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As the name implies, it is about living your “one life” to its fullest potential without any psychological or psychiatric limitations. My practice is about the holistic model for mental health with medications, therapy, and alternatives. It is an integration of optimal aspects of Western medicines (avoiding potential side effects or complications) with various therapy modalities (CBT, DBT, Psychodynamic Psychotherapy, etc). One Life Psychiatry provides a unique blend of patient-driven treatment, from an educational perspective, empowering the patient to select a treatment modality that aligns with his/her values, whether it be medications (psychopharmacology), therapy, and alternatives. In addition, I will explore and find whole body alternatives (if you prefer). As a child psychiatrist, I was very attuned to over prescription of medicines that could have potentially long-term consequences, including addiction, among the least. I will integrate nutritional supplements, herbal/plant based meditation, meditation/mindfulness, and particularly important health habits such as sunlight (vitamin D3), etc. I will continue update these pages with diagnosis, treatments options (including pros and cons), alternatives, knowledge about the different types of therapy (particularly what conditions they are effective for, alternative remedies, self-help books, clips on philosophy. Anything that will give you hope for a first quality of life and a healthy transformation.

Does psychiatry’s future lean towards online practice? Telepsychiatry is a form of telemedicine that uses telephone or video conferencing tools to provide psychiatric services . As with in-person psychiatric treatment, telepsychiatry providers can evaluate and diagnose, provide therapy, and prescribe medication. On the one hand, I fully agree with Dr Varas that something is lost when we are not meeting in the same room with our patients. As I stated in my article, however, I think that telepsychiatry will increasingly be the way of the future, especially with younger generations of patients and therapists, along with continued advances in technology. Dr. Reddy believes that telepsych allows patients that are in remote areas of the country of state the access to quality doctors. People feel more comfortable taking about sensitive issues in their own environment. It eliminates the white coat syndrome. The no show rate is dramatically improved as it is much more flexible than commuting at least 30 minutes to 1 hour for an appointment, then seeing the doctor then being stuck in traffic. In this fast paced word, we don't have much time. The advantage of telepsych is we don't have to do a physical examination on patients, which is unlike many other fields who are transitioning into telehealth. The Way to Improve Mental Health in Missouri and Kansas City I see patients from 7 hours away which would have been impossible with the benefits of telepsychiatry. I can see patients all over Missouri and Kansas City which is a major advantage as they are often burned out by their local providers and want a clean state. Now a days it's common to psychiatrists to practice in multiple states to reach more patients. I hope to expand with more Midwest states in the near especially with the patient population i see which is highly vulnerable. Dr Vilash Reddy is the owner of One Life Psychiatry. As a child/adult/addiction psychiatrist, he has a holistic approach mental health, through the use of medication, therapy, and alternative remedies. His main focus he believes is vitally important is to educate and empower patients that are struggling with mental illness. He places a strong emphasis on understanding the patient way before prescribing random medicines which why he often the 2nd, 3rd, etc opinion.

I remember what it was like to be a medical student at a well-known cancer hospital where patients were dying of cancer. In life's final stages, it was not uncommon for physicians to increase the dose of morphine ; it alleviated pain, eased labored breathing, and yes, probably hastened the inevitable for patients who were in their final hours. In these scenarios, no one considered this euthanasia, and no one questioned whether it was the right thing to do. Fast-forward to 2023 when the act of a physician hastening a patient's death has become a controversial topic as criteria have expanded. Like all such topics in our polarized society, people aligned on sides, politics, and religion rush to the head of the room, legislation is proposed, and words take on new meanings. If you're in favor of legalization of clinician assistance in a patient's death, the term is medical assistance in dying (MAID). If you're opposed, the term is the more graphic physician-assisted suicide . The scenario is entirely different from what I saw in my medical school rotations decades ago. It's no longer an issue of easing the pain and discomfort of patients' final hours; the question now is whether, faced with a potentially terminal or progressively debilitating physical illness, a patient has the right to determine when, and how, their life will end, and the medical profession is given a role in this. In many places the bar has been further lowered to incorporate nonterminal conditions, and Belgium and the Netherlands now allow physician-facilitated suicide for psychiatric conditions, a practice that many find reprehensible. In these countries, patients may be provided with medications to ingest, but psychiatrists also administer lethal injections. While Belgium and the Netherlands were the first countries to legalize physician-facilitated death, it could be argued that Canada has embraced it with the most gusto; physician-assisted suicide has been legal there since 2016. Canada already has the largest number of physician-assisted deaths of any nation, with 10,064 in 2021 — an increase of 32% from 2020. The Canadian federal government is currently considering adding serious mental illness as an eligible category. If this law passes, the country will have the most liberal assisted-death policy in the world. The Canadian government planned to make serious mental illness an eligible category in March 2023, but in an eleventh-hour announcement, it deferred its decision until March 2024. In a press release, the government said that the 1-year extension would "provide additional time to prepare for the safe and consistent assessment and provision of MAID in all cases, including where the person's sole underlying medical condition is a mental illness. It will also allow time for the Government of Canada to fully consider the final report of the Special Joint Committee on MAID, tabled in Parliament on February 15, 2023." As a psychiatrist who treats patients with treatment-refractory conditions, I have watched people undergo trial after trial of medications while having psychotherapy, and sometimes transcranial magnetic stimulation or electroconvulsive therapy (ECT). The thing that is sustaining for patients is the hope that they will get better and go on to find meaning and purpose in life, even if it is not in the form they once envisioned. To offer the option of a death facilitated by the very person who is trying to get them better seems so counter to everything I have learned and contradicts our role as psychiatrists who work so hard to prevent suicide . Where is the line, one wonders, when the patient has not responded to two medications or 12? Must they have ECT before we consider helping them end their lives? Do we try for 6 months or 6 years? What about new research pointing to better medications or psychedelics that are not yet available? According to Canada's proposed legislation, the patient must be aware that treatment options exist, including facilitated suicide. Physician-assisted suicide for psychiatric conditions creates a conundrum for psychiatrists. As mental health professionals , we work to prevent suicide and view it as an act that is frequently fueled by depression. Those who are determined to die by their own hand often do. Depression distorts cognition and leads many patients to believe that they would be better off dead and that their loved ones would be better off without them. These cognitive distortions are part of their illness. So, how do we, as psychiatrists, move from a stance of preventing suicide — using measures such as involuntary treatment when necessary — to being the people who offer and facilitate death for our patients? I'll leave this for my Canadian colleagues to contemplate, as I live in a state where assisted suicide for any condition remains illegal. As Canada moves toward facilitating death for serious mental illness, we have to wonder whether racial or socioeconomic factors will play a role. Might those who are poor, who have less access to expensive treatment options and social support, be more likely to request facilitated death? And how do we determine whether patients with serious mental illness are competent to make such a decision or whether it is mental illness that is driving their perception of a future without hope? As psychiatrists, we often struggle to help our patients overcome the stigma associated with treatments for mental illness. Still, patients often refuse potentially helpful treatments because they worry about the consequences of getting care. These include career repercussions and the disapproval of others. When this legislation is finally passed, will our Canadian colleagues offer it as an option when their patient refuses lithium or antipsychotics, inpatient care or ECT?

Mental health is one of the most important aspects of overall wellness, but it is frequently overlooked. Many people believe that psychiatry is only for people suffering from severe mental illnesses, but it can benefit anyone looking to improve their quality of life. Whether you are suffering from anxiety, depression, ADHD , bipolar disorder, or simply feeling overwhelmed by life's challenges, psychiatry provides tools and strategies to help you regain balance, function better in daily activities, and improve your overall sense of well-being. For many, the term psychiatry conjures up images of hospitals, medications, and crisis care. While psychiatrists treat serious conditions, their responsibilities are much broader. Psychiatry is the branch of medicine that studies, diagnoses, and treats mental health issues . Psychiatrists are trained physicians who can evaluate both biological and psychological aspects of health. Unlike therapists and counselors, psychiatrists can prescribe medication as needed. However, modern psychiatry frequently combines medical treatment with therapy, lifestyle advice, and holistic approaches. The goal is not only to alleviate symptoms, but also to assist people in living more fulfilling, productive lives. How Psychiatry Enhances Daily Life One of the most significant barriers to seeking psychiatric treatment is stigma. Many people believe that seeing a psychiatrist indicates that they are weak or broken. Seeking psychiatric care demonstrates strength and self-awareness. Just as people see doctors for diabetes or high blood pressure, seeing a psychiatrist for mental health is a normal, healthy step toward wellness. In fact, early intervention frequently prevents symptoms from worsening and assists individuals in developing stronger coping skills before they interfere with daily life. Psychiatric care can improve daily life in several important ways. Improved Emotion Regulation Anxiety, depression, and mood disorders can all cause overwhelming emotions. Psychiatry provides effective tools for managing these emotions. With the right treatment, people frequently experience: Less irritability and emotional outbursts. An increased sense of calm. Increased resilience in stressful situations. This simplifies everyday interactions, whether at work, home, or school. Improved concentration and productivity. Mental health issues frequently impair concentration, motivation, and decision-making. For example, someone with untreated ADHD may struggle to complete tasks, whereas depression can deplete energy and motivation. Psychiatric treatment can include: Restore clarity of thought. Boost motivation. Improve your organizational skills. As a result, patients frequently report improved work performance, academic success, and personal goal achievement. Healthy Relationships Communication, empathy, and stability are essential components of relationships, which can be disrupted by mental health challenges. Psychiatry helps people reconnect with loved ones by treating mood swings, irritability, and social withdrawal. Many people realize they are More patient and understanding. Better at expressing needs. Less prone to conflict. This results in stronger, healthier relationships with family, friends, and partners. Improved Physical Health Mental and physical health are intricately linked. Stress, depression, and anxiety can all lead to high blood pressure, heart disease, sleep problems, and weakened immunity. When treating psychiatric symptoms , people frequently experience: Improved sleeping patterns. Healthier lifestyle options (exercise, diet, self-care). Lower risk of stress-related physical illness. In other words, a healthy mind promotes a healthy body. Increased sense of purpose and fulfillment. Many psychiatric conditions can make people feel hopeless or disconnected from reality. Treatment helps to restore a sense of purpose and motivation. Psychiatry helps patients rediscover joy in their daily activities, hobbies, and relationships, whether through therapy, medication, or lifestyle changes. When to Consider Seeing a Psychiatrist If you're wondering if psychiatry can help, ask yourself: Do I frequently feel overwhelmed, anxious, or sad? Do my mood swings interfere with my relationships or at work? Am I having trouble concentrating, sleeping, or staying motivated? Do I feel like I've lost interest in the things that used to make me happy? Have I tried other approaches, but the symptoms persist? If any of these apply to you, psychiatry may be able to help. Taking the first step may be difficult, but consulting a psychiatrist could be one of the most life-changing decisions you make. Just as we invest in physical health through regular check-ups and healthy habits, prioritizing mental health through psychiatry is critical for long-term wellbeing.

TOPLINE: Less than half of US adolescents with major depressive episode (MDE) received treatment for the condition, with Black, male, and rural participants having significantly lower odds of receiving specialist care than their peers, a new study showed. Additionally, insurance coverage strongly affected access to telehealth services. METHODOLOGY: Researchers analyzed data from the 2022 National Survey on Drug Use and Health, which was conducted in all 50 US states and the District of Columbia. The analysis included more than 2000 adolescents aged 12-17 years (71% girls, 54% White and 12% Black individuals, 58% from large urban areas) who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for MDE in the past year. Main outcomes included the use of various types of mental health services, such as treatment by a specialist clinician, prescription medication, and telehealth services . Disparities in the use of services were assessed while adjusting for rurality, race or ethnicity, sex, age, health insurance coverage, and poverty level. TAKEAWAY: Overall, 48% of participants received any mental health treatment; 39% received treatment by a specialist clinician, 25% received prescription medication, 31% used school-based services, and 35% used telehealth services. Rural adolescents had significantly lower odds of receiving specialist treatment (adjusted odds ratio [aOR], 0.6) or telehealth services (aOR, 0.6) than urban adolescents (P < .05 for both); participants with private insurance (aOR, 3.3) or public insurance (aOR, 3.4) were significantly more likely to use telehealth services than those with no insurance (P < .05 for both). Black adolescents had markedly lower odds of receiving any mental health treatment (aOR, 0.4), treatment by a specialist clinician (aOR, 0.4), and prescription medication (aOR, 0.3) than non-Hispanic White adolescents (P < .05 for all). Girls had higher odds than boys of receiving any mental health treatment (aOR, 1.6), treatment by a specialist clinician (aOR, 1.52), and prescription medication (aOR, 1.5) than boys (P < .05 for all). IN PRACTICE: “Our findings continue to illustrate the persisting inequity in mental health treatment among adolescents from marginalized groups,” the investigators wrote. “Policy and clinical initiatives should be informed by further research into how cultural and systemic factors influence the utilization of mental health services and help-seeking behaviors in race/ethnic minority populations,” they added. Note: This article originally appeared on Medscape .

Key Takeaways Cannabis use in older adults has increased significantly, with many seeking relief for pain, insomnia, and anxiety, despite limited geriatric-specific evidence. The regulatory environment for cannabis is inconsistent, with federal restrictions contrasting state-level legalization, complicating clinical guidance. Age-related pharmacokinetic changes heighten risks of cognitive decline and physical impairments, necessitating cautious cannabis use in older adults. Cannabis shows potential for managing dementia-related agitation, but evidence is mixed, requiring careful consideration of risks and benefits. Once relegated to young adults and college campuses, cannabis is now edging its way into retirement communities and geriatric clinics. This generation is increasingly lighting up or dropping tinctures for pain or anxiety relief, or a better night’s sleep. Cannabis use among adults 65 years and older has increased more than 10-fold over the past 2 decades, from just 0.4% in 2006 to 7% in 2023. Clinicians are now tasked with guiding cannabis use in older adults using evidence largely derived from younger populations, applied to products with inconsistent potency, and with minimal data specific to a vulnerable demographic. Research in this area has not kept pace with public enthusiasm, leaving psychiatrists with limited guidance on how to navigate cannabis use with their older patients. Metabolic shifts, polypharmacy, cognitive changes, and fall risk make cannabis use in this population even more complex. This article provides an overview for psychiatrists and mental health clinicians who are increasingly encountering patients older than 65 years using cannabis in ways that range from cautious to curious, and often without adequate clinical guidance. Cannabis 101 Older adults report turning to cannabis primarily for what they perceive as therapeutic reasons: pain, insomnia, anxiety, depression, and Parkinson disease symptoms. Although these indications reflect a growing interest in self- directed symptom management, it is important to recognize that much of the evidence s upporting cannabis for these conditions remains scant, particularly in geriatric cohorts. Cannabis use patterns in this age group are as diverse as the ailments. Some individuals are lifelong users, others return after decades-long hiatuses, and many are newcomers. New users, often motivated by health needs, prefer noninhaled methods including edibles, tinctures, or topicals, whereas consistent users are more likely to smoke or vape and engage in higher-frequency use. The Regulatory Landscape The current US regulatory environment for cannabis is a chaotic patchwork. At the federal level, cannabis remains a Schedule I substance, meaning it is classified as having no accepted medical use and a high potential for abuse. Yet over 40 states have legalized cannabis for medical use, and more than 20 have approved it for recreational use. Within this murky framework, only 3 cannabis-related medications have received US Food and Drug Administration (FDA) approval: Dronabinol (synthetic tetrahydrocannabinol [THC]; brand names Marinol and Syndros): Approved for anorexia in patients with AIDS, and for chemotherapy-related nausea and vomiting. Nabilone (synthetic cannabinoid similar to THC; brand name Cesamet): Approved for chemotherapy-induced nausea and vomiting. Cannabidiol (CBD; brand name Epidiolex): Approved for specific seizure disorders (Lennox-Gastaut and Dravet syndromes) and tuberous sclerosis complex. FDA-approved cannabinoid agents are tightly regulated and have well-characterized pharmacokinetic profiles, in stark contrast to the cannabis products accessed by older adults through dispensaries, which often exhibit significant variability in potency, purity, and accuracy of product labeling.8 That said, older patients often turn to dispensary products due to substantial monetary costs associated with off-label use of FDA-approved medications. Many obtain these products independently, without physician involvement, navigating a landscape of loosely regulated dispensaries with variable labeling standards. Pharmacokinetics Considerations THC and CBD are both highly lipophilic, subject to extensive hepatic metabolism (via CYP450 enzymes), and affected by the physiological changes that define aging: decreased hepatic and renal clearance, increased body fat, and altered receptor sensitivity. In older adults, these changes increase the volume of distribution and reduce clearance, potentially amplifying THC’s duration and intensity of effects, even at lower doses. When taken orally, THC undergoes significant first-pass metabolism to 11-OH-THC, a more psychoactive metabolite with greater blood-brain barrier penetration, which accounts for the stronger and longer- lasting effects of edibles compared with smoked forms that largely bypass this conversion. CBD, often touted as a gentler, nonpsychoactive compound, carries risk in this population as well. CBD inhibits CYP-2C19, CYP-3A4, CYP-2C9, and CYP-2D6, among other enzymes, raising the potential for pharmacokinetic interactions, particularly with antidepressants, benzodiazepines, opioids, blood thinners such as warfarin, and antiepileptics. Neuroprotective or Neurotoxic? In all age groups, cannabis is well known to acutely impair attention, memory, psychomotor function, and executive function, with dose-dependent effects. In terms of long-term effects, 2 large longitudinal studies found that heavy cannabis use was linked to modest declines in verbal memory by midlife. In the Dunedin cohort, long-term users showed broader cognitive decline including a 5.5-point drop in IQ and reduced hippocampal volume by age 45 whereas infrequent users did not, indicating that both frequency and duration of use influence cognitive outcomes. Short-term medical cannabis use in older adults appears relatively benign, with some studies even suggesting modest cognitive improvements likely secondary to symptom relief (eg, improved sleep or reduced pain). Long-term recreational use, however, has been linked to slower processing speed and reduced executive functioning, and more recent cannabis use is associated with poorer working memory. Findings from the Health and Retirement Study reinforce this: Older adults using cannabis more than once per week demonstrated deficits in attention and short-term memory. Encouragingly, some of these effects may improve with sustained abstinence. The bottom line is that cognitive effects likely depend on the age of onset, frequency, duration, and abstinence intervals. However, the threshold for concern is lower in older adults, especially those already experiencing mild cognitive decline. Risky Business: Injuries and Driving Cannabis use in older adults particularly formulations higher in THC can impair balance, reaction time, and coordination, increasing the risk of falls and other injuries. These impairments extend to driving, where cannabis use is associa ted with a 2-fold increase in the risk of serious or fatal motor vehicle crashes. In one study of older drivers, cannabis users were 4 times more likely to report driving under the influence of alcohol, compounding risk. Reflecting these dangers at the population level, cannabis-related emergency department visits among adults 65 years and older surged by more than 1800% between 2005 and 2019, with the highest rates seen in men, those aged 65 to 74 years, and individuals with multiple comorbidities. Notably, even older adults without significant health issues experienced increases, highlighting that cannabis-related harms are not limited to the medically vulnerable. Agitation in Dementia Agitation is one of the most distressing neuropsychiatric symptoms of dementia and often drives caregiver burnout, hospitalization, and long-term care placement. Current pharmacologic options, like antipsychotics, offer only modest benefit and carry serious risks, so it is no surprise that cannabis has attracted growing interest as a potential alternative. Several small randomized controlled trials have tested cannabinoids for agitation, with mixed results. Notably, studies using low doses of THC have largely been negative, whereas more recent trials employing higher doses such as synthetic THC or CBD/THC oil—have shown promising reductions in agitation. A large multicenter trial of dronabinol is under way and early results suggest meaningful reductions in agitation with good tolerability.28 Sedation remains the most common adverse effect, although it is often manageable with dose adjustment. Until larger, published trials provide clearer guidance, cannabinoids remain a cautiously intriguing option unlikely to replace first-line behavioral interventions, but potentially helpful when conventional strategies fall short. Concluding Thoughts: Between Green Rush and Gray Area Cannabis in older adults is here to stay. The wave of baby boomers aging into Medicare while embracing cannabis as medicine or pleasure will continue to grow. We clinicians must approach this topic with clinical curiosity, pharmacologic rigor, and humility. The evidence base remains underdeveloped, and the physiological nuances of aging demand caution. Until we have more robust data, the best we can offer is thoughtful, individualized guidance that weighs potential benefits against real and often underestimated risks. Note: This article originally appeared on Psychiatric Times .

Key points Rates of psychiatric disorders can vary considerably across time. A new study tracked the relative rates of various psychiatric disorders in youth from 2013 to 2021. Some diagnoses, such and anxiety and depression, became more common while others, like bipolar disorder, fell. What is behind these trends isn't exactly clear but it's important to investigate further. The rates of various psychiatric diagnoses as applied to children and adolescents can change quite a bit over time for various reasons. There is much debate about the increased prevalence of diagnoses such as autism and ADHD over the past 30 years or so. In the 1990s and early 2000s, there was also a dramatic and controversial increase in the number of youth being diagnosed with bipolar disorder in part due to a shift in how the disorder was conceptualized by mental health professionals. What have been some of the latest trends in diagnoses? There have been hints from different sources about these. Certainly there is the sense that depression and anxiety have been increasing. At the same time, there is also the impression that some “externalizing disorders,” characterized by aggression, breaking rules, and defiance may be decreasing for the current generation that seems more likely to spend time quietly in their room on their phone than pushing limits and defying rules. To get a better sense of recent trends, a team of researchers well known for examining different shifts in mental health behaviors and treatments examined millions of mental health records from youth all over the country who received services at publicly funded treatment services from the years 2013 to 2021. The main finding was that there were indeed some major changes in the rate of various diagnoses being applied across the study period, but the direction of these changes varied considerably from diagnosis to diagnosis. Perhaps the most striking change was that the percentage of bipolar disorder diagnoses dropped from 10% to 1.3% across the study period. Those externalizing disorders like oppositional defiant disorder (ODD) and conduct disorder also fell significantly. Going in the other direction were diagnoses related to mood and anxiety. The percentage of diagnoses related to anxiety conditions rose from 9.6% to 19.2%, while depressive and trauma-related disorders also increased, particularly for adolescents. The most common diagnosis assigned was ADHD at around 27% but, surprisingly, no major trends in either direction occurred. This study, unfortunately, was not equipped to evaluate why these trends were occurring, as there are many factors that could be contributing to these shifts including: True changes in the number of youth struggling with these conditions. Changes in the way diagnostic criteria are being applied and interpreted by mental health professionals. Change in the demographics of youth presenting to publicly-funded clinics versus other types of treatment facilities. For example, right when this study period began in 2013, a new version of the Diagnostic and Statistical Manual (DSM), which lists the official criteria for various mental health conditions, was published. One of the big changes to DSM-5 was the inclusion of a new diagnosis called Disruptive Mood Dysregulation Disorder (DMDD), which was intentionally created as an alternative to bipolar disorder for youth who presented more with chronic dysregulation rather than clear cycles of depression and mania. This new diagnosis could have been one of the reasons the rate of bipolar disorder dropped, although unfortunately the study didn’t track DMDD diagnoses. It is inevitable that some folks will interpret these fluctuations as evidence that the diagnoses aren’t “real” in the first place. In my view, this would be an inaccurate conclusion based on the data. At the same time, however, it is important not to get too swept up in the labels we apply imperfectly and focus on what meaningful changes are occurring and why. Perhaps, for example, it is true that youth really are feeling more stressed and less hopeful than they did in the past. Perhaps it is also true that youth are less inhibited about acknowledging this and seeking help than were previous generations. These two trends together could produce the increased rates of mood and anxiety diagnoses we are seeing. As for bipolar disorder, it is likely that many folks will be glad to see the rate of diagnosis dropping, but what does this really mean? Is this trend translating into changes in important areas like medication usage or is it just swapping one name for another? Much follow-up research is needed, but it is clear that the landscape of youth mental health is continually changing and we need to try and be as aware as possible about this shifting environment. Note: This article originally appeared on Psychology Today .

A meta-analysis of more than 1.5 million participants has suggested that coffee and energy drinks have opposing effects on suicide risk. High coffee consumption more than 60 cups per month was linked to significantly reduced suicide attempts, probably because of its stimulating and mood-enhancing properties. In contrast, even a single can of an energy drink per month was observed to increase the risk for suicidal thoughts and attempts, with a dose-dependent effect that can triple the risk at higher consumption levels. This difference may be explained by the presence of other psychoactive ingredients in energy drinks such as taurine, guarana, and ginseng along with their high sugar content, which can trigger anxiety and mood swings, particularly in young men, who are the primary consumers. Medscape’s French edition spoke with Guillaume Davido, MD, a psychiatrist specializing in addiction studies at Bichat-Claude Bernard Hospital in Paris, about the findings of this study. Why do you think this study is of particular interest? The results are quite striking: Suicide attempts were 30% lower among coffee drinkers compared with energy drink consumers. This meta-analysis is also interesting because it encourages us to be more nuanced about the effects of caffeine and to clearly distinguish caffeinated energy drinks from coffee. It seems that coffee, despite being a stimulant, does not increase suicide risk . This is, to say the least, surprising. For me, it is almost a revelation. Why does this protective effect of caffeine surprise you? The idea that caffeine could improve suicide risk is quite counterintuitive. Not to mention that many publications discuss caffeine's effects in psychiatry, particularly its effect on sleep quality: The less we sleep, the more stressed and impulsive we are, and the more likely we are to develop depressive comorbidities. Depressive comorbidities imply suicidal risk. Psychiatric disorders would be more destabilized in patients who consume caffeine. We thought it was mainly the “caffeine” aspect of energy drinks that could potentially increase these types of disorders, yet this study rather concludes a protective effect of caffeine. However, it is not surprising that energy drinks are linked to higher suicide risk , given that their consumption is associated with more addictive and psychiatric comorbidities. Until now, there was no specific research on suicide, but this seems plausible. Beyond caffeine, how do you explain the potential link between suicide risk and energy drink consumption? The meta-analysis cites publications on psychiatric comorbidity risk factors and suicide risk that are aggravated by energy drink consumption. They specifically mention taurine, guarana, or ginseng, which may promote anxiety. Nevertheless, current literature remains very cautious about the real toxicity of these substances. It also seems important to keep in mind that energy drink consumption [sometimes] occurs within an overall risky lifestyle, which likely partly explains the observed associations. What about effects on the microbiome and gut-brain axis? It is true that coffee has antioxidant effects and benefits on the microbiome. Caffeine could positively affect mood. In contrast, other components of energy drinks, notably sugar, have a harmful effect on the microbiome. For example, one study showed that regular energy drink consumption decreased the expression of bacterial genes beneficial for mood and reduced microbial diversity in the gut. Do you consider the coffee-vs-energy drink comparison in this study to be solid? It is interesting but has its limits. In the meta-analysis, the amount of coffee — and by extension, caffeine — is well defined, with a threshold of 60 cups per month, whereas for energy drinks, quantities are less clear, described as one can. A cup of coffee is about 200 mL, and a can of an energy drink represents roughly two cups of coffee. We know that these drinks contain more caffeine than coffee or other conventional cola-based drinks, with content ranging from 75 to 300 mg per beverage. Moreover, energy drink enthusiasts consume large amounts, often unaware of how much caffeine they ingest. This raises questions about the meta-analysis results: Are coffee drinkers protected by caffeine, or do they simply consume less than energy drink users? Publications highlighting psychiatric risks associated with coffee indicate that moderate consumption is generally safe. There may even be a neuroprotective effect. So having two cups of coffee per day does not seem problematic. What about the population consuming energy drinks? This is also a limitation noted by the meta-analysis authors. We know that people who regularly consume energy drinks do not have the same profile as “classic” coffee drinkers. They are mostly young men. Suicide risk is higher among young men, and energy drink consumers sometimes also use other substances; there is a well-established link in the literature between energy drinks and addictive substances. Patients with addictive issues also have increased suicide risk. Therefore, further exploration of this population is needed. But for me, this is also one of the main interests of this study: It is important to understand this bidirectional link between energy drink consumers and suicidal patients. In consultations, use of energy drinks should be seen as a “red flag.” Whether in general medicine or psychiatry, if a patient consults for psychological concerns, it is relevant to assess energy drink consumption because it may indicate other issues: They may also be consuming other substances or have a risky lifestyle, which allows discussion of lifestyle habits. They may crave large amounts of sugar or have an eating disorder like binge eating. Sugar is known to be depressogenic and causes metabolic complications, which in turn lead to psychiatric complications. Identifying these behaviors helps detect other associated risks, such as metabolic syndrome or fatty liver disease from excessive sugar consumption. Do you ask your patients about energy drink consumption? Not enough! In sleep-focused consultations, this question should be systematically included to assess overall caffeine intake. In my practice at the hospital and psychiatric emergency unit, I do not routinely ask during the initial consultation, as we primarily manage acute crises. However, it becomes relevant during follow-up or at the end of care. The goal is not to demonize caffeine but to address it appropriately. In anxious patients, we recommend limiting stimulants and avoiding consumption after 4 PM, as it can worsen anxiety or disrupt sleep. More broadly, general practice screening for anxiety disorders should include detailed questions about caffeine and energy drink intake. Are there potential interactions between energy drinks and psychiatric medications? At the molecular level, interactions exist but are debatable. If you consume caffeine with an antidepressant or antipsychotic, you do not necessarily experience harmful effects, but some publications report interactions with clozapine, an antipsychotic used as a last-resort treatment for treatment-resistant schizophrenia . Caffeine may modestly increase clozapine levels. Also, caffeine and most psychotropics share hepatic metabolism, with enzymes such as CYP1A2 involved in caffeine metabolism. But whether this results in mental effects from concomitant intake cannot be firmly stated. Nevertheless, blood glucose and clozapine levels could be affected in heavy energy drink consumers, and monitoring may be warranted, though evidence of health impact remains unclear. For antidepressants, no known interactions exist. Finally, it is recommended not to consume energy drinks or coffee when taking sedatives, as it would be like pressing the accelerator and brake simultaneously. Identifying such consumption is important in patients prescribed hypnotics. In conclusion, what do you take away from this study? I think the authors of this meta-analysis did not necessarily intend to highlight a protective effect of coffee but rather to assess whether caffeine, in coffee or energy drinks, impacts suicide risk. They found, somewhat surprisingly, a significant difference between the two groups of consumers. In practice, I take away that: Caffeine may offer a protective effect against suicide risk when consumed in moderation. In contrast, very high doses such as those found in large quantities of energy drinks may increase this risk. For example, someone consuming 15 cups of coffee per day is unlikely to experience the protective benefits, given the impact on sleep and other metabolic functions, including cardiovascular effects. Close attention should be paid to energy drink consumers, and patients should be questioned, as this type of consumption may be associated with multiple comorbidities, including addictive substances, metabolic syndrome, and suicidality. Note: This article originally appeared on Medscape .

Consuming low- and no-calorie artificial sweeteners may harm cognitive function, results of a longitudinal study of middle-aged and older adults showed. In adjusted analyses, people who consumed the highest total amounts of these sweeteners had a 62% faster decline in overall thinking and memory skills, equivalent to about 1.6 years of aging, than those consuming the lowest amount. The link was found in people younger than 60 years but not in older adults and was stronger in people with diabetes. “For neurologists, the key message is that dietary exposures in midlife may impact long-term brain health, and artificial sweeteners may not be the harmless alternatives to sugar that many assume,” study author Claudia Kimie Suemoto, MD, PhD, with University of São Paulo in São Paulo, Brazil, told Medscape Medical News. “This is important to keep in mind when counseling patients, especially those at higher risk for dementia or those with diabetes who often rely heavily on these products,” Suemoto said. The findings were published online on September 3 in Neurology . Higher Consumption, Faster Decline The research is the largest and longest prospective study to date investigating the association between artificial sweetener consumption and cognitive decline. “While previous research had linked sweeteners to conditions such as diabetes, cardiovascular disease, and depression, their long-term impact on cognition had not been systematically explored,” Suemoto said. The study included 12,772 adults participating in the Brazilian Longitudinal Study of Adult Health Brazilian. As part of the study, they underwent standard cognitive tests every 4 years across three study waves (2008-2010, 2012-2014, and 2017-2019). A food frequency questionnaire was used to calculate combined and individual consumption of seven low- and no-calorie sweeteners, including the artificial sweeteners aspartame, saccharin, and acesulfame-K; the sugar alcohols erythritol, sorbitol, and xylitol; and tagatose, a natural sweetener. Participants were divided into three groups based on the total amount of sweeteners consumed. The lowest group consumed an average of 20 mg/d and the highest group consumed an average of 191 mg/d. For aspartame, this amount is equal to one can of diet soda. Sorbitol had the highest consumption, with an average of 64 mg/d. In the overall sample, after a median follow-up of 8 years, participants in the two highest tertiles of combined low- and no-calorie sweetener consumption had a 35% and 62% higher rate of decline in global cognition, respectively, than peers in the lowest tertile. That corresponds to an excess 1.3 and 1.6 years of cognitive aging. Verbal fluency also suffered, with participants in the two highest tertiles of combined low- and no-calorie sweetener consumption showing 110% and 173% higher rates of decline in verbal fluency decline, respectively. Long-Term Consequences for Brain Health In analyses stratified by age, consumption of low- and no-calorie sweeteners was associated with faster decline in global cognition and verbal fluency in those younger than 60 years but not in older individuals. The association between higher intake of low- and no-calorie sweeteners was more pronounced in people with diabetes, particularly for memory decline, suggesting a heightened vulnerability in this group, the researchers said. Similar positive associations with cognitive decline were found in analyses looking at consumption of all of the individual low- and no-calorie sweeteners — except for tagatose, the only natural sweetener. “Our findings highlight the need to look more critically at what we are using to replace sugar in our diets, and they underscore that dietary choices in midlife can have consequences for brain health decades later,” Suemoto told Medscape Medical News . “For people who love diet sodas and other sugar-free products (including myself), our findings do not mean that people should panic, but they do suggest it is wise to limit consumption as much as possible, ideally avoiding daily use. Whenever possible, choose natural options to add flavor, like fruit, honey, or spices, and try to shift toward a more balanced diet rich in whole foods,” Suemoto advised. A limitation of the study was that not all artificial sweeteners were included (such as sucralose). And while a validated food frequency questionnaire was used, the possibility of misreporting bias cannot be ruled out. Also, diet was assessed only at baseline, which may reflect diet changes over time. ‘Compelling’ Data Writing in a linked editorial, Thomas Monroe Holland, MD, with Rush Institute for Healthy Aging, Rush Medical College, Chicago, said the findings are “compelling” and add to “mounting evidence that common dietary exposures, particularly ultraprocessed food additives, once considered benign, may influence brain health in ways neurologists and other healthcare professionals are only beginning to understand.” Although previous research has linked artificially sweetened beverages to cognitive risk, the use of rigorous and advanced statistical techniques in this study “makes the results more accurate and less biased and strengthen our confidence in the observed cognitive associations,” Holland pointed out. The finding that associations between these sweeteners and cognitive decline were strongest in younger adults has “profound implications for neurologic counseling. This suggests that midlife dietary exposures, decades before cognitive symptoms emerge, may carry life-long consequences for brain health,” Holland wrote. The findings may prompt neurologists to reconsider standard dietary recommendations, particularly for patients with diabetes, metabolic syndrome, or cerebrovascular risk factors, he said. The widespread assumption that low- and no-calorie sweeteners represent a safe sugar substitute may be “misguided, especially given their ubiquity in products marketed as ‘healthier’ alternatives,” Holland added. “For the medical community, this study poses a fundamental question: In our efforts to prevent stroke and preserve cognition through dietary modification, are we inadvertently recommending substances that may accelerate the very cognitive decline we seek to prevent?” Holland concluded. Note: This article originally appeared on Medscape .

Psychiatrists are trying our ketamine-assisted psychotherapy in their clinical practices. What do patients think of this treatment? FROM OUR READERS This article is a response to the article “Doing It Together: Ketamine-Assisted Psychotherapy in a Small Group” by Dinah Miller, MD. Excellent nuanced points made by Dinah Miller, MD. I am another doctor who utilizes ketamine-assisted psychotherapy (KAP) in her private psychiatry practice. I believe that for the most part, psychiatrists utilizing KAP come to the practice with curiosity and determination to try to help our patients who struggle chronically and who have, in most cases, tried myriad other pharmacological and sometimes interventional alternatives. I worked as a psychiatrist for over a decade before exploring this treatment modality. I was trained in KAP in 2020 and entered the training (a 5-day in-person retreat with didactic and experiential components) with a healthy dose of skepticism; even after training, it took me several months to conclude that I wanted to give this a try in my own practice. Almost 4 years later, I can say I am glad I went there. In my practice, 75% to 80% of patients have noteworthy benefit. While we have little evidence-based data regarding KAP for reasons Dr Miller described, we do have evidence that psychotherapy helps patients, and that the specific type of psychotherapy is less important than the therapeutic alliance. So to my mind, combining a good therapeutic alliance (in a safe and intentional setting, with ample preparation) with the generic form of a medicine we know to be helpful for depression is not a huge clinical or ethical leap; in fact, patients of mine who have done a Spravato protocol and then come to my practice for KAP report that compared with the Spravato REMS protocol, the KAP approach feels like a completely different and much-improved version of treatment. The biggest hurdle here is affordability; like Dr Miller I sit with my patients for the 3-hour sessions and most insurance companies will only reimburse very minimally, if at all, for this non-FDA approved version of ketamine treatment. Note: This article originally appeared on Psychiatric Times .

Key Takeaways Immersive VR meditation offers personalized experiences, enhancing symptom relief for MDD and GAD compared to traditional meditation. The study utilized Meta Oculus Quest 2 headsets, with participants engaging in 30-minute sessions over 10 weeks. Emotional regulation improvements were measured using HeartMath biofeedback, affirming VR meditation's efficacy. Limitations include a single-arm design and small sample size, yet findings support VR integration in mental health care. A new study shows that meditation using immersive virtual reality devices provides greater relief from major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms than meditation alone. “Treatments that use medications are the most effective in addressing mental health disorders, but they also can bring unwanted side effects,” said Junhyoung Kim, PhD, a researcher in the Department of Health Behavior involved with the study. “That led to the current effort to develop treatments that rely less on drugs or are entirely drug-free, such as the practice of mindfulness through meditation.” In this longitudinally designed, single-arm clinical trial, participants used Meta brand Oculus Quest 2 digital headsets for 30-minute meditation sessions 3 times a week for 10 weeks. Investigators recruited participants based on referrals from clinician progress notes and initial entrance exams. Of the initial group of 36 participants, each participant engaged in an average of 5.1 sessions, but 11 participants left the study without undergoing the exit assessment when they were discharged from the hospital. This left the 25 participants—11 males and 14 females, with a mean age of 42.1 years—who took part in an average of 2.7 intervention sessions, equaling a total of 68 observations. The most important part of immersive virtual reality meditation that distinguishes it from traditional meditation is the personalized meditation experience. The headsets provided an immersive virtual reality experience in which users selected their desired outcome, such as stress reduction or improved sleep3,4; scenery, like a meadow, savannah, or beach; and natural sounds, like birds chirping. The 30-minute sessions were provided according to the preference and requirements of each participant. Before and after each session, participants completed a General Anxiety Disorder-7 questionnaire. They also completed the Patient Health Questionnaire-9 before and after 2 sessions. Investigators also used HeartMath (electrocardiogram) to measure the changes in emotional regulation related to immersive virtual reality meditation participation. HeartMath, a biofeedback monitoring system that measures heart rhythm changes and coherence levels between sympathetic and parasympathetic activities in the autonomic nervous system,5 allowed investigators to objectively measure coherence level and related achievement scores that are associated with levels of depression and anxiety (Drageset et al., 2012; Edwards, 2016; Minen et al., 2021). The study affirmed previous findings that virtual reality meditation sessions significantly alleviated participants’ MDD and GAD symptoms and improved their emotional regulation. “This is important knowledge for mental health professionals, clinicians and caregivers,” Kim said. “Meditation using immersive virtual reality has the potential to greatly benefit those in the United States who will experience depression at some point.” Limitations included the single arm clinical trial and small sample size. “While the outcomes of the study cannot be generalized and there are reliability issues, our study can serve as an initial test of the application of a technology to mindfulness therapy for MDD and GAD patients,” wrote the study authors. “The results of our study provide a rationale for implementing immersive virtual reality meditation with patients with MDD and GAD and shed light on how mental health professionals , clinical practitioners, and caregivers can integrate VR technology into existing mental health care programs.” Note: This article originally appeared on Psychiatric Times .

Two different approaches can work in tandem to help those with mental disorders. Key points Major neuroscientific advances are leading to new treatments for psychiatric disorders. Public mental health targets social factors that increase risk of developing psychiatric disorders. Both approaches are important in decreasing disabilities associated with mental illness. Psychiatric disorders are common and among the most disabling of all medical illnesses. Even disorders with less severe symptoms can lead to substantial disability. Over the last decade, major progress has been made in elucidating the genetic and neuroscientific underpinnings of psychiatric illnesses. Advances in molecular sciences, cognitive sciences, and neuroimaging are increasingly attracting research-oriented medical students, including those in combined MD-Ph.D. programs, into psychiatry residency training. New classes of medications are being developed. Evidence-based treatments, including, for example, specific psychotherapies, transcranial magnetic stimulation, and ketamine infusions, are increasing the number of therapeutic tools available to mental health professionals. Although treatments are available, substantial barriers can interfere with a person’s ability to access treatment. These barriers may include lack of or inadequate health insurance, provider shortages, and/or illness-related symptoms that hinder willingness to seek and follow through with treatments. Implementation research to develop better ways of reaching individuals who would benefit from treatment could lessen the impact of disabilities resulting from mental illnesses. Public Mental Health Although reaching individuals already suffering from mental disorders is imperative, there is an additional approach that can decrease harm from mental disorders. This approach involves public mental health. In addition to biological underpinnings of mental disorders, societal factors can increase the risk of psychiatric illness. These factors may augment biological risks. As pointed out by Ulrich Reininghaus and colleagues in a recent review in JAMA Psychiatry , “Ethnicity, education level, and socioeconomic status can lead to different risk distributions for subpopulations depending on their position in the social strata.” Public mental health strategies attempt to identify interventions that may decrease these risks and thus reduce the number of individuals who develop mental illness. Biologic factors may have a stronger influence than predisposing societal factors in the development of some disorders. However, adverse early life experiences can substantially increase the risk of developing certain psychiatric illnesses . Public mental health approaches can help determine which groups of individuals are most susceptible to specific social adversities that predispose them to various behavioral and cognitive symptoms. As reviewed by James Kirkbride and colleagues in an article in World Psychiatry, specific types of early interventions may be effective at diminishing the later development of certain disorders. Such interventions may involve early recognition and intervention programs, early education programs , and public policies addressing poverty and childhood adversity. The purpose of this post is not to review the field of public mental health. Rather, it is to encourage a multi-pronged research agenda that works to develop treatments to ameliorate symptoms of mental illnesses and interventions to decrease the development of such disorders. These approaches must be complementary, not competitive. Note: This article originally appeared on Psychology Today .