LOS ANGELES — Artificial intelligence (AI) falls short of human therapists when it comes to empathy and emotional connection in the delivery of cognitive behavioral therapy (CBT) , initial results of a new pilot study suggested. However, the results showed that AI performed well in providing a structured therapeutic approach. “While AI may offer structured CBT components and serve as a supplementary or triage tool, it lacks the nuance and flexibility to serve as a stand-alone therapy,” study investigator Esha Aneja, a fourth-year medical student at California Northstate College of Medicine, Elk Grove, California, told Medscape Medical News. “Physicians and therapists should view AI as a potential adjunct, not an alternative.” “Human oversight, ethical safeguards, and empathy remain essential to safe and effective mental health care.” The findings were presented on May 17 at the American Psychiatric Association (APA) 2025 Annual Meeting . Demand for CBT Outstripping Supply Currently, there aren’t enough psychiatric professionals in the United States — or globally — to meet the growing demand for CBT. Patients frequently face delays in accessing care, so more are turning to AI tools like ChatGPT to address their mental health needs, said Aneja. However, she noted in her presentation that large language model (LLM)–based AI chatbots for text-based therapy are still largely theoretical in psychiatric literature. While LLMs have been integrated into electronic health records for diagnostic purposes, the ability of AI to execute CBT remains understudied. The goal of the study was to compare the effectiveness of therapy delivered by humans with AI. Experts familiar with CBT principles using the Cognitive Therapy Rating Scale (CTRS) compared a human therapist with an AI model (ChatGPT-3.5) in responding to a third-party patient presenting with a specific mental health concern. CTRS is a gold-standard observational tool for assessing the quality and fidelity of CBT sessions. It evaluates multiple domains, each rated on a 0-6 scale, with higher scores reflecting more skilled therapeutic delivery. Both the human therapist, who conducted the session over Zoom, and the AI therapist, ChatGPT-3.5 (the most current version at the time), interacted with the patient solely via text chat. Reviewers received transcripts of each session but were blinded to whether the responses came from a human or AI. The study surveyed 75 reviewers to compare the quality of human-based and ChatGPT-3.5-based interactions with patients. Participants included medical students, social work students, psychiatric residents, and board-certified psychiatrists. Humans Win the Day The human therapist outperformed ChatGPT-3.5 across all domains. Areas where the differences in mean CTRS scores were statistically significant included feedback (4.48 vs 3.03), collaboration (4.91 vs 3.84), pacing (4.60 vs 3.67), and guided discovery (0.35 vs 3.45), as well as “focus on key cognitive behaviors” and “application of CBT techniques” (P = .001 for all). Areas where the ratings were similar between the two groups included agenda setting, understanding, interpersonal effectiveness, and strategies for change. When it came to therapeutic approach and empathy, respondents disagreed on whether the human therapist demonstrated enough empathy, Aneja reported. “Some praised their warmth and responsiveness, while others felt the therapist focused too much on technique and missed emotional cues,” she said. “In contrast, AI was more uniformly described as ‘robotic’ or ‘surface-level’ in its empathy, with little variation.” While AI may become “cognitively empathetic” in the future and therefore able to respond more appropriately, “emotional or embodied empathy, the kind that comes from shared human experience, is beyond its current capabilities,” said Aneja. And, even in the areas that were more compatible with AI such as structure and agenda, respondents felt AI was “too wordy” and “robotic” and included “a lot of lecturing,” she added. They also noted AI lacked personalized recommendations with respect to patient understanding and tailored approaches. While the researchers suspected AI might fall short, this new study “quantifies and contextualizes those limitations in a real-world CBT framework,” said Aneja. AI could “definitely” be used as a screening tool in psychiatry, particularly when patients can’t get to see a provider in a timely manner, she said. It could “look for things like suicidality or situations where urgent attention is important.” However, therapists should keep the tool’s limitations in mind, especially the empathy component, she added. Weighing in on these results, Howard Liu, MD, chair of the Department of Psychiatry at the University of Nebraska Medical Center, Omaha, Nebraska, and chair of the APA Council on Communications, Washington, DC, called the study “fascinating,” especially with the backdrop of psychiatrist shortages across the country. However, he stressed the importance of informing patients when using AI. “Different health systems have different policies about whether you can, in fact, feed in protected health information into these systems,” he pointed out. Philip R. Muskin, MD, professor of psychiatry at the Columbia University Irving Medical Center, New York City, said he was not surprised by the findings overall or the comments about the “lecture-like quality” of the AI “therapist.” “Human responses vary, even when rigidly following a CBT agenda,” he told Medscape Medical News. “Reading about therapy, which is essentially what the AI software does, isn’t comparable to a therapist who has read training materials but has incorporated the information through human interaction.” Note: This article originally appeared on Medscape .

TOPLINE: In patients with depression resistant to National Health Service (NHS) Talking Therapies, mindfulness-based cognitive therapy (MBCT) plus treatment as usual was more effective in alleviating symptoms than treatment as usual alone, a new trial found. Additionally, MBCT plus treatment as usual had a 99% probability of being cost-effective. METHODOLOGY: Researchers conducted a parallel, randomized, controlled, superiority trial across three sites in the United Kingdom (2021-2023). The study included 234 patients with major depressive disorder (mean age, 42.5 years; 71% women; 86% White) who couldn't achieve remission after ≥ 12 sessions of NHS Talking Therapies. Participants were randomly assigned to receive either treatment as usual alone (n = 116) or MBCT plus treatment as usual (n = 118), with minimization on the basis of depression severity, antidepressant use, and recruitment site. The primary outcome was depression symptoms, measured using the Patient Health Questionnaire-9 at 34 weeks. Cost-effectiveness was assessed using the Adult Service Use Schedule. TAKEAWAY: Participants who received MBCT plus treatment as usual had significantly reduced depression symptoms than those who received treatment as usual alone (P = .0006). MBCT plus treatment as usual resulted in lower costs and higher utility scores than treatment as usual alone during the study period. Analysis revealed a 99% probability that MBCT plus treatment as usual was cost-effective at the £20,000 per quality-adjusted life-year threshold. No serious adverse events related to the trial or treatment were observed. IN PRACTICE: "Our findings show that psychological further-line treatment for depression can bring clinical benefit at an affordable price, potentially helping to reduce the long-term disability burden and economic costs associated with difficult-to-treat depression," the authors wrote. SOURCE: The study was led by Thorsten Barnhofer, PhD, School of Psychology, University of Surrey, Guildford, England. It was published online in the June 2025 issue of The Lancet Psychiatry . Note: This article originally appeared on Medscape .

Key Takeaways Structured safety plans, such as the Stanley-Brown model, significantly reduce suicide attempts by 43% compared to treatment as usual. The Collaborative Assessment and Management of Suicide (CAMS) and CBT-SP are effective interventions focusing on suicidal drivers and ideations. Early implementation of safety plans in outpatient settings can prevent progression to severe suicidality and should be part of clinical policy. Telehealth adaptations and environmental safety measures, including firearm and medication management, are essential for effective suicide prevention. Despite advances in medicine, suicide rates continue to rise. As of 2022, the suicide rate in the United States was 14.2 deaths per 100,000 people, which translates to approximately 49,476 suicides. Most mental health clinicians, tragically, will experience at least 1 patient who will die from suicide during their career. One of the most daunting clinical difficulties is that suicide is almost impossible to predict. After a comprehensive assessment, if we determine that the patient is not in imminent danger, we then attempt to collaboratively engage them in a safety plan. A more formal written safety plan was developed by Stanley and Brown in 2008, which clarifies the warning signs, internal coping strategies, external distraction strategies, engagement of selective specific supportive individuals and professional contacts, and removal of access to weapons. The Suicide Plan Intervention (SPI) has been identified as a best practice by several suicide prevention organizations. Those of us who trained prior to Stanley and Brown’s safety plan and many others do not use a formal safety plan template. Traditionally, we perform a comprehensive risk assessment and make a formulation and plan. If the patient is deemed not to be in imminent danger, a plan of safe follow-up addressing state-based factors and monitoring would be discussed. This more informal plan may be sufficient, but it may miss certain key pieces that a more formalized structured plan would fulfill as a part of practice habit or policy. Also, for medical directors in large group practices, such as myself, overseeing clinical quality and care for many clinicians that include psychiatrists and advanced practice providers, a structured system of clinical assessment and plan for suicidal patients as a part of clinical policy and/or practice culture makes sense. When faced with anxiety of treating a patient with acute suicidality, a structured safety plan system such as the SPI that has been put in place at a time prior to crisis can be stabilizing and grounding. Other interventions and resources for clinicians that have been studied to address suicide in the outpatient setting include the Collaborative Assessment and Management of Suicide (CAMS). CAMS also uses a templated form entitled the Suicide Status Form (SSF). This form also addresses many of the elements of the SPI. Additionally, it focuses on the patient’s suicidal drivers, such as psychological pain, hopelessness, and self-regard/self-hatred and makes these drivers a central focus of therapy. There have also been manualized therapies such as cognitive behavior therapy (CBT)-SP, a 12 session CBT focused on suicidal ideations and behaviors. This treatment integrates the SPI within a CBT model. These models are primarily therapy models for patients with suicidal ideations and behaviors. This article is primarily aimed at outpatient psychiatric clinicians who provide medication management and supportive therapy. Clinicians who have supportive add-on therapies have a significant role in identifying suicide warning signs and implementing CBT/dialectical behavior therapy skills into a medication follow-up. I propose that implementation of the SPI early in treatments, before a crisis, may prevent progression of more severe suicidality. I will also make some suggestions for how to implement a safety plan system in a larger group practice, especially one that contains a variety of different levels of clinical clinicians. I will describe how clinicians must develop the ability to identify warning signs, build coping strengths, create strategies for external distraction, identify primary support individuals and professional contacts, and address environment safety within a collaborative relationship. My goal is to provide a description of how this written template can be incorporated into an ongoing medication management treatment. Safety Plan Background Studies utilizing formalized written safety plans demonstrate significant benefits. Meta-analysis of the SPI in emergency patients has shown 43% decrease in suicide attempts and/or completion (NNT 16) when compared with treatment as usual (TAU). TAU was basically that after a comprehensive suicidal assessment, the patient was given a follow-up appointment in mental health. It is well-known that patients do not have reliable follow-up from emergency departments, making an SPI type intervention that much more important. The interventions were performed primarily face-to-face and took an average of 20-25 minutes. Although the intervention decreased suicidal behavior, it did not significantly change suicidal ideations. This indicates that patients have a greater behavioral capacity to refrain from acting on suicidal thoughts, although the ongoing distress that generates thoughts of ending their life persists and underscores the continued need for ongoing treatment. With the rise of telehealth in psychiatric outpatient practice, it is important to examine whether telehealth safety plans might differ significantly from in-person ones. Typically, the protocol involves collaboratively filling out the form in writing and then printing it for the patient to take home. This process can be adapted for telehealth by uploading the completed form to the patient’s portal or emailing it to them. Additionally, it may be beneficial for the patient to upload the safety plan to their mobile phone, take a picture of it, or write down the key elements in their phone’s note section for easy reference during stressful times. Surveys of clinicians find that most clinicians (87.6%) believe that a written safety plan is appropriate when patients have “thoughts about ending their life by suicide.” I would propose that in the context of ongoing outpatient treatment, it should be implemented even earlier, perhaps even with passive suicidal thoughts. If it is discussed as a part of the ongoing treatment, then the creation of a written document is very brief, much less than 20 minutes. It makes suicide prevention an explicit goal of the treatment and develops a potential plan before the clinician is suddenly thrust into a crisis in which intent and plan has become imminent. Some clinicians may include a separate tab in the EHR for safety plan documentation, or it can be documented within the history of present illness and referred to in future sessions. Discussing the safety plan as part of ongoing treatment allows the clinician to revisit aspects of it as needed, depending on the level of warning signs. This can be as frequent as every session and can be actualized by verbally identifying the warning signs as they present and revisiting the already rehearsed and practiced coping strategies. Identifying Warning Signs Identifying warning signs is enhanced by a strong ongoing therapeutic relationship. This is much more difficult in a fast-paced brief medication model. If working within a brief medication model, it is very important to recognize when the tempo needs to slow down, and the sessions shift toward a combined medication-therapy model at greater frequency. One of the frequent problems that I see as a medical director managing morbidity and mortality case reviews is the tendency to not recognize when a patient should be seen in longer and more frequent sessions. It is important to have a working alliance that focuses not only on symptom stabilization with medications, but on increasing awareness of emotional triggers for regression that could lead to self-destructive action-oriented behaviors. This allows for a discussion very early on about how to address thoughts, feelings, images, and behaviors that are counter to the working goals of the treatment before it manifests as acute suicidal behavior. For example, think about a patient with borderline psychic structure and emotional dysregulation who has had a series of self-harm incidents, such as cutting and burning, triggered by comparative cognitions. Whenever she is with someone who appears more successful than her, negative automatic thoughts about her own worthlessness and self-disgust are triggered. Understanding this dynamic is part of the therapeutic alliance, and having processed these feelings during outpatient treatment enables us to label them when they occur. Building Internal Coping Strategies The next level of a written safety plan after identifying warning signs is to clarify the patient’s internal coping strategies to be used when suicidal ideations intensify. Having them written out early on enables the patient and clinician to revisit these strategies as distress levels wax and wane. In primary medication management with add-on supportive therapy, there can be the development of a dialogue around a discussion that goes like this: “When this happens (self-harm urge secondary to comparing thoughts, which has a dynamic origin) use a behavioral skill such as relaxation response, grounding techniques, or mindfully observing the thoughts nonjudgmentally and nonreactively, etc.” The skills should have utility, and be worked on and revisited in the treatment. Developing a List of People and Places That Provide Distraction Distraction is the next line of defense in a safety plan. The patient is encouraged to independently utilize their internal coping and distraction strategies to take their mind off problems without necessarily having to contact specific supportive individuals. The distraction list is a group of people that they can connect with, but not necessarily disclose that they are having suicidal ideations. List of Supportive People to Be Contacted by the Patient in Crisis This level of need requires some forethought. Who are the patient’s safety net? In the case of a crisis, who would be the individuals that would understand the level of distress the patient is experiencing and respond in a way that is deescalating? This goes beyond having people and places for distraction. This level of engagement requires a patient’s trust in the support person at the level of disclosing significant distress and safety needs. This is an opportunity to talk about the patient’s family and core support systems. It is crucial to involve them ahead of time if it appears that the risk of regression is significant. Patients often resist contacting and letting people know. The clinician can often facilitate these discussions by contacting the family member either separately, if given permission, or together with the patient. It is important to frame the connection in a way that is not intrusive and has the possibility of enhancing supportive understanding. It is helpful to let the patient know that the goal is not to share private information, but rather to thank the support person for being there for the patient and help them understand the situation in a destigmatizing manner. It is also important to discuss with the patient what will be shared with the family member or support person prior to calling and to collaboratively come up with an explanation that is comfortable for the patient. This is especially critical when there is cultural or familial stigmatization of mental illness. Knowing that you have a connection to a supportive person of a suicidal patient can be extremely comforting to both the patient and their clinician. The adage ‘it takes a village to raise a child’ applies to the care of a patient with suicidal ideation as well, who needs a wraparound supportive system that can monitor the patient much more than a single clinician can in outpatient clinical practice. The benefits of developing nonprofessional support networks for patients with suicidal ideation have been studied. For example, in the Youth Support Team study, adolescents with suicidal ideation being discharged from the hospital nominated “caring adults” to serve as support persons for them after hospitalization. These adults attended a psychoeducational session to learn about the youth’s problem list and treatment plan, suicide warning signs, communicating with adolescents, and how to be helpful in supporting treatment adherence and positive behavioral choices. The adults received weekly supportive telephone calls from YST staff for 3 months. Remarkably, the hazard ratio indicated a 6.6-fold increased risk of death for the TAU group vs the YST group. This increased mortality may not necessarily be from suicide alone, as it included accidental deaths from motor vehicles or drug overdose. Continued studies looking at the mechanisms of benefit are needed, but it does speak to the power of the clinician attempting to facilitate patients reaching out and designating a caring support team, as well as actively supporting and educating the patient’s chosen support team. A List of Professionals That Can Be Contacted in Crisis In addition to the list of close friends and family that can be contacted in a crisis, it is important to have a clear, explicit list of contact numbers for professionals and professional services. This should include the psychiatrist and therapist and could also include a primary care physician. Additionally, it should list professional service lines such as the crisis line 988, which is staffed 24/7 by crisis counselors who can help stabilize and direct patients in times of need. It is crucial to clarify when these professionals are available and ensure the patient understands that they should access emergency services if they are in a crisis with intent to end their life. Making the Environment Safer Discussing a plan to make the environment safe is imperative but can be challenging, especially with patients who are reluctant to give up their guns. This reluctance is more common among men. Although men attempt suicide half as frequently as women, they are twice as likely to complete it, largely due to the use of more lethal means, particularly firearms. Approaching the issue as a temporary measure to ensure safety while working on finding the right medication regimen and stabilizing the patient's mental health can sometimes be understood and agreed upon by the patient. Some negotiation may still be necessary. Ideally, it would be best if the guns were removed and placed in another family member’s house. However, during negotiations, it is important to remember that the level of risk associated with the gun lies on a spectrum depending on where and how it is stored. The clinicians’ goal is to put as much of a barrier between the patient and their loaded gun as possible. For example, a loaded gun on the bedside table poses a much higher risk than an unloaded gun locked in a gun cabinet in the basement. Limiting the number of pills that the patient has access to is another way to help keep them safe. If the patient is at significant risk, it might be appropriate for the clinician to prescribe no more than a week’s supply at a time. Alternatively, if the patient has a trusted support person and can work within a collaborative safety plan, it could be beneficial for the family member to manage the medications and distribute a week's supply in an administrative tray. There can be challenges with the patient feeling infantilized by these systems, but it is important to frame it as a testament to their executive decision-making and planning abilities. While many patients may struggle to acknowledge their vulnerability to impulsivity, they are often more willing to accept the clinician’s authority that the medication, rather than themselves, could make their brain more prone to impulsive actions. Therefore, a different structure is needed while medications are being titrated. This is especially important when starting a new antidepressant, particularly in younger individuals where the prefrontal cortex is less developed. Prescribing the appropriate number of refills for patients requires significant care and caution. The best practice is to time refills for when the patient has a return appointment, allowing medications to be reconciled and the appropriate amount prescribed based on a current evaluation and risk assessment. However, if a patient misses an appointment and calls for a refill, this can be problematic, especially if there have been changes in the patient's life that affect their level of risk since the last visit. Clinicians generally set the next appointment based on medical necessity, but this can be disrupted if the patient is inconsistent with keeping appointments. With EHR, clinicians might reflexively click the quick refill option, which can be particularly problematic if the original prescription was for 90 days. As medical directors/managers, it seems prudent to educate clinicians in the group not to prescribe a refill without scheduling another appointment and to provide only a bridge prescription until that appointment. A good practice policy is to only give 90-day prescriptions without refills to patients who are well-known and stable. It also would seem to be good management to encourage clinicians to only see patients every 90 days if they are in remission with stable medications and otherwise approximately monthly or even less according to medical necessity. Concluding Thoughts Formal safety plans save lives. Evidence suggests there is significant benefit in incorporating the plan early for patients with ideations or past intent. This allows the patient and clinician to collaborate on a plan that minimizes suicide risk well before a crisis occurs. The need to tailor the frequency and length of sessions to the patient’s level of risk is emphasized. For the clinician and patient to be aware of warning signs, a certain level of depth and insight into the patient’s individual vulnerabilities must be achieved. This is best accomplished within treatments that include, at least when medically necessary, add-on supportive therapy with sessions of sufficient length and frequency. Making safety plans a part of a medical director’s policies for group practices has significant benefits, especially where there are clinicians of various levels of training and experience. We strongly encourage safety plans to be implemented early for patients with ongoing suicidal ideations or past intent or attempts. Hopefully, this intervention, which requires relatively brief time-commitment, will help mitigate the increasing suicide rates and contribute to our continued efforts to achieve the ideal goal of zero suicides. Note: This article originally appeared on Psychiatric Times .

Maintaining optimal vascular health throughout late life can significantly lower the risk of developing dementia before age 80 years, new research showed. Investigators estimated the proportion of new dementia cases linked to modifiable vascular risk factors. The results suggested that 22%-44% of dementia cases by age 80 years could be attributed to poor vascular health through age 74 years. The findings highlighted the “potentially immense value of early detection of vascular risk factors and primordial prevention (eg, vis-à-vis promotion of physical activity and healthy body weight management) beginning in midlife,” wrote the study team, led by Jason Smith, PhD, with Johns Hopkins Bloomberg School of Public Health in Baltimore. The study was published online on June 2 in JAMA Neurology . Vascular Health Equals Brain Health Hypertension, diabetes, and smoking are widely recognized modifiable vascular risk factors for dementia. While their roles have been studied individually, the cumulative impact of these risk factors across the lifespan — and how this varies by genetic background, race, and sex — has been less clear. Smith and colleagues used data from the Atherosclerosis Risk in Communities Neurocognitive Study, with 33 years of follow-up, to assess the fraction of dementia attributable to hypertension, diabetes, and smoking measured at different life stages. A total of 7731 participants were included in the analysis of risk factors measured at age 45-54 years (58% women, 71% White, 29% Black); 12,274 contributed data at age 55-64 years (55% women, 76% White, 24% Black); and 6787 contributed data at age 65-74 years (56% women, 80% White, 20% Black). Overall, a total of 2218 people developed dementia by their 80th birthday. By age 80 years, the population attributable fraction of dementia attributable to at least one vascular risk factor measured at age 45-54 years was 22%; at 55-64 years, it was 26%, and at 65-74 years, it was 44%. Only 2%-8% of dementia cases occurring after age 80 years were attributable to these vascular risk factors. Subgroup differences emerged. For example, the attributable fractions for the vascular risk factors were higher in APOE-ε4 noncarriers aged 55 years or older (range, 33%-61%). “This reflects the fact that in populations with lower genetic Alzheimer risk, the extent of the relative contribution of vascular disease to dementia risk is greater,” the study team explained. Attributable fractions for the vascular risk factors were also higher in Black individuals aged 45 years or older (range, 26%-53%) and women aged 55 years or older (range, 29%-51%). Risk factor clusters such as hypertension plus diabetes and smoking plus diabetes significantly increased dementia risk, with hazard ratios ranging from 2.00 to 3.54, depending on age and risk factor combination. The importance of hypertension and diabetes increased with age, whereas the importance of smoking decreased with age. “Given the contribution of vascular disease to dementia and the overlap in risk factors between CVD and dementia, interventions that address these underlying risk factors have the potential to reduce the risk of both outcomes,” the co-authors of a linked editorial said. These results also suggest that “to be optimally effective, interventions to reduce dementia risk by addressing vascular risk factors may need to be individualized and targeted based on factors such as age, genetics, race, and sex,” Roch A. Nianogo, MD, PhD, with University of California, Los Angeles, and Deborah E. Barnes, PhD, MPH, with University of California, San Francisco, wrote. Note: This article originally appeared on Medscape .

Key Takeaways: The antipsychiatry movement is experiencing a resurgence, challenging the legitimacy of psychiatric practices and treatments. Recent government actions and influential figures are questioning the role of psychiatric medications, potentially impacting public perception. Psychiatry is supported by scientific evidence, proving the reality and treatability of mental illnesses. Education and advocacy are crucial for psychiatrists to counter misinformation and maintain public trust in mental health care. AFFIRMING PSYCHIATRY The Wall Street Journal recently published an article provocatively entitled “Generation Xanax: The Dark Side of America’s Wonder Drug.”1 Writing as if it were the 1970s, the authors for this exposé reveal that “as concerns increase about the potential adverse effects of these drugs, some patients who try to quit are suffering what amounts to a hangover they can’t escape.” They then outline the usual risks and document common downsides of benzodiazepine use, such as overuse, dependence, and withdrawal. For instance, “many doctors” say the drugs are overprescribed, whereas “some doctors” have given up prescribing them altogether. And, of course, there are quite a few horror stories of patients who took benzodiazepines and got drastically worse or found it agonizing to get off of the medications. As the article concludes, one patient explains, “I went from being independent and totally functional to just slowly declining into this absolute pit of hell.” These stories are indeed horrible, and they are the kind of thing that keeps us psychiatrists up late into the night. But missing from the article are any mentions that anxiety disorders are medically disabling, increase mortality, and raise the risk of other chronic illnesses such as stroke and heart disease. The article contains no indication of the countless individuals with life-threatening and treatment-resistant anxiety who have been helped by benzodiazepines. Nor does it compare negative reactions to benzodiazepines with horror stories that some individuals taking nonpsychiatric drugs such as statins or various antibiotics could tell us. Finally, it fails to explain how almost all doctors work very carefully with patients to avoid overuse. Large-scale studies have shown, for instance, that long-term benzodiazepine use rarely results in escalating doses, does not increase the risk of dementia, and does not increase the risk of hip fractures due to falls. Healthy Again—Without Psychiatry? However, it is not the rather banal and distorted content of the article that is worrisome. Rather it is the timing of this article that is particularly ominous. It comes a month (to the day) after the White House published President Donald J. Trump’s executive order establishing the Make America Healthy Again Commission. Overall, the stated intention of the document is to address escalating rates of chronic illness within our society. But psychiatry is not to be neglected here. Citing concerns about increasing diagnoses of autism and attention-deficit/hyperactivity disorder (ADHD) , this sweeping document directs executive agencies to “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors [SSRIs], antipsychotics, mood stabilizers, stimulants, and weight-loss drugs,” as well as to assess the “threat” of medication overuse toward worsening chronic illness. Perhaps not coincidentally, the order accompanies the arrival of Robert F. Kennedy Jr. as the new Secretary of Health and Human Services. In confirmation hearings, Kennedy confirmed that he wanted to study whether SSRIs contribute to mass shootings and claimed that some people he knows “have had a much worse time getting off SSRIs than people have getting off heroin.” Does God Believe in Mental Illness? One person who would likely agree with Kennedy’s skeptical view of psychiatric treatment is the famous evangelical Christian pastor John MacArthur. In addition to his ministerial work, MacArthur has published more than 100 books with multiple bestsellers, including his million-selling MacArthur Study Bible. His influence is immense, and for the past year, he has been using it to let the public know that mental illness does not exist. Rather, it is a “noble lie” of psychiatry that is finally being disproved. He has written: “There’s no such thing as PTSD [posttraumatic stress disorder]. There’s no such thing as OCD [obsessive-compulsive disorder]. There’s no such thing as ADHD.” It turns out that PTSD is simply grief, according to MacArthur, and depression is just a feeling of sadness or melancholy—a truth that ought to lead to the “death of antidepressants.” Certainly, many evangelical Christians were scandalized by his comments, and there has been a strong response from that community. But MacArthur was hardly put off by this, publishing a written document called “Dispelling Myths About ‘Mental Illness’: A Biblical Perspective,” in which he doubles down on his claims about psychiatry, citing the usual antipsychiatry list of grandees, including Thomas Szasz and Robert Whitaker. Antipsychiatry Zombie Apocalypse All this makes me wonder whether the antipsychiatry movement is as moribund as it seemed to be only a few short years ago. Antipsychiatry—the belief that psychiatric practice is unscientific, toxic, and oppressive—peaked in the 1970s, after all. Although not all of its criticisms of psychiatry turned out to be valid, the antipsychiatry movement did have the positive effect of spurring psychiatry toward more careful diagnosis, more scientifically justified treatments, and greater patient empowerment in the treatment process. Since the 1970s, the antipsychiatry movement has slowly faded. Although critics still raise their voices on a regular basis, those voices have become decreasingly relevant and increasingly distant from mainstream public views about the nature and treatment of mental illness. Fortunately, the vast majority of the American public now fully supports mental health diagnosis and treatment, and the struggle to enforce parity laws continues to advance. When I published a book on this subject in 2021, my biggest concern was whether it would be rendered unnecessary within a few years—the current rate of social acceptance seemed to indicate that the view of mental illness as medically treatable and real was going to achieve the status of common sense, not only among medical professionals but also the public at large. And yet, the antipsychiatry movement seems to have lurched off its deathbed and staggered into the streets. Unlike the zombies featured in most apocalypse movies, this one is armed to the teeth. Suddenly, the antipsychiatry movement has the ears of those in high places. Suddenly, the government apparatus is going into action against our field. Suddenly, government-funded research is going to switch from investigating which psychiatric treatments help us to help our patients and instead focusing on which ones might hurt us. Education Is Advocacy What are we, as psychiatrists, to do in a time like this? What we should do is what psychiatrists should always do when dealing with a crisis: Keep our heads up and stick to the science that guides us. In this case, the most important thing we can do is remember that reality is on our side. Major mental illnesses are scientifically proven to be medically real. Major mental health treatments are scientifically proven to be effective. The majority of the public wants our help, and the majority of the public has experienced mental illness themselves or in a loved one. Time and reality are on our side. As always, our job as psychiatric clinicians is to educate others, starting with our patients, their families, our own families, and our own communities. Next, our job is to explain the nature and treatment of mental illness to community groups, members of the media, and members of government. We have every reason to be optimistic that our efforts will ultimately succeed and put us back on the right path. Once people see that mental illness is a real medical illness, they cannot unsee it. And once people experience (directly or indirectly) quality mental health treatment, then nothing is going to convince them that the whole thing is a sham. There is no way of getting the genie of mental illness back into the bottle. Psychiatry is not going to go away. It is not going away because the life-or-death need for psychiatry is not going away in our lifetimes, so we will persist. We will get on with the work of treating our patients and educating our communities, and they will stand with us. Note: This article originally appeared on Psychiatric Times .

Keypoint: The government has always played an important role in health care. Recent changes, however, are actively altering the practice of medicine and are posed to have a deep and lasting psychiatric impact on patients. Learn more here. The government has always played an important role in health care: it has established agencies to ensure drug safety, created Medicare and Medicaid to improve access, etc. Recent changes, however, are actively altering the practice of medicine and are posed to have a deep and lasting psychiatric impact on patients. Although this is a rapidly evolving situation, here is a closer look at the facts as this issue went to press. Cuts to Top Health Agencies In early 2025, the US Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA), Veterans Administration (VA), and other organizations experienced huge slashes to their budgets and staff.1 Additionally, on January 20, President Donald J. Trump issued an executive order freezing government hiring.2 Elon Musk, formerly a leader of the Department of Government Efficiency (DOGE), was directed to “dismantle government bureaucracy, slash excess regulations, cut wasteful expenditures, and restructure federal agencies.”3,4 The sudden cuts, as well as terms like wasteful, have startled experts like Robin Weiss, MD, a past president of The Maryland Psychiatric Society and psychiatrist who has worked for the National Academy of Sciences, a federal advisory panel, and in private practice. “It’s exhausting and demoralizing to find that every day, the institutions one holds dear are not just being defunded but also slandered,” Weiss told Psychiatric Times. “I am 75 years old, and I worked for the National Academy of Sciences in the 1980s during the early years of the HIV/AIDS epidemic. There was plenty of warranted controversy about our country’s response, but I also got to know many public servants during those years. So many people who choose to devote themselves to public service have amazing expertise, and they often forfeit the opportunity to earn more in the private sector in exchange for meaning. They care about us—the public—and they have devoted their careers to serving us, so to watch them be treated shabbily, and their expertise dismissed, is heart-wrenching.” With much discussion on both sides, what are the actual numbers? FDA Budget: The “FDA’s budget request reflects the Agency’s support of the Make America Healthy Again (MAHA) agenda in key areas of importance for human and animal health… [which includes] $234. million... to address the nation’s chronic disease epidemic, restore trust in our food system, and strengthen America’s nutritional and food safety.” Official documentation lists a $6.8 billion budget for 2026, which represents a decrease of about $270 million compared with the FY 2025. This includes a 4% increase in user fees, now sitting at $137.3 million. Layoffs: The FDA lost 3500 full-time staffers to layoffs, including Brian King, PhD, MPH, the chief tobacco regulator, and his fellow deputies, along with Peter Marks, MD, PhD, who led the development of the COVID-19 vaccine. Even more resigned after being offered reassignment in distant US locations. Impact: The expansive staffing cuts are expected to slow public notices about recalls and product safety issues, as 130 members of the communications team were part of the layoffs. Additionally, thus far, notices that have been released contain more mistakes and less plain language, which experts fear could lead to delays in the delivery of critical information. CDC Budget: The CDC experienced significant cuts to its budget, including the rescinding of $11.4 billion in grant funding to state and local health departments, largely related to COVID-19. Layoffs: Approximately 2400 staffers from various departments and programs were laid off. Layoffs fell predominantly in areas involving deaths and injuries, apart from infectious diseases, such as programs focused on the prevention of asthma, smoking, gun violence, climate change, and more, many of which impact patients with mental illness. Also cut were the Freedom of Information Act team, the Division of Violence Prevention, and laboratory teams testing antibiotic resistance. Additionally, the research center focused on protecting worker health was almost entirely eliminated. Lastly, at least 9 high-level directors were placed on administrative leave and offered reassignment to another US Department of Health and Human Services (HHS) agency. Impact: The administration has shared that the CDC will now “focus on returning to its core mission of preparing for and responding to epidemics and outbreaks.”1 However, workforce reduction has key opinion leaders concerned that the remaining “skeleton staff” may be “capable only of performative gestures toward the work mandated by law and congressional budgets.” David Fleming, MD, who chairs the advisory committee to the CDC director and previously served as acting CDC director in 2002, expressed his concern in a recent JAMA report: “It is resulting in a federal agency that is not going to be able to function effectively." Weiss echoed this concern, sharing with Psychiatric Times that those who remain employed may be feeling traumatized by the loss of their peers. “I see a patient whose funding comes from the CDC. Some of it is now tied up in the lawsuit that the states brought against the federal government, so for right now, it isn’t cut. But there is worry that their core funding from the CDC will be cut completely in the 2026 budget. This patient coined a tragically apt term in our session: Pre-TSD, or pretraumatic stress disorder. They go to work every day and wait for the other shoe to drop. So many state and federal workers are in similar positions. It’s like a mass trauma.” Furthermore, this may impact disease prevention worldwide. The CDC maintains a repository of data for research references, and laboratories globally submit biological samples and data for historical filing; now, there are very few staff left—if any at all—to receive such information, damaging critical research infrastructure. NIH Budget: The administration has canceled hundreds of NIH grants. Furthermore, a draft of the budget for the HHS proposes a $20-billion cut for the NIH in 2026, which equates to an approximate 40% reduction. According to a recently released Senate Committee on Health, Education, Labor, and Pensions minority staff report, $2.7 billion in NIH funding for research has also been cut. Additionally, the number of new research grants hit its lowest point in more than a decade. Layoffs: The NIH lost more than 1000 employees in an initial round of firing, followed by at least 1200 jobs in April. Other dismissals included scientists involved in research on the brain, computer specialists, and nearly the entire communications staff. At least 5 directors of the NIH’s 27 institutes and centers were put on administrative leave or removed, including Eliseo J. Pérez-Stable, MD, from the National Institute on Minority Health and Health Disparities; Diana Bianchi, MD, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; Shannon Zenk, PhD, MPH, RN, FAAN, from the National Institute of Nursing Research; Vence Bonham, Jr, JD, the acting deputy director of the National Human Genome Research Institute; and Jeanne Marrazzo, MD, MPH, from the National Institute of Allergy and Infectious Diseases. Impact: Approximately $68.8 million in NIH grants related to mental and behavioral health were terminated. Because of canceled grants and loss of funding, many research labs have come to a halt, including in key research areas like Alzheimer disease. One researcher, who previously received a grant of approximately $6 million from the NIH to research the underlying mechanisms of neurodegenerative diseases, claimed, “It is not an exaggeration to say that the true cost of the NIH’s decision may be that thousands of American lives are needlessly degraded or sacrificed.” SAMHSA Budget: Approximately $1 billion in appropriated SAMHSA funds slated to help reduce the overdose crisis have been rescinded. Additionally, state and county public health departments are facing abrupt cancellations and revocations of approximately $11.4 billion in COVID-19–era funding for grants connected to addiction and mental health. Layoffs: Under the restructuring of the HHS, SAMHSA will become a part of the new Administration for a Healthy America (AHA). This restructuring announcement followed the reduction of the HHS by 20,000 employees. SAMHSA began the year with approximately 900 employees, but up to 50% of them may be part of the cuts. In a recent statement, an HHS official said, “The reorganization of SAMHSA into AHA is part of ongoing efforts to improve the efficiency and effectiveness of public health programs. By consolidating SAMHSA’s operations under AHA, we aim to streamline resources and eliminate redundancies, ensuring that essential mental health and substance use disorder services are delivered more effectively. This restructuring will enhance the ability to address public health needs by fostering a more coordinated approach to prevention, treatment, and recovery services.” Impact: SAMHSA has made profound recent improvements in addressing the mental health, substance use, and suicide crises in America. The 988 Suicide & Crisis Lifeline has helped more than 16.5 million individuals since its launch in 2022. In the past year, overdose deaths have decreased by 24%. Leaders of psychiatric organizations are deeply concerned by these new cuts and how they may undo this progress. “I am most concerned about federal cuts to agencies like SAMHSA that provide vital funding for community mental health programs, crisis services, and workforce development. These aren’t abstract line items—they’re the foundation of care for patients with serious mental illness, particularly in underresourced areas. Disrupting these supports at a time when our mental health system is already strained will deepen disparities and increase suffering. I also believe that health care funding cuts, in groups under so much strain, will also impact health care professionals who care for them and increase the moral injury they experience in the field,” Jhilam Biswas, MD, FAPA, told Psychiatric Times. Biswas is director of the Psychiatry, Law, and Society Program at Brigham and Women’s Hospital and president of the Massachusetts Psychiatric Society (MPS). VA Budget: The VA maintains a vast network of contracts that equate to $67 billion annually. In February, DOGE instructed the VA to cancel approximately 875 contracts; this number was later reduced to 585 “non–mission critical or duplicative” contracts worth $1.8 billion. Layoffs: At least 2400 VA probationary employees have already been laid off. Many of those eliminated were veterans; some could be reinstated following pending court actions. However, the administration has shared plans to eliminate 80,000 more jobs and review thousands more contracts. Impact: A decrease in staff could equal a decrease in services, with longer wait periods, fewer appointment options, and fewer services for veterans. Studies involving veteran participants and experimental treatments have been disrupted; approximately 200 research staff members involved in 300 or more trials were affected by the changes, affecting treatment for nearly 10,000 veterans. “What I think is most important for mental health clinicians outside of the VA to know is that their fellow mental health practitioners and their leaders in VA mental health are demonstrating enormous courage and integrity in fulfilling their commitment to high standards of care for veterans despite facing unprecedented challenges,” an anonymous source shared with Psychiatric Times. Terminology Under Scrutiny Although there is no official documentation, agencies and news sources have reported and compiled a list of more than 350 words that have been flagged per directives and guidance issued by the federal government (Table). These words have been eliminated from government websites and documents, and their mention can result in the cancellation of research grants or other agreements. However, the list continues to grow, and it is unclear which words are outright banned vs which should be avoided, as the directives are vague and inconsistent across agencies. “The assault on our science and on our terminology is a fundamental assault on our knowledge and our profession. We are nothing if we cannot explore all that our science and our values point us to. I would point to an example from the Reagan administration. It ruled that the word social be stricken from all federal grants and set American psychiatry back for almost 40 years. The current list of banned words and related concepts is much more extensive, and the costs in terms of progress will be substantial,” Kenneth Thompson, MD, a public service psychiatrist, told Psychiatric Times. Researchers are scouring existing grants using lists of flagged words and self-censoring future work in the hopes of improving grant likelihood. Others are moving toward safer topics to ensure they can finish their advanced degrees and move into academia. Some may leave academia altogether. “The cuts to research funding will have devastating impacts and will undoubtedly stall career pathways for many promising early-career scientists,” said Steve Koh, MD, MPH, MBA, DFAPA, chief of the General Psychiatry Division and director of the Community Psychiatry Program at the University of California, San Diego. “Restricting the language clinicians and researchers can use—whether implicitly or explicitly—has far-reaching consequences. If we cannot name the realities of public health, trauma, inequity, or systemic risk, we risk creating blind spots in care and innovation. We must not allow fear or politics to erode scientific inquiry or silence clinical truth,” Biswas said. H. Steven Moffic, MD, an award-winning psychiatrist, longtime activist, and Psychiatric Times columnist, believes these banned words are an attack on the very core of the field. “Psychiatry, at its essence, is based on word interchanges. Starting way back with Sigmund Freud, patients need to feel comfortable in expressing anything, while we have to say the right things at the right time to help patients through very uncomfortable problems that they would rather repress. All of us in mental health care and our connected organizations have to do some soul-searching about how we will react to banned words and books. This list reminds me of the book 1984. One strategy I would not recommend is just ignoring the whole matter,” Moffic said. By limiting the ways in which research can be communicated, scientific integrity is threatened, and the evidence base that informs public health policy becomes skewed. This ultimately harms minoritized populations. “Banning specific words in clinical research and health care will not erase the realities and needs of the individuals those words represent. These bans only create obstacles to studying the very populations they aim to obscure, which further emphasizes the underlying political motives behind them. Given how long the list of words is, there comes a point in time when one must ask: Which words aren’t banned? Ironically, banning words that represent minority experiences actually hurts everyone. Neglecting the distinct influences of race, gender, ethnicity, sexual orientation, and/or gender identity in research obscures vital insights that could improve health care outcomes for all,” said Scott Leibowitz, MD, a child and adolescent psychiatrist who worked in 3 academic pediatric gender clinics and is a board member at-large for the World Professional Association for Transgender Health. Many clinicians are expressing particular fear for LGBTQ+ individuals, specifically transgender individuals, who seem to bear the brunt of research censorship initiatives. “Recent actions by the federal government have completely decimated research that aims to improve the health of LGBT people. We are likely to lose an entire generation of researchers who had dedicated their careers to supporting this population, which experiences dramatic mental health disparities,” said Jack Turban, MD, a pediatric psychiatrist, author of the book Free to Be: Understanding Kids & Gender Identity, and Psychiatric Times advisory board member. “Perhaps even more insidious is that recent anti-LGBT laws and other government actions are likely worsening the health of these populations, but we will not be able to study or document these impacts to protect future generations. LGBT people already suffer from dramatic disparities in terms of both mental and physical health. These will undoubtedly worsen as we lose our ability to study and support the health of this population.” This panic has trickled down to patients and their caregivers as well, as shared by Weiss. “I have patients who are fearful: one with a transgender kid who worries that the country’s mood is turning against her child; a lesbian in a gay marriage who fears that, in an economic downturn, things could get ugly for them; others who feel defeated because there’s hate in the air.” A White House spokesman claims that this compiled list is an error and that the only words that do need to be prohibited revolve around “gender ideology”: gender, inclusion, identity, diversity, inter, intersex, equity, equitable, transgender, and trans. However, the list of banned words circulating at the National Science Foundation includes several other words that raise red flags, such as women, disability, bias, status, trauma, Black, Hispanic, socioeconomic, and ethnicity. “Many researchers in this area will try to find research funding from nongovernment sources, but there simply are not enough private foundations to compensate for this massive loss of research funding,” Turban told Psychiatric Times. Concluding Thoughts In the wake of change and uncertainty, mental health clinicians are banding together and relying on community to help navigate the new reality. “At MPS, we are actively listening to our members across the state to understand how these policy shifts are affecting their work on the ground. Our strategy is to advocate clearly and collaboratively—with legislators, community stakeholders, and other medical organizations—to protect research integrity and patient-centered care. Clinicians and researchers should know they are not alone. We must stay informed, speak up, and support our professional voice and solidarity through these uncertain times,” Biswas said. Psychiatric clinicians believe a united front is the best way to communicate the importance of mental health care for all. “It is of paramount importance to ensure that we maintain scientific integrity and keep patients at the heart of all the research work that we do. Regardless of changes from the federal government, our commitment to our patients will remain our top priority. We will continue to value and treat all patients with equal regard and respect. Some words may change but our research initiatives to seek the truth and to improve patients’ lives will not change. We encourage our colleagues to focus on our truth north of continuing to advance our knowledge and improvements to care for our patients,” Koh said. “The attacks on the funding and the direction of federal health and mental health policy will injure all populations who depend on federal policy and federal resources. All marginalized communities will feel the brunt, including communities of color and sexual minorities. Psychiatry must respond by unfalteringly continuing to build a diverse workforce that reflects the people of the nation. It must advocate for communities in need, and it must oppose the inhumane, antihuman rights initiatives of this regime,” Thompson said. “We have a hard fight before us. The questions will be: What side did psychiatry take in the struggle—for democracy or against it? For human rights or against them? For a humane, caring society or against it?” Note: This article originally appeared on Psychiatric Times .

LOS ANGELES — Vitamin D is important for brain health, but this might be particularly true for women but doesn’t appear to have this beneficial effect in men, early research suggested. The large study showed an association between greater plasma vitamin D levels in females and better memory and larger subcortical brain structures. “We found that vitamin D for women was correlated with better cognitive outcomes, but we need to do more research to find out what role vitamin D actually plays at a mechanistic level,” study investigator Meghan Reddy, MD, Psychiatry Resident, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, told Medscape Medical News . The findings were presented here at the American Psychiatric Association (APA) 2025 Annual Meeting . Protective Effects This latest study added to the growing body of literature of research on vitamin D and brain health. Previous studies have shown that vitamin D may influence cognition and brain function in older adults, potentially through its anti-inflammatory, antioxidant, and neuroprotective effects. Research also suggested it may promote brain health by increasing neurotrophic factors and aiding in the clearance of amyloid from the brain. Recent findings published in the American Journal of Clinical Nutrition suggested that vitamin D may also affect biological aging by preserving telomeres — the protective caps at the ends of chromosomes that shorten with age. Other research has also shown telomere length may help protect against brain diseases, including a study previously reported by Medscape Medical News, which linked longer leukocyte telomere length to a lower risk for stroke, dementia, and late-life depression. In the current study, Reddy and colleagues used data from the multisite Human Connectome Project to track individuals over time to understand age-related changes in brain structure, function, and connectivity. They are investigating various biomarkers that might correlate with aging, including hemoglobin, creatine, glycated hemoglobin (for blood glucose levels), high-density lipoprotein, and low-density lipoprotein, in addition to vitamin D. The idea, said Reddy, is to track cognitive health using biomarkers in addition to brain imaging and cognitive testing. The study included 1132 individuals, 57% of whom were women and 66% of whom were White. The average age was approximately 62 years, with participants ranging from 36 to 102 years old. Participants underwent neuropsychological testing to assess short-term memory and fluid intelligence — the capacity to reason and solve problems, which is closely linked to comprehension and learning. They also provided blood samples and underwent MRI scans. Researchers divided participants into two age groups: those younger than 65 years and those 65 years or older. The investigators found a significant association between vitamin D levels and memory in women (P = .04). Sex Differences “What’s interesting is that when we looked specifically at memory, higher vitamin D levels were linked to better memory performance — but only in women, not men,” said Reddy, adding that she found this somewhat surprising. In women, investigators found a significant association between vitamin D levels and the volume of the putamen (P = .05) and pallidum (P = .08), with a near-significant trend for the thalamus. In contrast, studies show that in men, higher vitamin D levels were associated with smaller volumes of the thalamus, putamen, and pallidum. There were no differences in the impact of vitamin D by age group. Sex differences in the relationship between vitamin D, cognition, and brain volume warrant further investigation, Reddy said. She also noted that the study is correlational, examining memory, brain volume, and vitamin D levels at a single timepoint, and therefore it can only offer a hypothesis. Future studies will include multiple time points to explore these relationships over time. The results did not determine an ideal vitamin D plasma level to promote brain health in women. Commenting on the research for Medscape Medical News, Badr Ratnakaran, MD, a geriatric psychiatrist in Roanoke, Virginia, and chair of the APA’s Council on Geriatric Psychiatry, said the finding that women may get more brain benefits from vitamin D than men is “key” because dementia is more prevalent among women since they tend to live longer. Other research has shown vitamin D may help manage depression in older women , which makes some sense as dementia and depression “go hand in hand,” he said. Ratnakaran recommended that women take a vitamin supplement only if they’re deficient, as too much vitamin D can lead to kidney stones and other adverse side effects. Note: This article originally appeared on Medscape .

TOPLINE: A history of depression was associated with a 14% higher risk for incident heart failure (HF) than no history of depression in a new study, even after adjusting for known HF risk factors and sociodemographic data. METHODOLOGY: This cohort study analyzed data of more than 2.8 million US veterans (median age, 54 years; 94% men; 69.5% White individuals; and 20% Black individuals) of the Veterans Affairs Birth Cohort between 2000 and 2015, with a median follow-up of 6.9 years. The included participants were free of HF at baseline and had three outpatient visits within 5 years. The time to incident HF was compared among participants with prevalent depression at baseline (8%) and those without depression at and after baseline. The analysis was adjusted for sociodemographic covariates, such as age, sex, race, and ethnicity, and clinical comorbidities and HF risk factors, such as diabetes, cholesterol, coronary artery disease, stroke, and atrial fibrillation. TAKEAWAY: Participants with depression had a higher rate of incident HF than those without depression (136.9 vs 114.6 cases per 10,000 person-years). After adjusting for covariates and cardiovascular risk factors, participants with depression had a 14% increased risk for incident HF compared with those without depression (adjusted hazard ratio [HR], 1.14; 95% CI, 1.13-1.16). Analysis of a low-risk cohort without comorbidities at baseline revealed that depression was associated with a 58% higher risk for incident HF (adjusted HR, 1.58; 95% CI, 1.39-1.80) after adjustment. Among participants with prevalent depression, men had a greater risk for incident HF than women (adjusted HR, 1.70; 95% CI, 1.60-1.80). IN PRACTICE: “Depression is a leading cause of disability around the world, affecting 4.4% of the world’s population (322 million people), and this rate continues to increase. Thus, depression remains a widely prevalent disease and a risk factor for HF that may be modifiable,” the investigators wrote. SOURCE: The study was led by Jamie L. Pfaff, MD, Vanderbilt University Medical Center in Nashville, Tennessee. It was published online on May 8 in JAMA Network Open . LIMITATIONS: This retrospective study relied on older electronic health record data and billing codes through 2015, which may have led to misclassification bias. It lacked detailed information on depression treatment and socioeconomic risk factors, and it did not compare depression with other mental health conditions linked to cardiovascular risk. DISCLOSURES: The study was funded by the National Institutes of Health . One investigator reported receiving grants from the National Institutes of Health during the conduct of the study. Note: This article originally appeared on Medscape .

Mindfulness-based cognitive therapy (MBCT) is a cost-effective treatment option for adults with major depressive disorder (MDD) who have not achieved remission through standard psychological therapies, a new study showed. Compared with treatment as usual (TAU), addition of MBCT achieved a greater reduction in depressive symptoms, with benefits sustained up to 6 months later. Improvements in participants’ work and social functioning were also observed. “We know there’s a gap in services for people with depression who haven’t got better through National Health Service [NHS] Talking Therapies,” study coauthor Barney Dunn, PhD, from University of Exeter, Exeter, England, said in a statement. “These people often don’t qualify for further specialist mental health care, and so, are left with no further options. We’ve shown that offering MBCT to this group can be effective and cost-efficient to deliver, and we hope this will lead to it being implemented widely,” said Dunn. The study was published online on May 14 in Lancet Psychiatry . Nonremission Common It’s estimated that about half of individuals with MDD fail to achieve remission after psychological therapy within the UK NHS Talking Therapies program. MBCT offers a promising nondrug option, leveraging mindfulness training to counter habitual maladaptive thinking. However, no large trials had conclusively tested its efficacy and cost-effectiveness in psychological therapy nonremitters until now. In a randomized controlled superiority trial conducted across 20 NHS services in the United Kingdom, 234 adults (mean age, 42 years; 71% women) who did not reach remission after 12 or more sessions of high-intensity therapy were assigned to MBCT plus TAU or TAU alone. MBCT consisted of eight weekly group-based sessions delivered by videoconferences and teaching mindfulness skills and how to respond more effectively to difficult emotions. Six months after treatment, patients in the MBCT group had significantly lower levels of depression symptoms than peers in the TAU-only group, with an adjusted between-group difference on the Patient Heath Questionnaire-9 of 2.49 points (P = .0006). The average effect of MBCT was in the small to moderate range, similar to other trials of psychological treatment for MDD and comparable to treatment with antidepressants. Effects were maintained up to 6 months after treatment ended, the study team said. MBCT plus TAU was superior to TAU alone in reducing symptoms of generalized anxiety and increasing mental wellbeing more broadly. Based on economic analyses, MBCT had an estimated 99% chance of being cost-effective at a threshold of £20,000 per quality-adjusted life year gained and a 91% probability of being less costly and more effective than TAU alone, the study team found. No serious trial-related adverse events were observed. This study adds “robust” evidence to existing research and brings the combined evidence to a level at which MBCT “should be considered for guideline endorsement as a further-line treatment in the UK,” the investigators concluded. Conclusive Evidence, With Caveats In a statement from the nonprofit UK Science Media Centre, Jesús Montero-Marín, PhD, Department of Psychiatry, University of Oxford, Oxford, England, said this study is a “major advance in the treatment of resistant depression.” “This work provides conclusive evidence that MBCT can be an effective and cost-effective second-line treatment option in structured clinical settings. Its implementation could lead to a substantial improvement in the continuity of care for cases of difficult-to-treat depression,” said Montero-Marín. Also weighing in, Elena Makovac, PhD, senior lecturer in clinical psychology, Brunel University of London, London, England pointed out a key limitation of the study. “By comparing MCBT plus treatment as usual with the treatment-as-usual group, we cannot definitively determine whether the observed improvements were specifically due to the MCBT or if they resulted from the fact that the MCBT group received more treatment overall compared to the control group. This improvement could potentially have been achieved with an extension of the originally delivered Talking Therapies,” Makovac said in the statement. “While research into additional treatments for difficult-to-treat depression is essential, it is even more important to offer interventions grounded in well-understood mechanisms. This process begins with a crucial first step: Answering the question of why some patients do not respond to talking therapies,” Makovac added. Note: This article originally appeared on Medscape .

Prescription stimulants taken during childhood for attention-deficit/hyperactivity disorder (ADHD) do not cause psychosis, according to a new study published on Monday in Pediatrics, contradicting what some observational studies had suggested. Instead, the new study found children with more severe attention and hyperactivity issues or other mental health conditions such as anxiety were more likely to be medicated for ADHD. These children were also more likely to experience psychotic episodes, suggesting stimulants such as Adderall were not the cause. “These results provide reassurance both to families and to prescribers that routine ADHD medication treatment is unlikely to cause psychotic experiences,” said Ian Kelleher, PhD, chair of child and adolescent psychiatry in the Centre for Clinical Brain Sciences at The University of Edinburgh in Edinburgh, Scotland, who led the trial. Kelleher and his colleagues used data from the Adolescent Brain Cognitive Development Study, a longitudinal study tracking brain development and child health in the United States. The study included more than 8300 children and teens who were between 9 years and 14 years of age from 2016 to 2020. At the beginning of the study, none of the children were taking a prescription stimulant. In the first year, 460 kids were prescribed a drug for ADHD, which included methylphenidate, dexmethylphenidate, amphetamine, dextroamphetamine, and lisdexamfetamine. They did not have information on the dose of medication. Researchers then compared rates of psychosis among these children with approximately 7900 children who were not on one of these medications. The researchers analyzed self-reported questionnaires from each child, which they filled out at baseline and again 1 year into the study. The screener for psychosis risk asked 21 questions about whether they had experienced hallucinations or delusions, and if so, how distressed they were by these experiences. Among the population taking stimulants, the drugs were not associated with psychosis after adjusting for confounding factors that can predispose a person to psychosis, including mental illness, parental income, and race (odds ratio [OR], 1.09; 95% CI, 0.71-1.56). In the unweighted analysis, children prescribed ADHD medications were about 1.5 times more likely to have had a psychotic episode than those not taking a stimulant (OR, 1.46; 95% CI, 1.15-1.84). Those who had more severe ADHD symptoms , like hyperactivity or impulsiveness, and those who had other, co-occurring mental health symptoms like anxiety and depression, were most likely to report psychotic episodes. This group, as well as boys generally, were also more likely to have been prescribed stimulants. “It’s important to recognize that any difference in risk may not be due to stimulant treatment,” Kelleher said. “If you take children with ADHD and you divide them into two groups, kids treated with medication and kids not treated with medication, those two groups are not the same.” Kelleher said previous research linking stimulants with episodes of psychosis had not done a thorough job of factoring in a person’s mental health or severity of ADHD. One observational study published in 2024 suggested higher doses of prescription amphetamines were associated with more than a fivefold increase in the risk of developing psychosis. A 2023 meta-analysis also cited studies suggesting taking higher doses of stimulants than typically prescribed for ADHD could cause psychosis. An observational study published in 2024, in the Journal of the American Academy of Child & Adolescent Psychiatry, concluded that while risk for psychosis was low, taking amphetamines and atomoxetine for longer periods of time may increase a person’s risk for psychosis. However, the authors of the meta-analysis did note that clinicians may have misidentified a child’s symptoms as ADHD instead of signs of psychosis. In addition to factors like race and age, researchers should consider that hallucinations and delusions are “quite common” during childhood, said Melissa Batt, MD, MPH, an assistant professor of psychiatry at the University of Colorado Anschutz Medical Campus, Aurora, Colorado, who was not involved with the trial. They should take this knowledge into account when looking into potential causes of psychotic episodes in kids. “They are usually fleeting and usually go away,” Batt said, adding that only a small number of young people who report having a psychotic episode are eventually diagnosed with a psychotic disorder. “Upwards of 90% do not go on to have a diagnosis,” she said. Batt said one limitation of the study was the 9- to 14-year-old age range. “They are missing a pretty critical range of folks, especially older teens and people in their 20s. Those are the ages that we see who develop psychosis or mania,” she said. Batt agreed observational studies left out a lot of factors that could connect psychotic episodes to influences other than stimulant medications. Family history, she said, is a huge influence in whether a person develops a psychotic disorder. Future trials should build on these new findings and take different patient characteristics into account, she said. “We should be looking at family history, other medications they are taking, they could be using other substances such as cannabis, which they didn’t control for,” she said. “That is a huge variable we should be looking at.”. Note: This article originally appeared on Medscape .

Psychiatrists and sleep physicians may be using the same medications to treat certain issues... so why not work together? Sam A. Kashani, a sleep physician, discusses the impact of sleep medication on psychiatric disorders and how the treatment team can best work together to improve outcomes. As discussed in a previous video , collaboration between psychiatrists and sleep physicians helps improve "the whole picture" for the patient, especially since psychiatric and sleep clinicians have a lot of overlap in terms of prescribing pharmacologic treatments. "Collaboration is everything, especially when it comes to prescribing medications," shared Kashani. According to Kashani, narcolepsy is often underdiagnosed, as there is often a long delay from the onset of symptoms to the time of diagnosis. It is also mistaken for major depressive disorder or attention-deficit/hyperactivity disorder (ADHD) . It is therefore important for clinicians to tease out the disorders they are dealing with, which can be difficult. "It's very common to have narcolepsy with comorbid ADHD or with comorbid mood disorders or anxiety," said Kashani. "Because there's so much overlap in the medications that are used for these specific entities, I just feel that collaboration is the first and foremost thing." Note: This article originally appeared on Psychiatric Times .

Key Takeaways Pediatric sleep disordered breathing often resolves with tonsil and adenoid removal, unlike adult cases. Insomnia in children is managed with behavioral interventions, while adults may require medication. Treatments for hypersomnias like narcolepsy are similar across adult and pediatric patients. Treatment approaches for sleep disorders are case-dependent, highlighting the need for individualized care. What's the difference between sleep disorders in adult patients vs pediatric patients? Quite a lot, shares Sam A. Kashani, a sleep physician and expert. He describes a number of specific points of difference, including: Sleep disordered breathing, such as sleep apnea, is treated differently in pediatric patients. If pediatric patients still have their tonsils and adenoids, removing them can resolve sleep disordered breathing. Pediatric patients are typically not prescribed medication for insomnia. Evidence has demonstrated that behavioral measures and treatments are sufficient and effective. Adults may be less inclined to want to try behavioral treatments. However, notes Kashani, treatment for hypersomnias like narcolepsy are relatively the same between adult and pediatric patients. "It really just depends on the case," said Kashani. Note: This article originally appeared on Psychiatric Times .