but in terms of all women of reproductive potential, it may be going a bit far.” The task force also did not reach consensus on replacing anticholinergic medications used to manage antipsychotic-induced movement disorders with alternatives such as amantadine (68% agreement). And panelists were divided on the common clinical practice of not restarting a medication that a patient previously overdosed on; only 46% agreed on that practice after two rounds of discussion. Among the most common concerns raised by panelists was the challenge of developing general guidance for clinical situations that are often patient specific. The lack of empirical studies on deprescribing also led panelists to suggest that some recommendations may be more intuitive than evidence based. “This supports the third-most common concern of panelists: because most serious psychiatric conditions are highly recurrent or chronic, true pharmacological endpoints are often elusive,” the authors wrote. “Panelists often eschewed all-or-nothing generalizations about deprescribing in the absence of more nuanced information about a given patient’s circumstances, clinical status, and preferences, instead advocating for a dialogue with patients as stakeholders in their own outcomes,” they added. An ‘Important Moment’ Experts have long acknowledged the lack of consensus in the field on whether or when to stop psychotropic medication. That makes the development of the statement “a very important moment in psychiatry,” said Allen Frances, MD, professor emeritus of psychiatry and behavioral sciences at Duke University School of Medicine, Durham, North Carolina, and chair of the task force that developed the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. “Clinicians are trained from the very first minute they begin psychiatric residency to prescribe medicines. They’re very poorly or not trained at all in stopping [deprescribing] them,” Frances told Medscape Medical News . “Any idiot can prescribe medicine. It takes real skill to deprescribe medicine.” The adherence problem is compounded by poor prescribing practices, he added. “Very often, people were never given an adequate dose of the first medicine. It’s never determined for sure whether it worked, and rather than raise the dose, another medicine is added,” said Frances, who was not part of the task force that developed the guidance. “The overall result is careless, reckless polypharmacy.” Authors of an accompanying editorial agreed. “The relative lack of attention to deprescribing has often left individuals without clear guidance about the anticipated duration of treatment, while saddling some with unnecessary adverse effects, drug interactions, and costs that might have been averted with more critical reappraisal of their medications at regular intervals,” corresponding author Jonathan E. Alpert, MD, PhD, Department of Psychiatry and Behavioral Sciences at the Albert Einstein College of Medicine, Montefiore Einstein, Bronx, New York, and colleagues wrote. “The apparent lack of priority accorded to deprescribing in psychiatric practice has also reinforced, in some quarters, mistrust of the field as being unduly biased toward long-term pharmacotherapy or overly complacent about refilling prescriptions beyond the point they are needed,” the editorialists wrote. The consensus statement brings the issue of stopping psychiatric medication to the foreground of clinical practice and study, marking “an important milestone in psychopharmacology,” the editorialists added. While many of the recommendations may not be new to long-time clinicians, the authors said that areas that achieved consensus are “worth integrating into best practices.” They also took note of topics that were met with disagreement, including that only two thirds of panelists agreed with routinely discontinuing valproate in women of childbearing potential, adding that “the use of valproate among women of childbearing potential is widely discouraged, including by the World Health Organization and by most reproductive psychiatrists due to definitive evidence for teratogenicity.” They also took particular note of the lack of consensus among task force members on the common practice of restarting a patient on a medication involved in a previous overdose was of particular note. The lack of consensus “likely reflects the recognition that this prevalent practice is based on clinical lore rather than research,” they wrote. Note: This article originally appeared on Medscape .