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Alkaloid 7-hydroxymitragynine: What is it, and what are the risks? Keypoint: Kratom is an herbal extract that comes from the leaves of a tree in Southeast Asia. Kratom-7 OH is a synthetic form of kratom that is highly potent. Kratom-7 OH has risks similar to opioids. Kratom, a Southeast Asian tree in the coffee family, has become widely available in the United States in various forms for several years now. It is often sold at convenience stores, gas stations, and online. As an addiction psychiatrist, I saw use and abuse of kratom explode during the COVID-19 pandemic. This herbal extract has been used medicinally for centuries in Thailand and other Asian countries. Its leaves have traditionally been chewed or smoked as a remedy for managing pain and fatigue. In the United States, manufacturers have sold it in pill or capsule form to treat mood, pain, and insomnia. Kratom has a familiar story in the drug world: an exotic herbal with a long history in Eastern culture, once brought to the West, becomes highly touted for its medicinal benefits and as a cure-all for many ailments. As it became more available in the United States during COVID-19, evidence of its addictiveness grew. Though kratom was promoted as a cure for pain, insomnia, anxiety, and depression, people began using it for opioid withdrawal as well. In low doses, it acts as a stimulant and in higher doses as an opioid. The extract of the plant can be turned into a liquid product, which is marketed as a treatment for muscle pain, cramps, and diarrhea. It is widely available in Florida, where I practice, and is found in local stores, gas stations, and strip mall smoke and vape shops. Many of the benefits don’t generally pan out. Additionally, there are serious side effects, including liver toxicity, seizures, and psychosis. It has a strong addictive potential. Detoxification from kratom looks like detox from opioids and can be very rough. Withdrawal symptoms include: Joint and bone pain Runny nose Diarrhea Mood swings Depression Anxiety Irritability Tremors Chills Sweating Pin-point pupils Gooseflesh Kratom is not regulated under the Controlled Substances Act, and the Food and Drug Administration (FDA) has not approved kratom for any medical use. The U.S. Drug Enforcement Administration lists it as a Drug and Chemical of Concern. In 2023, the state of Florida banned kratom sales to individuals younger than 21, but legislation to ban sales altogether has not passed. The risks and addictive potential make kratom a far more complicated and potentially dangerous product than its marketing would have you believe. Synthetic Kratom More recently, kratom-7 OH has surged through areas of Florida. It has been available in the form of eye-catching products like gummies, drinks, and powders, and, again, promoted as a safe “health” product that can benefit many ailments. Kratom-7 OH is an alkaloid found in kratom leaves at low levels. Clever manufacturers have isolated kratom-7 OH from the leaves into a concentrate, making it a highly potent synthetic form of kratom. And very addictive. Kratom-7 OH has been marketed as 7-hydroxymitragynine, 7-OH-mitragynine, 7-OHMG, 7-Hydroxy, 7-HMG or 7. Legal Implications Nationally, the FDA Commissioner, Dr. Marty Makary, took initial steps to place kratom-7 OH on the federal schedule of dangerous drugs in August of this year. The FDA has also labeled kratom-7 OH as an emerging opioid threat, given its action on the body’s opioid receptors, its potency, and its addictive potential. Following the FDA announcement in July 2025, Florida passed an emergency ban on sales of kratom-7 OH in August 2025. New Research Older and more recent animal studies have shown that there may be an overdose risk with kratom-7 OH, with respiratory depression shown to be three times greater than morphine. Kratom-7 OH potency in a recent study was 13 times that of morphine. Many patients I see are seeking treatment for addiction to kratom-7 OH, with signs and symptoms of opioid withdrawal when they stop using it. They have struggled so badly with withdrawal that they have gravitated to other addictive and harder drugs as well to ameliorate their symptoms. Cautionary Tales During the thick of COVID-19, I treated a patient who was addicted to kratom. He was in his late 30s and until recently had been a healthy athlete. He started taking kratom for mood and energy, and was initially happy that it helped him with his physical training. He became addicted and found it difficult to stop using. He had started to drink alcohol excessively to reduce the pain of kratom withdrawal. He fell into depression as well, but after entering treatment and completing detox, his mood improved. He is now doing well in recovery. More recently, we treated a patient with kratom-7 OH addiction. In her 20s, she came in for detox, having been unable to stop using it, which resulted in her losing her job. Her detox symptoms were identical to what we see with opioid withdrawal, but as intense as what we see with fentanyl, a highly potent opioid. She had started using alcohol and cannabis heavily as well to reduce her symptoms. Instead of the benefits to her mood, she had developed depression. All of this came from some gummies she bought at a vape shop in the panhandle of Florida. Treatment was difficult and challenging. It certainly gave us insight into how dangerous some products marketed as health foods can be. Note: This article originally appeared on Psychology Today .

Early research has linked Alzheimer’s disease (AD) medications cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists to modest cognitive benefits in children and adolescents with autism spectrum disorder (ASD) and comorbid cognitive disability. The preliminary evidence, which is drawn from a mix of randomized controlled trials (RCTs), cohort studies, case series, and case reports suggests these medications most frequently had a positive effect on learning and memory, though some improvements were also reported in complex attention, executive function, perceptual-motor functioning, and general cognitive ability. The only three drugs assessed were donepezil, rivastigmine tartrate, and memantine. “Given the lack of FDA-approved treatments for cognitive impairment or core features of ASD, these findings highlight a critical opportunity to explore the therapeutic potential of these pharmacologic classes for improving neurocognition in this population,” investigators led by Nicholas Diamandis, research coordinator in the lab of senior author Kristina Denisova at The City University of New York, New York City, wrote. “Given the promising evidence synthesized in the present scoping review, there may be a need to shift focus from treating core symptoms of ASD (social communication, restricted or repetitive behaviors or interests) to cognitive abilities,” they added. Most of the studies were small, however, and several relied on findings only from case reports. The authors also noted substantial differences in what improvements were reported based on the age of the participants with younger children showing greater potential benefit and durations of treatment, which ranged from 1.5 to 212 weeks. The study was published online on November 17 in Translational Psychiatry . Potential Autism/AD Link Children with ASD and co-occurring intellectual disability (ID) face particularly poor cognitive-development trajectories and have a nearly threefold increased risk of developing AD in later life compared with those without comorbid ID and the general population. This suggests there could be an important mechanistic link underlying ASD and AD and that “individuals with these conditions may stand to benefit from similar psychopharmacological treatments,” the investigators noted. To evaluate and synthesize the evidence on the effect of AD medications on neurocognitive outcomes in children and adolescents with ASD and low intelligence quotient (IQ) the researchers conducted a scoping review. The investigators searched PubMed, PsycInfo, Scopus, and Web of Science to conduct a scoping review of studies in any language published through May 2025 that published empirical results on the use of FDA-approved AD medications in individuals aged 2-21 years with ASD and an IQ at least one SD below the mean. The review included studies evaluating any of these AD drugs: donepezil, galantamine, rivastigmine, benzgalantamine, memantine, aducanumab, lecanemab, or donanemab. The studies also needed to provide an estimate of intellectual ability and at least one outcome in one of the six domains of neurocognitive ability. These include complex attention, executive function, learning and memory, language, perceptual-motor function, and social cognition. Of 404 studies initially identified, 12 studies, with a total of 353 participants and published between 2002-2024, met the criteria. They included four RCTs, a prospective open-label trial, a retrospective open-label trial, two retrospective observational studies, three retrospective case series, and one case report. The majority of studies were conducted in the US, one was conducted in Canada, and two in Israel. Mixed Findings Six of the studies, with 152 combined participants, reported on treatment with a cholinesterase inhibitor, mostly donepezil plus one on rivastigmine tartrate. The other six studies included 201 participants and reported on the NMDA receptor agonist memantine. Four of the five studies assessing language reported statistically significant improvements following treatment with a cholinesterase inhibitor. These included two RCTs of donepezil — one showing gains in receptive language among children but not adolescents, and another demonstrating improvements in both receptive and expressive language. Two retrospective case series, one involving donepezil and the other rivastigmine tartrate, also reported improvements in expressive language. Of the two studies evaluating executive function, a retrospective open-label series reported improvements in hyperactivity with donepezil, and another study showed gains on the Delis-Kaplan Executive Function System sorting test during an open-label extension that followed a negative RCT. Only one study assessed complex attention, and it showed improvement after treatment with rivastigmine tartrate. Two studies reported on general cognitive ability, with one finding significant improvements after 12 months of donepezil and the other finding no improvement. Some Notable Improvements Among the five studies reporting on memantine treatment and language, three of them showed improvements, but one was a case study and another was a case series of two patients, with both relying solely on clinical evaluations and caregiver reports rather than objective assessments. The third was a retrospective case series. Four studies reported on executive function, and three found improvements. These included one case study and two observational studies, one retrospective with 18 participants and one prospective with 14 participants. The same case study showed improvement in complex attention, the only study to report on this outcome with memantine, and it was among two of the three studies reporting improvement in visuospatial abilities. The other showed improvement in one of eight children in a case series. One of the two studies reporting on general cognitive ability reported improvement, a small RCT in which five of seven participants receiving memantine improved in verbal IQ while no participants receiving placebo improved. Finally, both studies looking at learning and memory after memantine treatment found significant improvements, 1 in 23 children after 24 weeks of treatment (but not 12 weeks) and 1 in 14 children after 8 weeks of treatment. Although the results of the review suggest justification for further investigation of these medications in populations with ASD and low IQ, the authors emphasized both the lack of safety data for these medications in children and the poor understanding of how the drugs might work in pediatric patients. More Research Needed Commenting on the findings, Glen Elliott, MD, PhD, chief psychiatrist and medical director at the Children’s Health Council and part-time associate training director at Stanford Medicine’s Division of Child and Adolescent Psychiatry in Stanford, California, agreed that more investigation is necessary before any of these medications could be considered for pediatric populations. “It’s far too early to believe that either of these medications are going to be provide a major contribution to the outcome of children with autism,” Elliott, who was not involved in the research, told Medscape Medical News . “The summary of the results are that we could call for more research, but these are not likely to become mainstream medication for use in autism spectrum disorder.” Even with AD, Elliott noted that the therapeutic benefits of these medications can be marginal. Just as autism is complex, so is cognitive dysfunction, so attempting to identify therapies that address both is even more challenging, he added. While both Elliott and the investigators noted that it’s not entirely clear why a drug with potential benefits for AD might also offer therapeutic value in children with autism autistic children, a leading hypothesis they both identified is that the drugs may influence the brain’s neuroplasticity, “particularly with language,” Elliott said. “You’d like the language areas to be more amenable to change, and these drugs may have that effect,” he added. Like the investigators, Elliott underscored the importance of continued investigation into treatments for autistic children with significant cognitive dysfunction because many of those families feel left behind by autism research. “The people who did these studies should be applauded for working on this particular population with medications that are different than what have been used traditionally,” Elliott said. “We don’t have much to offer this population in terms of medications .” But he also does not advise that families try giving these medications to their autistic children, and even if they did so, they’re unlikely to see significant, notable improvement. Statistically significant results reported in these studies do not necessarily translate to clinically significant results, and the medications are unlikely to make a substantially noticeable difference in everyday life, he said. “These are very modest results and certainly not what would be considered a breakthrough,” he said. Note: This article originally appeared on Medscape .

David Beuther, MD, PhD, isn’t quite sure how to define his presence on social media. He’s online regularly, but he’s not publishing posts or sending friend request. Instead he’s observing, what is being discussed online related to healthcare. While he’s often encouraged by the availability of helpful information that is shared by reliable sources, he’s equally worried how quickly misinformation and unsubstantiated claims can spread — often to those who should instead be receiving care and guidance from their providers. Among the more troubling viral conversations are those involving supposed strategies to getting a better night’s sleep. “It’s certainly understandable that people are looking for solutions because sometimes it feels like nobody is sleeping very well anymore,” said Beuther, professor of medicine at National Jewish Health, Denver. “And that can range from not getting enough sleep, irregular sleep, poor sleep quality , or insomnia. There are many different things that can contribute to these prevalent problems, and many times the solutions are not quick fixes. Sometimes the solution is spending time with your doctor, but people struggle to find that time these days. And that’s fertile ground for trying to solve problems outside of established proven medical interventions.” Beuther and others said it’s important for pulmonologists and other clinicians to be aware of the various sleep trends that are becoming popular, whether they’re rooted in online platforms or not, to improve awareness about the dangers being presented to patients, and to help identify symptoms that could be associated with unhealthy “sleepmaxxing hacks.” Tempting Sleep Trends More often than not, patients often attempt at-home sleep remedies due to difficulty managing prescribed treatments such as continuous positive airway pressure, bilevel positive airway pressure, and cognitive behavioral therapy. Common examples of trends today include the use of aerosol or topical essential oils, drinking nonalcoholic “sleepy girl mocktails,” consuming cannabis-based ingestibles, practicing “bed rotting” (spending extended time in bed during times of nonsleep to feel more rested) and perhaps most likely mouth taping. Mouth taping is the use of medical or hypoallergenic tape to seal the lips closed during sleep to prevent mouth breathing. “That’s the trend that I’m most concerned about,” said Beuther. “A lot of these types of trends come and go, but this mouth taping has been out there for well over a year. It’s certainly not a flash in the pan, and many people are doing this. And there’s real serious concern because there isn’t any good evidence that mouth taping does anything to help someone. It could be dangerous.” Other problematic trends include the overuse of the supplements melatonin and magnesium, two products that might be helpful when used in moderation but have become popular for being taken in excess. “Melatonin is generally safe; however, taking it at high doses could cause problems,” said Jeffrey Chester, DO, medical director at Ohana Luxury Addiction Treatment Center in Kailua-Kona, Hawaii. “Melatonin could also potentially interact with other drugs like selective serotonin reuptake inhibitors and cause sedation the next day,” he said. Sudha Tallavajhula, MD, a professor at the McGovern Medical School, University of Texas Health Houston, and medical director of TIRR Memorial Hermann Neurological Sleep Medicine Center in Houston, said pediatric specialists in particular are cautioning against the use of melatonin in children, which can lead to emergent situations if administered incorrectly, and could include additives that are harmful in their own right. “And magnesium is another commonly advertised sleep supplement that can also be harmful at high doses,” said Tallavajhula. While Beuther said he’s not yet having frequent encounters with patients who are mouth taping, he believes his clinic is a bit of an outlier based on the patient population, which skews toward older adults. “They’re slower to adopt these viral trends,” he said. “Older patients are often more medically experienced and understand better that they’re going to talk to their doctor before doing something because their health has been a problem longer.” He said it also appears that those who are living with more serious chronic lung conditions aren’t typically trying activities that they might read about online without talking to him. “But I have had patients who have asked me about mouth taping,” he said. “It’s been prevalent enough that I feel the need to be able to answer intelligently when patients ask about it and to know what’s out there, what the evidence is showing, and knowing what the concerns are.” For those patients who have experimented with trends, restricted airflow during sleep can occur with mouth taping while “bed rotting” can lead to disruption in circadian rhythm and lowered sleep drive, said Gunjan Narwani, MD, MS, a neurologist with Houston Methodist Clear Lake Hospital, Nassau Bay, Texas. “For example, in those individuals with nasal obstruction or sleep apnea, mouth taping could seriously affect airflow during sleep, further exacerbating the ability to breathe,” she explained. While these risks might not be high, especially among younger patients, Beuther worries that breathing could quickly become compromised if any lingering congestion becomes worse after falling asleep. “The mouth is an important relief valve, and everyone gets a cold where we can’t shut our mouth at night because that’s the only way we can breathe,” he said. “The other thing that can happen is there may be increased resistance to breathing at night, which causes increased respiratory effort to get adequate breathing. And that can be disruptive to sleep and can create more negative pressure or almost suctioning in the chest. That increases the risk of reflux and aspiration into the lungs.” Focus on Screening According to the National Sleep Foundation, an estimated 50-70 million Americans experience some type of sleep disorder. The key is appropriately identifying these individuals when they’re in the presence of a healthcare provider, said Beuther.“There’s a lot more need out there that has to be met,” he said. “We have an aging population, and our healthcare system is not doing well in just about every aspect. Patients don’t have the access to care that they need, healthcare is getting more expensive, and as patients get older, there’s an epidemic of multiple chronic conditions. I think a lot of patients are struggling to get help.” Aside from respiratory conditions including asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD), comorbid factors contributing to sleep issues can include congestive heart failure, reflux, sinus issues, arthritis and other types of chronic pain, diabetes, and obesity. “There are a lot of different pulmonary and nonpulmonary problems that can disrupt sleep,” said Beuther. “Sleep problems are not all about weight, but these weight-related issues and the obesity epidemic directly cause a lot of problems. Weight causes a particular problem at night with breathing, the mechanical effect of your lungs, the increased risk of sleep apnea, and the increased risk of reflux.” Anxiety is also a culprit and can be brought on by several factors, including a tendency to become fixated on one’s sleep struggles. “There’s a lot going on in the world,” Beuther said. “The world moves much faster than it used to. People are much more tied to electronic devices and hits of dopamine from various sources. It seems like we as a society are more anxious.” With time constraints being felt by providers and patients alike, Beuther and others suggest directly asking about each patient’s sleep to aid diagnosis and raise general awareness about the propensity for sleep problems. “I think we often forget to ask about sleep, or maybe we’re afraid to ask because it can be a long conversation,” said Beuther. “I think what we hear back today about patients’ sleep patterns is a longer and more complicated answer than it used to be. But patients really want to talk about this and, oftentimes, this is a top priority for them. Asking the open-ended question, “How is your sleep?” can start the conversation.” Narwani said she is quite methodical about how she enters these discussions. “I take detailed histories from my patients about their sleep, including what they may be doing in order to troubleshoot concerns they have with either the quantity or quality of their sleep,” she said. “If I identify behaviors that are lacking in evidence or that may be potentially harmful, I make sure to not only discuss them but also work towards developing strategies to address the problems using more evidence-based methods.” There are also patients who are adherent with their ongoing sleep therapies who can still experience disturbances as a result of those treatments. “Once we get the durable medical equipment, these artificial devices in your environment can make some things with sleep difficult,” explained Beuther. “You typically have a noisy, heat-generating appliance plugged into your oxygen tubing. And some people have trouble with the tubing because they get tangled in it. Sometimes the equipment generates so much heat that patients can’t keep their room cold.” While sleep can be improved with effective treatment of existing conditions, there aren’t always easy solutions. Overnight asthma symptoms can be particularly challenging for sleep, said Beuther. “There’s shortness of breath, cough, and waking up needing to use the inhaler,” he said. “There’s that circadian variation where inflammation in the body is at its highest around 3 AM. If asthma is not well controlled, many patients will experience waking up with respiratory symptoms.” General mucus buildup overnight can also disrupt sleep and should be part of the conversation in clinic. “We always want to ask about that because it’s a sign that maybe there’s an opportunity to do better to control conditions,” said Beuther. “It’s really important that we ask about this in asthma, COPD, bronchitis, and other respiratory health issues. Oftentimes, if the condition is very well controlled, patients do better with sleep.” Need for More Research For now, there have not been enough valid studies conducted to objectively determine any real benefits to various viral sleep trends. “There have been numerous small studies that are very poor quality,” said Beuther. “Almost no study of any quality has looked at mouth taping by itself without some other intervention.” Tallavajhula said some patients might be frustrated to learn that the best advice to improve sleep is to avoid these trends and to implement better sleep hygiene habits, such as lack of food and drink close to bedtime, consistent bedtimes and wake times, behavioral techniques, and to give sleep the priority it deserves by consulting a sleep specialist. Beuther also suggested environmental adjustments, such as keeping the bedroom quiet and dark as well as not watching TV, reading, or scrolling on a phone soon before bed. “There are different examples of behavioral aspects of sleep,” he said. “The majority of the population does a lousy job of that. Sleep is complicated, and I don’t think laypeople understand it very well.” Note: This article originally appeared on Medscape .

How neuroinflammation is misdiagnosed and mistreated by clinicians. Key points Kids with inflamed brains are misdiagnosed with behavior problems instead of neuroimmune conditions. Standard intakes miss infections, flares, and neuroimmune red flags that precede “sudden” psychiatric decline. Before labeling kids, we must rule out neuroinflammation and treat the immune system, not just the behavior. Our children are sitting in therapy offices with inflamed brains. Psychiatrists are prescribing medications for immune-driven symptoms. Parents are being counseled on behavior while their child’s immune system attacks the brain. This is not rare. This is systematic. The mental health system is structurally designed to miss neuroimmune disease, not because clinicians are incompetent, but because the diagnostic framework itself cannot see what it was never built to recognize. Every intake form, every assessment protocol, every treatment algorithm moves a child with brain inflammation directly into psychiatric care without ever asking if the brain itself is diseased. For example, a mother brings her 12-year-old daughter for a psychiatric evaluation. The intake focuses on family stressors, school functioning, trauma history, mood patterns, and behavioral challenges. What the therapist does not ask is equally important. No one asks whether she was recently sick. No one asks about tick exposure, sudden cognitive slowing, episodes where she seems disconnected, or rages that look panicked rather than oppositional. No one asks whether symptoms shift dramatically from one day to the next in ways that do not fit any psychological pattern. Or if there are significant fluctuating changes after she gets sick. This is not due to incompetence. The standard intake form does not include these questions. The diagnostic model does not recognize these clues. The child has a neuroimmune disorder. The intake will not uncover it. Psychiatric treatment starts. Her condition worsens. And because no one is trained to consider brain inflammation, no one identifies the true cause. How the System Misses Neuroimmune Root Causes The mental health system is structurally incapable of recognizing neuroimmune disease. Psychiatrists are trained in psychopharmacology, not immunology. Therapists are trained to observe symptoms from a psychological perspective, not infectious disease. We operate in separate domains. A child with brain inflammation falls through the gaps. Our diagnostic categories describe phenomenology, not causation (Insel, 2013). "Major depressive disorder" tells us about symptoms, nothing about whether those symptoms originate from monoamine deficiency, hypothyroidism, or brain inflammation. We treat the category without investigating the mechanism. Before psychiatric diagnosis, we should rule out five critical neurological root causes (Gertel Kraybill, 2020): underlying infections (including PANS/PANDAS and autoimmune encephalitis) traumatic brain injury medication side effects genetic predisposition environmental factors Yet insurance reimburses therapy and medication management but resists comprehensive medical workups for "behavioral" symptoms (Swedo et al., 2012). The system incentivizes psychiatric treatment rather than medical investigation. What Neuroimmune Reactive Avoidance Reveals Neuroimmune Reactive Avoidance (NRA) is a framework I developed to understand how immune dysregulation produces specific behavioral manifestations often misidentified as psychiatric resistance (Gertel Kraybill, 2025). The avoidance is not psychological; it is a direct neurological consequence of neuroinflammation. Read more about NRA here. When the brain is inflamed, it cannot properly execute motor planning and behavioral initiation. When the prefrontal cortex is compromised by immune attack, it cannot regulate impulse and emotion (Dalmau & Graus, 2018). The child experiences demand as neurologically intolerable because the neural circuits required to respond are actively compromised. This is why cognitive-behavioral interventions fail. We attempt to modify behavior by engaging cognitive processes in a brain that cannot execute those processes. The inflammation must be addressed first. Distinguishing Clinical Features Parents describe children as "not there," having vacant eyes, and confused by their own behavior. This is altered consciousness and loss of volitional control, not anxiety or opposition. Symptoms fluctuate with immune activity. A child is functional for three days, incapacitated for two, and then functional again. This correlates with immune flares (Chang et al., 2015; Gertel Kraybill, 2025). Psychiatric conditions don't fluctuate in this way. The symptom constellation crosses domains: avoidance plus motor tics plus urinary urgency plus handwriting deterioration plus sleep fragmentation plus sudden food restrictions (Gertel Kraybill, 2020). These reflect inflammatory processes affecting multiple brain regions. Most significant is the response to immunological treatment versus psychiatric treatment . When immune dysregulation is addressed, symptoms can improve dramatically (Frankovich et al., 2015). With only psychiatric medications, improvement is minimal or absent. The Moment a Child Is Saved or Lost A 10-year-old develops strict avoidant/restrictive food intake disorder (ARFID) and almost stops eating, repeating, "I want to die." Door #1: Intake. Depression diagnosis. SSRI prescribed. Activation syndrome. Switch medications. Antipsychotic added. Day 120: Three medications, out of school for four months, parents devastated, marriage fracturing. The child has autoimmune encephalitis. Every day without treatment, inflammation continues. The condition becomes more chronic and resistant to any intervention. Door #2: Day 1: Clinician recognizes acute presentation, asks about recent illness, and refers to a neurologist. Day 7: Elevated inflammatory markers, positive autoantibodies, recent strep. Day 8: Treatment begins. Day 14: Significant improvement, child is eating, and suicidal ideation has resolved. Day 30: Continued improvement with accommodations. The difference is medical treatment of disease versus years of psychiatric intervention for symptoms caused by untreated inflammation. The difference is medical treatment of disease versus years of psychiatric intervention for symptoms caused by untreated inflammation. The Mother Who Knew Her son got the flu. Two weeks later, everything collapsed. He could not tolerate anyone speaking, developed tics, washed his hands compulsively, and screamed about things touching him when nothing was there. The pediatrician said it was anxiety. The therapist said it was OCD. The psychiatrist said they should start an SSRI. She kept repeating that it all began after he was sick and that something was wrong with his brain. They kept insisting that children can develop anxiety suddenly and that he needed therapy and medication. She documented every symptom. She found information about PANDAS, brought articles to appointments, and was dismissed. She was told it was controversial and that her son simply had anxiety. Eventually, she found a PANS-informed doctor four hours away and paid out of pocket. Testing showed elevated strep antibodies. Treatment began. Her son improved. She spent six months fighting every professional. Her son's pediatrician and two others told her she was wrong. But what happens to parents who trust the system? What happens to families without resources? Those children fall apart while everyone believes they are doing the right thing. I Am That Mother My story is different yet grounded in the same core reality. I was dismissed repeatedly by medical providers even though I, as the parent, held the only complete perspective on my child’s symptoms and their timeline. This should never hinge on whether I am a therapist or a stay-at-home parent. Clinicians must recognize parents as the primary source of information, the ones who witness the onset, the pattern, and the suffering, and who hold the deepest authority on their child’s well-being. What Must Change Medical screening before psychiatric diagnosis. For any child with acute-onset neuropsychiatric symptoms, medical rule-outs should be mandatory: inflammatory markers, autoimmune screening, and infection testing. If red flags exist, there should be an immediate neurology referral. Integrated training. Every mental health professional should recognize presentations warranting neuroimmune investigation and know when to refer. Interdisciplinary care. We need clinics where psychiatrists work alongside neurologists and immunologists. These are extremely rare. For Parents and Clinicians Parents: You know something is medically wrong. Your knowing is dismissed as denial. You watch treatment fail while being counseled on consistency. Trust your observations. Document everything. Find clinicians who investigate rather than dismiss. Do not accept a diagnosis until neuroimmune root causes are ruled out. Clinicians: We are failing these children and their families. Learn to recognize these presentations. Develop relationships with neuroimmune specialists. Refer early. Listen when parents insist that something is medically wrong. This Reality Is Unacceptable When a child presents with NRA, we are looking at brain inflammation producing neurological symptoms that manifest behaviorally. Until our diagnostic frameworks, training, insurance systems, and clinical practice align around this reality, children and their families will continue to suffer from well-intentioned treatment of the wrong thing. We know how to identify these conditions. We know how to treat them. We are simply not doing it. This should enrage us. That anger belongs in the service of real systemic change for children who are suffering. As a PANDAS and autoimmune encephalitis mother, I am heartbroken by the consequences of uninformed medical care and by professionals who are not willing to listen or to treat my son appropriately. Week after week, new data show how strongly the immune system shapes neuropsychiatric symptoms. It is no longer acceptable to ignore this science. We must all get informed. Note: This article originally appeared on Psychology Today .

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

A familiar diagnostic tool also has other uses, including in the brain. Key points Successful detection of enemy submarines paved the way for the use of ultrasound in medical diagnosis. Low-intensity ultrasound’s gentle warming is used to treat damaged muscles A high-intensity focused beam may become a treatment option for Parkinson’s disease. As with deep brain stimulation, attempts will be made to establish a wider use in psychiatry. Medical ultrasound is widely known. Cardiologists use it to check the heart is pumping normally. Ophthalmologists use it to check for detached retinas and for tumors. But its most familiar application is probably in obstetrics. Ultrasound scans display the fetus in the womb. They enable early identification of gender and of various possible abnormalities and they allow the obstetrician to check that the fetus is growing normally. In the United States, a pregnant woman might receive 3, 4, or even 5 ultrasonograms in the course of her pregnancy. Since there are over 5 million pregnancies each year in the US alone, we can assume that many people are familiar with ultrasonography. Whilst medical ultrasound is widely known, its military origins are not. At the end of the 19th century, Francis Galton, an English scientist, discovered sound waves beyond the range of human hearing. Dogs could hear them but humans could not. The search for practical applications began in 1915, during the First World War. It had nothing to do with health care. German submarines were becoming a menace to Allied shipping. A Russian émigré in Paris, Constantin Chilowsky, suggested that the submarines could be located by sending ultrasonic waves into the sea. When they struck the submarine, the waves should be reflected back: the echo effect. The French government asked the eminent physicist Paul Langevin to investigate. He set to work, using a quartz crystal to generate the waves in a large water tank containing small fish. The experiment was successful. Gradually, scientists learned how the properties of ultrasonic waves varied with wavelength and intensity. Striking a hard surface, they could be reflected, like sounds echoing in a tunnel. During the Second World War, reflected ultrasound became "Sonar," and was successfully used to detect enemy submarines. Langevin had also noticed that small fish swimming in the tank died. From Ocean to Clinic Inspired by wartime experiences, in the 1940s and 1950s medical interest in ultrasound flourished. Radiologists, neurologists, oncologists, and, later, gynecologists and obstetricians all experimented with using it diagnostically. There were successes and failures. Attempts to locate brain tumors failed, partly because the skull was too hard and impenetrable. Despite initial professional skepticism, by the 1970s, ultrasonic scanning was becoming routine in obstetrics and gynecology. Ultrasonic waves don’t only reflect. The death of the fish in Langevin’s experiment was due to something else: The waves produced heat. Some medical practitioners began to use ultrasound therapeutically. In the 1940s, an excess of postwar enthusiasm led to unrealistic claims for ultrasound treatments. But growing understanding of how the properties of ultrasonic beams depend on frequency and intensity paid off. Damage to muscles could be treated using the warming effects of low intensity ultrasound. This led to its now well-established use in physiotherapy. In the 1950s, William Fry at the University of Illinois showed that a focused high-intensity beam could surgically destroy affected tissue. Fry and colleagues then began treating patients with Parkinson’s disease. They treated 50 patients successfully, and then stopped. Treating Parkinson’s Disease Parkinson’s disease involves deterioration in a specific area of the brain. Its most familiar symptoms are slow and involuntary movements, and muscular tremors. But at an advanced stage it can give rise to depression, cognitive dysfunction, and behavioral disorders. There is no known cure. At the root of the problem is a lack of dopamine, a neurotransmitter which plays a vital role in passing instructions from the brain to the muscles. The Illinois researchers stopped their work on Parkinson’s disease because of a simpler pharmaceutical alternative. In the 1960s, clinical trials found the drug Levodopa effective in treating disease symptoms. Administered orally, Levodopa is converted to dopamine in the brain. Approved by the FDA in 1970, Levodopa was soon used widely. Nevertheless, it was no miracle drug. It isn’t always effective, and used over a long period of time, its effects can fade. In the late 1990s, the search for alternative treatment options led to approval of deep brain stimulation (DBS). DBS uses electrodes surgically implanted in the brain to stimulate and reactivate failing regions. It’s not known how exactly it works, although today more than 200,000 people benefit from it. However, because the procedure is invasive, it involves a degree of risk. A non-invasive alternative is now entering the clinic. It’s ultrasound again, but at high intensity and highly focused. It is known as Focused Ultrasound (FUS). FUS is a technologically-updated version of what Fry once tried: By converging ultrasound energy at precise focal points, FUS can destroy tissue or open the blood-brain barrier without a single scalpel cut... It's like using a magnifying glass to focus beams of light on a point and burn a hole in a leaf. Magnetic Resonance Imaging (MRI) is used to direct the beam to the target spot. In 2016, an FUS device, Insightec’s ‘Exablate Neuro’, received FDA approval for the treatment of essential tremor. In 2018, it was approved for treating tremor-dominant Parkinson’s disease, and subsequently for patients with other Parkinson’s symptoms. Between Neurology and Psychiatry In 1999, it was suggested that DBS could also be used to treat psychiatric disorders such as OCD. While hopes were high, its use in psychiatry has remained limited. This might be due to a lack of belief in the biology of psychiatric disorders. It might also be due to ethical issues traditionally associated with neurosurgery. Since FUS involves no invasive surgery, however, ethical doubts may be less. In 2021, South Korea approved it for OCD treatment, although the FDA has not followed suit in the United States. Whether it becomes a more widely available treatment option in psychiatry than DBS remains to be seen. Note: This article originally appeared on Psychology Today .

Every child acts out from time to time, arguing with their parents, breaking rules, or pushing boundaries. These behaviors are frequently considered normal part of growing up. However, if a child consistently exhibits patterns of aggression, deception, defiance, or violation of others' rights, this may indicate a more serious mental health condition known as Conduct Disorder. Understanding conduct disorder is critical for parents, educators, and caregivers. Early identification and intervention can assist children in learning healthier ways to manage emotions, form relationships, and function in society. Understanding Conduct Disorder in Children Conduct Disorder is a behavioral and emotional disorder that usually starts in childhood or adolescence. It is distinguished by a consistent pattern of behavior in which the child repeatedly violates others' rights or age-appropriate social norms and rules. Children with conduct disorder frequently struggle to understand and respect boundaries. Their behaviors extend beyond simple mischief. They may engage in aggression, lying, stealing, property damage, or deliberate rule violations. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies conduct disorder as a disruptive behavior disorder, alongside Oppositional Defiant Disorder (ODD) and Intermittent Explosive Disorder. Types of Conduct Disorders Conduct disorders can be classified based on their age of onset and behavioral patterns: Childhood-Onset Type: Symptoms occur before the age of ten. These children frequently exhibit more severe and persistent behavioral problems, and they are more likely to develop antisocial personality disorder as adults. Adolescent Onset Type: Symptoms start after the age of ten. These children tend to engage in less aggressive forms of rule breaking and may respond better to intervention. Unspecified Onset: When the exact age at onset cannot be determined, the disorder is classified as unspecified. How Conduct Disorder is Different from Normal Misbehavior It is natural for children to test boundaries or act rebelliously, particularly during adolescence. However, the main distinction is in frequency, severity, and intent. Children with conduct disorder frequently Demonstrate a pattern of rule-breaking, not isolated incidents. Show lack of empathy or remorse for their actions. Engage in behaviors that have a serious impact on others' safety or rights. Have ongoing issues at home, school, or in social interactions. In contrast, typical childhood misbehavior is brief, situational, and responds to discipline or guidance. Conduct disorder can cause distress for both the child and their family. However, with compassion, structured support, and the appropriate interventions, change is possible. Recognizing the signs early and seeking professional help can help children overcome behavioral challenges and live fulfilling, responsible lives. At One Life Psychiatry , we believe that every child deserves the opportunity to thrive. Our dedicated team of psychiatrists and therapists collaborates with families to develop individualized treatment plans that promote emotional growth, resilience, and well-being.

Ketamine TOPLINE: Ketamine was no more effective than placebo in reducing depressive symptoms in surgical patients with major depressive disorder (MDD) , results of a new study, which contradict prior research, suggest. Although symptoms improved in both study groups, investigators say participants' expectations of an improvement from ketamine may be driving that result. METHODOLOGY: The randomized, placebo-controlled trial included 40 patients who had previously been diagnosed with MDD and who were scheduled for elective noncardiac, nonintracranial surgery. Participants completed pre- and post-surgery depression screenings with the Patient Health Questionnaire-8 (inclusion score was ≥ 12) and the Montgomery-Ǻsberg Depression Rating Scale (MADRS). Patients received an infusion of 0.5 mg/kg of saline (placebo group; n = 20) or ketamine (n = 20) during surgery, along with general anesthesia. At the end of a 14-day follow-up, patients were asked to guess whether they had received ketamine or placebo. TAKEAWAY: MADRS scores dropped by around half 1 day after treatment, indicating an improvement in depressive symptoms in both the group that received ketamine (mean decrease from 25 to 12.6 points) and the group that received placebo (mean decrease from 30 to 15.3 points). There was no significant difference between the two. Participants in the ketamine and placebo groups also reported high rates of clinical response (60% and 50%, respectively) and remission (50% and 35%, respectively), again with no significant difference based on treatment with ketamine or placebo. Only 36.8% of participants accurately guessed their treatment group. Those who guessed they had received ketamine had higher MADRS scores than those who guessed they had received placebo or said they didn't know (10.1 vs 19.2 vs 23.0). The ketamine group had a significantly shorter hospital stay (1.9 days) than the placebo group (4 days) ( P = .02). IN PRACTICE: "Our primary findings differ from those of previous antidepressant trials with ketamine conducted without adequate masking, which find robust effects of ketamine," the authors write, adding that "regardless of the intervention being tested, participant expectations of a positive outcome — also known as hope — may drive large decreases in depression symptoms seen in antidepressant trials." SOURCE: Heifets led the study, which was published online October 19 in Nature Mental Health . The study was funded by the Society for Neuroscience in Anesthesiology and Critical Care, the National Institutes of Health, and the Stanford School of Medicine Research Office. LIMITATIONS: The investigators did not measure participants' treatment expectations prior to randomization and could not determine what effect participant expectancy bias may have had on the results. In addition, there was no assessment of the blind for anesthesiologists who administered the ketamine or placebo to patients. DISCLOSURES: Heifets is on the scientific advisory boards of Osmind and Journey Clinical and is a consultant to Clairvoyant Therapeutics and Vine Ventures. Other disclosures are noted in the original article. Related Topic: Study Finds Esketamine Nasal Spray More Likely to Induce Remission in Treatment-Resistant MDD Than Quetiapine Extended Release FDA Approves First Oral Selective 5HT1A Receptor Agonist for MDD

It's no secret that alternative medical treatment is not so alternative anymore. Due to various side effects, natural ways of living it is estimated that approximately 40% of Americans are opting to try to use or augment their medical or mental health medications. Each year approximately $20 billion per year on these choices. Traditional medicine, can have its limitations, as there has been epidemic of inappropriate dispensing leading to epidemics like the opioid crisis or overuse of "benzos". Stricter regulations should have been enforced by the FDA at the time clinicians would careless prescribe such medications though it was out of their scope of practice. A lot of research is not dedicated to alternative medicine, as it is hard to patent a substance that grows from the ground, compared to prescription medications that can be patented for 10 years, priced at 30-40x times the cost of a generic medication. One question that comes to mind - how does someone without insurance or limited coverage able to pay for medication that is only name brand name. As example of such is the medication, Latuda is an expensive drug. The out-of-pocket cash price for a 30-day supply of 40 mg tablets is $1,776. That’s nearly $60 per pill, but 40 mg is on the lower end of Latuda dosages. There is a epidemic growth of popularity of herbs for mind to treat conditions, such as depression, anxiety, insomnia, memory deficits. "He that will not apply new remedies must expect new evils; for time in the great inventor" - Sir Francis Bacon. One factor that contributes to this shift in use of remedies, is ongoing issues with side effects of newly involving psychotrophic medications, despite millions, if not billions of dollars in research. Now the hard part is the internet is flood with various products that claim certain properties. I will discuss some simple well studied remedies. I will also include the supplement(s) that I would recommend based on high potency (not related to side effects) but maximum effect, but also maximum absorption and bioavailability. I think that it is important to be selective when purchasing items as a local grocery store, as it is unclear if your body is properly processing the ingredients labeled on the bottle. I have exclusive researched and created a list of supplements, which I think will be beneficial, which I recommend for my patients as well. In writing this article, I wanted to provide a disclaimer that this is only a suggestion that I am providing, as this is not a medication, it is your choice to try to supplement. I would highly recommend you do additional research to see if this is the right fit, however alternative medical treatment tend to have minimal side effects, if any at all. Regardless, if you don't feel that you are having a positive experience I would highly recommend discontinuing it. In this article and other article, I will provide an in-depth description of each herbal remedy and even discuss areas that I would be concerned about, before attempting to start the supplement. You can find more details about many herbal remedies in the book I would highly recommend. Herbal supplement(s) can be benign, however no one can truly know how it interacts with your body leading to potential allergic reaction, though a low probability. What is interesting is ask the average herbal shopper what is the actual remedy that is found in the product, often you are looked at with a blank stare, unless well read in the fundamental of herbal science. The irony of medicine in general is it has been a series of trial and errors, to this day. One interesting example, as an observation in the 1800's form a Viennese physician who was austerized to the point of having an emotional breakdown when he pointed out that women were dying during child birth because their doctors were not washing their hands. Now, it seems like a no-brainer that germs cause infection spread through unhygiene practices. Unfortunately, excessive handwashing based on this preoccupation with germs can be seen with OCD. It is important to recognize that every human being wants relief and wants to feel good and have a quality life. Depression hurts, stress kills, anxiety is unnerving, and insomnia is dangerous and unnerving, therefore it is not a mysterious that everyone is trying to find a solution that is in alignment with their values. Medication and/or therapy is not for everyone, however it should be an option to consider in the right situation. It is important to be open minded and feel free to discuss potential treatment options with your doctor, as herbal remedies can be helpful, but really dependent on your response. Check out this book that such the benefit of herbs, nutrients, and yoga in mental health care.

By: Lauren Mackler, Contributor Many people don't treat themselves verywell. They break promises to themselves, don't get enough sleep, are self-critical or fail to take good care of their bodies. In fact, if most people treated others the way they treat themselves, they wouldn't have many friends! A great technique for treating yourself better is by developing your Inner Nurturing Parent. Imagine you had a little child in your car. You'd make every cffort to keep them healthy and safe; to love and support them; to be forgiving of their mistakes, their inevitable slips; and to let them know how precious and important she is. That's what a loving parent does. Only, in this case, you're the parent and the child. Below are sevenways to strengthen your own Inner Nurturing Parent, and turn the goal of treating yourself better into daily, living action. women hug with both hands a red heart Send loving messages to yourself. Tell yourself, "I love you and appreciate who you are." When you do something well, give yourself : pat on the back. Say, 'Great job! I'm so proud of you. " When you're struggling or feeling low, be supportive by saying, "I'm here for you. You're not alone." Take good care of yourself. A loving parent would make sure you're nourished and get plenty of rest, sleep, fresh air and joyful movement. Practicing good self-care is an essential part of this process. Do nice things for yourself. Get into the habit of doing special things for yourself. Make yourself a cup of tea with the nurturing energy that you'd have when preparing tea for someone you love. Visit the sauna, get a massage or draw yourself a bath filled with special salts. Linger in it and relax. Make yourself a candlelight dinner -- delicious meal in a special setting. Coddle yourself. Treat yourself as a loving parent would treat you. Set healthy boundaries with others. Let people know what you want and don't want. Tell them what's okay for you and what's not. If you have a friend who's always late and you end up waiting for them and feeling annoyed, tell them how you feel. A nurturing parent wouldn't let someone treat you badly. A loving parent makes sure their child's needs are met. Become your own advocate. If someone is disrespectful or hurtful to you, speak up. Tell them you don't want to be spoken to that way. If someone was unkind, hostile or verbally abusive to your child, you'd stand up for them. Protect yourself as a nurturing parent would protect you. Believe in yourself. A nurturing parent would highlight your uniqueness, tell you how special you are, encourage you to build on your strengths and support you in a loving, nonjudgmental way. A nurturing parent says, "You can do it." "T believe in you." Become your strongest supporter, coach and cheerleader. And lastly and most important: Be compassionate with yourself. Have compassion for your humanity and your flaws. You're human and you're going to make mistakes. Look at yourself through the eyes of a loving parent; don't punish or criticize yourself. Reassure yourself. Comfort yourself. Accept yourself unconditionally. And show that same compassion for your own parents and others, because they, too, are human.

Fecal microbiota transplantation (FMT) may be an effective adjunctive therapy for depression , especially in patients with symptoms linked to gut disorders such as irritable bowel syndrome (IBS). However, experts caution that the evidence is preliminary. A large meta-analysis showed that FMT significantly reduced depressive symptoms in the short and medium term. Both oral capsule and direct gastrointestinal (GI) delivery were effective, although the benefits were greater with direct GI administration. However, the researchers cautioned that the overall quality of the evidence was rated as low to very low and highlighted the need for more robust and targeted research. The study was published online on October 5 in Frontiers in Psychiatry . Does Fixing the Gut Boost Mood? Depression, which affects over 280 million people globally, is increasingly linked to gut microbiome imbalances. FMT involves transferring gut bacteria from a healthy donor into a recipient’s GI tract to restore microbial balance. Long used for recurrent Clostridioides difficile infections, it is now under investigation for conditions linked to the gut-brain axis. Preclinical and clinical work suggests that restoring healthy microbial diversity may influence inflammation, neurotransmitter activity, and mood regulation. Yet current evidence on FMT for depression is “fragmented and inconclusive,” the researchers, with first author Xiaotao Zhang, of Nanjing University of Chinese Medicine, Nanjing, China, wrote. To gain a better understanding of the therapeutic potential of FMT for depressive symptoms, they synthesized data from 12 randomized controlled trials with 681 participants across China, Australia, Canada, Finland, and the US. All trials consistently evaluated the impact of FMT on depressive symptoms whether as a primary or secondary outcome using validated scales such as the Hamilton Depression Rating Scale, Montgomery-Åsberg Depression Rating Scale, and Hospital Anxiety and Depression Scale. The trials included patients with various conditions. Five trials focused on IBS and one on ulcerative colitis. Two trials targeted neurologic disorders including progressive supranuclear palsy-Richardson syndrome and Parkinson’s disease with comorbid GI disorders. Four trials included patients with COVID-19 experiencing diarrhea and depressive symptoms, severe obesity with insulin resistance, or fibromyalgia. Only one trial specifically included patients diagnosed with major depressive disorder (MDD) . The pooled results showed a significant reduction in depressive symptoms in the FMT group compared to the control group (standardized mean difference [SMD], -1.21; P = .0003). Although the included studies were highly heterogeneous, sensitivity analyses showed that depressive symptom scores were significantly improved in the FMT group compared with the control group (SMD, -0.56; P = .0003). Subgroup analysis showed stronger effects in patients with IBS (SMD, -1.06) than in those with neurologic/psychiatric-related conditions (SMD, -0.67), with moderate heterogeneity. Both oral capsules and direct GI administration (via endoscopy or enema) were effective, with slightly greater effects observed for direct GI delivery (SMD, -1.29 vs -1.06). Improvement in depressive symptoms was most notable in short- to mid-term follow-up, with the effects diminished by 6 months. To advance the field, the researchers recommended that future trials focus on clinically diagnosed depression, use standardized FMT protocols, and include long-term follow-up to evaluate sustained effects on depressive symptoms. They also emphasized the need to systematically account for factors such as diet, medications, and psychological therapies to minimize confounding. A New Therapeutic Target? Valerie Taylor, MD, PhD, professor and head of the Department of Psychiatry at the University of Calgary, Calgary, Alberta, Canada, who wasn’t involved in the study, told Medscape Medical News there is a “growing body of research to support really examining the gut microbiome as a therapeutic target in mental illness treatment.” “While we need to do longer studies to understand dosing and efficacy, this is an exciting new area. This study highlights there is successful translational work occurring in this space,” Taylor said. Her team in Calgary recently completed a study on FMT for treatment-resistant MDD, which is currently under review, she said. Jessica Green, MBBS, PhD, consultant psychiatrist and senior research fellow at the Food & Mood Center, Deakin University in Geelong, Australia, also wasn’t involved in the study, but was a reviewer on the paper. She said that while FMT is a “very promising” potential treatment for depression, the paper is “perhaps more optimistic about its interpretation of the findings than is justified by the preliminary nature of the data at this stage.” “That’s because the analysis uses data from studies that weren’t designed or powered for measuring depression, and it wasn’t known if a population was clinically depressed or not at baseline; if they weren’t clinically depressed, then improvement in the depression rating scale is not very meaningful,” Green said. She noted that most of the studies included people diagnosed with a range of disorders including IBS combined with mild-to-moderate anxiety/depression, COVID-19 with associated diarrhea and depressive symptoms and fibromyalgia. “You would expect mood to be impacted in these patients and if mood improved, it’s unclear whether the improvements were due to FMT or simply because IBS had resolved,” Green said. Still, Green said there is “every reason theoretically” that FMT could help with depression and “hopefully, we’ll get a better signal soon.” Note: This article originally appeared on Medscape .

Key points The U.S. mental health care crisis continues to worsen. Medicine is not likely to voluntarily correct its focus on physical disease, nor its profit motives. Only an angry public can overcome the chronic inertia. Americans have lived with a mental health crisis for as long as most of us can remember. And for just as long, medicine has been warned of two urgent fixes. First, the system must produce more psychiatrists. Second, medical education must prepare primary care physicians who provide 75 percent of all mental health care to recognize and manage psychiatric illness. Neither has happened. And almost no one pressed for what, in my opinion, is a key third fix: weaving psychology and other mental health professionals into the very fabric of medicine. The consequences of these failures are staggering. Primary care and other medical doctors, untrained in mental health, wrote most of the opioid prescriptions that fueled more than 200,000 overdose deaths in the opioid epidemic. Of 48,000 suicides per year, 40-45 percent of the patients see their medical doctor in the 2-4 weeks beforehand—potentially preventable suicides if doctors were universally and appropriately trained. Unfortunately, many medical doctors also overlook or administer the wrong treatments for depression, anxiety, and substance abuse in hundreds of millions of patients leading to avoidable divorces, job failures, school dropouts, addictions, homelessness, and incarceration. But don’t blame them, we're often told; they’re not trained. Why Hasn’t Medicine Changed? Two forces stand in the way of real, systemic change in the field. The first barrier is intellectual. Modern medicine grew out of the 16th- and 17th-century Scientific Revolution, which drew a sharp line between body and mind, today called the “mind-body split.” This model focused exclusively on physical disease and left the care of mental and social problems to the church or community. It worked with unrivaled benefits. Life expectancy doubled in the last century. But as people lived longer, mental disorders became the most common health problems, surpassing heart disease and cancer combined. Yet medical education still reflects the split. Students and residents spend more than seven years immersed in learning about physical illness. Less than 2 percent of training time addresses mental health and other psychosocial features such as empathy, lifestyle, and social medicine. The result is generation after generation of physicians trained primarily in physical disease. Compounding scarce exposure to mind issues, physicians and other clinicians are not trained to think “out of the box.” Medical education typically focuses on rote learning of facts (usually about physical disease), thus interfering with recognition of nonphysical disease problems to say nothing of the knowledge to diagnose and treat them. And it is not just practitioners who exhibit this. Physician leaders in medical education, research, and clinical care receive the same training. Many leaders have not grasped the need to better train and provide care for medicine’s most common health problem. We don’t teach any more mental health care than we did over 100 years ago. In clinical care, we have a worsening crisis. The second barrier is economic. By the mid-20th century, medicine’s successes gave rise to a powerful medical industrial complex (MIC), with hospitals, insurance companies, pharmaceutical firms, and medical equipment manufacturers among the key players. At first, these institutions advanced medicine’s altruistic goal: better care for all. But profit soon eclipsed purpose. Because regulations were weak and the financial incentives enormous, the MIC flourished by doubling down on medicine’s physical-disease orientation. Today, it prevails over doctors in control of the $5 trillion spent annually on health care, nearly one-half in hospitals alone. And with profits tied to maintaining the status quo, there is little appetite for change. I argue that these twin forces intellectual inertia and economic self-interest explain why medicine has not acted despite decades of warnings. Medicine is too entrenched in its outdated model to lead reform. The MIC, meanwhile, is thriving financially and has no incentive to jeopardize that success. Both institutions have been allowed to operate with minimal oversight. The political philosopher Hannah Arendt cautioned that sciences like medicine must be subject to public control, or they risk veering dangerously off course. Mental health care is a textbook example of what happens without such oversight. History also shows that resistant institutions rarely reform voluntarily. Civil rights, women’s rights, the end of the Vietnam War none came from the goodwill of entrenched powers. They came because ordinary citizens became outraged enough to demand change. Consumer activism has similarly toppled industries that put profit ahead of safety, from Ralph Nader's Unsafe at Any Speed to Rachel Carson’s Silent Spring. Health care, by contrast, has escaped such reckoning. Americans, likely grateful for the real advances in physical disease medicine, have largely trusted that the system also serves their best interests in mental health. I fear their trust is misplaced. Behind the curtain lies widespread neglect, staggering human loss, and trillions of wasted dollars each year. The truth is stark. America’s health crisis will not, in my opinion, be cured from within medicine. It will only change when the public demands it when citizens insist on accountability, when they refuse to accept preventable deaths and broken lives as the status quo. The stakes are painfully clear. Until outrage becomes action, America’s mental health crisis will grind on. But if history teaches us anything, an enraged public can do what medicine will not: force the change our mental health system so desperately needs. Note: This article originally appeared on Psychology Today .