Suicidality is a devastating public health problem, yet effective interventions are still lacking. This commentary outlines the theoretical foundations for applying mindfulness- and compassion-based interventions for suicide prevention, through explaining how the therapeutic elements of these interventions address common psychological risk factors for suicide. Accumulating research data from the meditation research literature points to the safety, feasibility, accessibility, and cost-effectiveness of mindfulness- and compassion-based intervention programs. Emerging data on their application to suicide prevention in outpatient as well as inpatient settings has demonstrated the safety and feasibility of these programs. Developing trauma-sensitive suicide prevention programs based on mindfulness and compassion is a promising direction for clinical innovations. Based on the potentials demonstrated from emerging research data, it is possible to develop mindfulness- or compassion-based intervention programs that are versatile, scalable, cost-effective and easily accessible across multiple sectors of suicide prevention.
Antidepressant-induced mania constitutes one of the most relevant and controversial complications of psychopharmacology, with direct implications in the choice and monitoring of the treatment. The incidence of this adverse effect varies widely in the literature, influenced by multiple factors, clinical and pharmacological. The scientific evidence about it remains fragmented, justifying a comprehensive systematic review that integrates clinical and pharmacological data in a critical way. The objective of this review was to analyze and synthesize and the incidence and the risk factors of this antidepressant-induced mania and mood destabilization. With resource to PubMed/MEDLINE, Embase and Cochrane Library, several studies were extracted and analyzed. Among the analyzed studies, 29 were included, whose inclusion criteria were fulfilled. Amid the studies, a great variability was observed in the occurrence of mania induced by antidepressants, however, was noted a higher risk of switch among the individuals with bipolar disorder, being lower in the individuals with major depressive disorder. Additionally, pharmacological and clinical risk factors associated to an increased risk were identified, respectively, hypomanic episodes and previous hospitalizations, bipolar disorder type I, rapid cycling, more severe course of illness and the use of tricyclic antidepressants, venlafaxine, and antidepressant monotherapy. Antidepressant induced mania is a subject with great relevance, which requires a meticulous clinical approach for the identification of a latent bipolarity and a tight follow-up upon institution of antidepressant therapy.
Ketogenic interventions, including ketogenic diets, are increasingly being explored as potential treatments for severe mental illnesses. Ketosis – the metabolic state characterised by high circulating levels of ketone bodies – is thought to be central to the beneficial effects of these diets. Hence, it is plausible that other interventions that induce ketosis may similarly improve mental health outcomes. Here, we critically appraise the evidence surrounding the use of ketosis-inducing interventions for the treatment of severe mental illness. Several uncontrolled trials suggest beneficial mental and metabolic health effects of ketogenic diets in depression, bipolar disorder and schizophrenia, but are limited by confounders and expectation bias. The only reported randomised controlled clinical trial so far suggested a small, greater between-group difference in antidepressive effect of a modified ketogenic diet over a phytochemical control diet in treatment-resistant depression, that did not reach statistical significance. Additionally, ketone levels did not correlate with psychiatric outcomes. Preclinical studies suggest a beneficial effect of ketogenic diets on psychiatric symptom correlates but largely did not explore ketone-outcome correlations. Exogenous ketone and oral medium-chain triglyceride supplements induce nutritional ketosis, however, they have not been tested in patients with severe mental illness. Fasting and time-restricted eating produce ketosis but it is unclear if this explains their reported mental health and metabolic effects. Large, randomised controlled clinical trials are needed to examine and compare the effects of different ketogenic interventions in severe mental illness. Trials should be designed to isolate the role of ketosis, investigate the mechanistic basis of beneficial effects observed, assess dose-response relationships, examine treatment adherence in routine clinical settings, ascertain the duration of treatment effects following discontinuation, and clarify the impact of ketosis-inducing interventions on the need for psychiatric medications and standard care.
Clinicians need guidance for screening, assessment and treatment of substance use in pregnancy. In this review, we examine the literature and current clinical practices that address substance use disorders in pregnant women. We provide current medication based treatment and psychosocial intervention options for alcohol, opioid, tobacco, cannabinoid and cocaine use disorders in pregnancy. Evidence supports using validated screening questionnaires, while toxicology testing has low sensitivity and is not an appropriate screen for substance use. While universal screening is recommended, clinicians must be aware of the legal implications of mandated reporting as a barrier to care for pregnant women seeking treatment for substance use disorder. Assessment requires full evaluations of psychiatric comorbidities as these are common and treatment of associated conditions improves recovery for pregnant women with substance use disorder. Trauma is associated with substance use in pregnancy and trauma-informed care mitigates risk to pregnant women. Research supports an increasing number of medication based treatment options for pregnant women with substance use disorder. Substance use in pregnancy is multifactorial and requires a comprehensive clinical approach that addresses trauma and comorbid psychiatric illness. The fear of legal repercussions that women experience when seeking substance use disorder treatment during pregnancy is a barrier to their recovery and care. Shared decisions making, a harm reduction approach, and trauma informed care work to address this barrier while legal advocacy can function to better protect women seeking treatment.
This exploratory bibliometric analysis maps the co-authorship structure, thematic organization, and temporal trajectory of the psychedelic-assisted therapy literature during 2019–2024, the most active publication window in the field’s history, representing approximately 75
Stimulant medications, including methylphenidate and amphetamine-based formulations, are the first-line pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). While their efficacy in reducing core ADHD symptoms is well established, evidence regarding their long-term cognitive, behavioral, and functional effects beyond symptom control remains limited. To systematically review the evidence on the long-term cognitive, behavioral, psychosocial, and neurobiological effects of stimulant treatment in adults with ADHD beyond the improvement of core symptoms. A systematized literature search was conducted in PubMed, b-on, and the Cochrane Library in accordance with PRISMA 2020 guidelines. The review protocol was prospectively registered in PROSPERO (CRD420261349587). Eligible studies included adults (≥ 18 years) with ADHD receiving stimulant treatment for at least three months and reporting outcomes beyond core symptom improvement. Outcomes included executive functioning, emotional regulation, reward processing, motivation, decision-making, impulsivity, working memory, cognitive flexibility, processing speed, social functioning, occupational functioning, and quality of life. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Twenty-three studies met the inclusion criteria. Overall, long-term stimulant treatment was consistently associated with improvements in executive functioning, attention, emotional regulation, inhibitory control, social and occupational functioning, and quality of life. Evidence also suggested beneficial effects on reward processing, decision-making, and motivational processes, although findings regarding working memory and broader cognitive enhancement were mixed, with several studies indicating normalization rather than enhancement of cognitive performance. Long-term treatment demonstrated an acceptable safety profile, with no consistent evidence of increased risks of serious cardiovascular events or substance misuse. Long-term stimulant treatment in adults with ADHD appears to confer clinically meaningful benefits extending beyond the reduction of core symptoms, particularly in executive functioning, emotional regulation, psychosocial functioning, and overall daily functioning. However, the current evidence is limited by the small number of prospective longitudinal studies, heterogeneity in outcome measures, and variability in study designs. Further high-quality longitudinal research is needed to better characterize the long-term cognitive, neurobiological, cardiovascular, and functional effects of stimulant therapy.
Emotional blunting is increasingly recognized among patients with major depressive disorder (MDD) receiving antidepressant treatment. Characterized by reduced positive and negative emotional experiences and associated with diminished quality of life and higher risk of treatment discontinuation, its mechanisms remain unclear, with debate if it represents a symptom of depression or a pharmacological side effect. Despite its prevalence, evidence-based strategies for diagnosis and management remain limited. This review aimed to synthesize current evidence on the mechanisms, prevalence, and management of antidepressant-induced emotional blunting (AIEB) while identifying gaps, to guide future research and clinical practice. Assessing English studies on emotional blunting in adults diagnosed with MDD, according to DSM-V-TR, treated with antidepressants, inclusions employed validated assessment instruments such as the Oxford Depression Questionnaire (ODQ). Case studies and studies that did not distinguish emotional blunting as a symptom of depression from a side effect of therapy, were excluded. A meta-analysis of AIEB prevalence was conducted using SPSS and RevMan 5.4.1. Twelve studies were included, with eight accepted for meta-analysis. The pooled prevalence of AIEB was 0.62 (95
Cognition is the set of mental processes through which individuals acquire, process, store, and apply information. It encompasses functions such as perception, attention, memory, language, reasoning, and problem-solving, enabling people to interpret their environment, make decisions, and generate knowledge. Perimenopause is accompanied by subjective cognitive complaints, often described as “brain fog,” which can have a significant impact on quality of life and may be associated with greater risk of cognitive impairment in later life. These symptoms are multifactorial, influenced by hormonal changes, psychological status, lifestyle behaviors, and neurobiological mechanisms. This review synthesizes the current research on management of cognitive symptoms in perimenopause through a mechanistic lens. The strongest evidence is for the use of lisdexamphetamine and creatine, though generalizability remain limited by study population characteristics and sample size. Among non-pharmacological approaches, physical activity has the most robust evidence for cognitive benefit. Further research is needed focusing on the perimenopausal population with a focus on subjective and objective cognitive outcomes as well as long-term efficacy and safety of treatment options.
Delirium due to an underlying causal condition or etiology is a common complication in hospitalized patients, especially among older individuals. Due to its complex nature and similarity in appearance with other psychiatric and neurological conditions, delirium is often unrecognised or wrongly diagnosed. Clinical guidelines should guide treatment decisions but there is a lack of clear, comprehensive, and easily implementable guidelines. The purpose of this review is to summarize the information provided by psychiatry guidelines on pharmacological causes, treatment options, and alternatives in adult delirium patients (> 18 years) with and without dementia, thereby facilitating patient management and care in psychiatric settings. The systematic review analyzed information from six international clinical guidelines aimed at treating patients with delirium. All guidelines focused on delirium with only one guideline offering some additional information on the treatment of delirium in dementia patients. Among all the medications listed in relation to, antipsychotics are the most frequently recommended. Only one guideline provides more detailed information on dosages, therapy duration and pharmacokinetic profiles in relation to individual medicines. Clinical guidelines are based on original studies that contain significant inconsistencies in medication efficacy, leading to a paucity of specific information in these guidelines and considerable discrepancies among them. There is still a need for clear and consistent evidence on pharmacological causes, treatment options, and alternatives in adult delirium patients (>18 years) with and without dementia.
Perinatal mental health conditions (PMHCs) are common, impactful, and frequently left untreated, affecting roughly one in five individuals during pregnancy and the first year postpartum. Despite their far-reaching consequences for parents, infants, and broader social outcomes, nearly 75
Psychedelic-assisted therapy (PAT) is a novel and promising form of treatment for posttraumatic stress disorder (PTSD). However, clinicians may experience challenges in interpreting the existing evidence for PAT to make informed decisions about treatment recommendations and selection with their patients. Prior commentators have noted the hype surrounding public discussions of PAT. This hype may stem, at least in part, from how some peer-reviewed articles have reported and contextualized their findings. Researchers and disseminators of novel treatments have a responsibility to clinicians and the public alike to accurately represent the current evidence for existing treatments when presenting their findings. This article identifies types of reporting errors in PAT research that foster inaccurate comparisons with existing PTSD therapies, and it provides specific examples of each error from the recent peer-reviewed literature. We offer recommendations for researchers to improve the accuracy and rigor of their reporting, and for clinicians and peer reviewers to engage more critically with the research to identify sources of potential hype.
Psychiatric symptoms such as depression, anxiety, psychosis, and cognitive impairment frequently accompany endocrine disorders and may precede or obscure the underlying diagnosis. This review aims to synthesize current evidence on the neurobiological mechanisms linking endocrine dysfunction to psychiatric manifestations and to outline clinically relevant diagnostic and therapeutic strategies. Growing evidence highlights the central role of neuroendocrine axes, circadian dysregulation, neuroinflammation, and impaired neuroplasticity in mediating psychiatric symptoms across a wide range of endocrine conditions, including thyroid and adrenal disorders, diabetes, polycystic ovary syndrome, parathyroid diseases, hypopituitarism, and neuroendocrine tumors. Population-based studies demonstrate increased risks of depression, anxiety, and cognitive dysfunction in these conditions, while neuroimaging and molecular data reveal structural and functional brain alterations related to hormonal imbalance. Importantly, correction of the underlying endocrine disorder often leads to partial or complete resolution of psychiatric symptoms, whereas isolated psychopharmacological treatment may be insufficient. Psychiatric manifestations of endocrine disorders represent potentially reversible neurobiological consequences of hormonal dysregulation rather than primary psychiatric disease in many cases. An endocrine-first, mechanism-informed approach—integrating targeted hormonal evaluation, cautious use of psychotropic medications, psychotherapy, and multidisciplinary care—is essential to improve diagnostic accuracy, reduce treatment resistance, and optimize long-term mental and physical health outcomes.
A growing number of people are using LLMs for mental health support, including general-purpose AI, AI companions, and mental health LLMs. Reasons include privacy, 24/7 availability, perceived quality, and fear of judgment. These technologies raise questions about disengagement, harm, risk mitigation, accessibility, and discrimination. Current challenges align with the core competencies and values of peer support, yet there has been limited integration of peer supporters or people with lived experience in LLM research or implementation. Digital peer support training, certification, and core competencies already exist, but predate widespread LLM use. Digital navigators, including peer supporters, show promise in increasing digital self-determination and improving outcomes. While lived experience inclusion has gained traction, definitions and effective implementation practices remain unclear. The foundations of peer support and evidence suggest that digital peer support and navigators can improve outcomes and increase education among those using LLMs. Leaders should prioritize expanding access to digital peer navigators and increasing LLM-related training for peer supporters. As technology continues to evolve, lived experience must be foundational to how we understand, design, and make decisions about these tools A growing number of people are using LLMs for mental health support, including general-purpose AI, AI companions, and mental health LLMs. Some reasons include viewing the tools as flexible, convenient, and effective. Others may use these tools to fill gaps in access to support and to avoid the fear of asking for help. Still others view them as alternatives, given mistrust of systems and a lack of culturally responsive resources and providers. While the growth of digital tools requires action to enforce accountability for quality and safety, many reasons people provide for using LLMs reflect foundational issues that led to the peer support movement. Issues such as voluntariness, person-centered support, harm reduction, and education are core to how peers support individuals in moving toward resources that meet their priorities and preferences. This paper does not argue that LLM use is inherently harmful, nor that peer support should replace digital tools. Instead, it argues that peer support is uniquely positioned to address the long-standing gaps that drive people to LLMs. Digital peer support and peer navigators can help people use, reduce, or disengage from LLMs in ways aligned with their own goals while strengthening connection to community and human support. More broadly, this moment calls for increased engagement of people with lived experience as experts to guide the shaping of these technologies. This requires conceptualizing lived experience not as a feedback mechanism but as epistemic justice, which centers those with direct knowledge to define what harms matter, what outcomes count, and what constitutes meaningful support.
Interest in artificial intelligence (AI) based conversational agents (“AI Chatbots”) for mental health care has grown rapidly in response to recent technological advancements, persistent gaps in access to mental health services, and the fact that people are already using general-purpose AI chatbots for emotional support. Although AI Chatbots may outperform non-AI chatbot digital mental health tools in terms of personalization, accessibility, and perceived empathy, important questions remain, including what constitutes optimal engagement with these tools. We discuss the lessons learned from research on engagement with non-AI digital mental health tools to inform research and implementation of safe, effective and ethical patient-facing AI Chatbots for mental health care. We argue that, similar to evidence-based human-delivered mental health care, AI Chatbots for mental health care should be optimized for engagement with the behavioral targets the interventions were designed to produce rather than engagement with the AI Chatbot itself, how this might contrast with industry incentives for maximizing active and sustained use of these tools, and offer suggestions for clinicians, researchers, and health care administrators to guide the development, evaluation, and implementation of AI Chatbots in mental health care.
Hypoactive delirium is a frequently underrecognized subtype associated with increased morbidity and mortality, yet it lacks clearly established pharmacologic treatment strategies. This scoping review aimed to map and critically examine the existing evidence on pharmacological interventions specifically evaluated for hypoactive delirium in hospitalized adults, focusing on symptom severity and clinical outcomes. The available literature is limited and heterogeneous. Identified studies included randomized controlled trials, observational studies, and recent systematic reviews evaluating agents such as antipsychotics, dexmedetomidine, melatonin, flumazenil, and methylphenidate. However, most trials were small, methodologically diverse, and not specifically powered for the hypoactive subtype. Evidence supporting atypical antipsychotics remains inconsistent, and no high-quality randomized trials demonstrate clear benefit for routine use in hypoactive delirium. Alternative agents such as flumazenil and methylphenidate have been explored in limited or exploratory contexts, without consistent improvement in clinically meaningful outcomes. Current evidence does not support the routine use of any pharmacologic agent as a standard treatment for hypoactive delirium. Existing studies are constrained by small sample sizes, heterogeneity in diagnostic criteria and outcome measures, and overlap across systematic reviews and primary trials. Further well-designed, subtype-specific randomized controlled trials are needed to determine whether targeted pharmacologic strategies can improve outcomes in this vulnerable population.
This narrative review aims to summarize the evidence supporting the use of antidiabetic agents as potential adjunctive treatments in bipolar disorder (BD). The focus is on the shared pathophysiological mechanisms linking insulin resistance (IR) and BD, and on how metabolic modulation may influence mood, cognition, and treatment outcomes. Emerging research indicates that IR and related metabolic abnormalities are highly prevalent in BD and are associated with illness progression, cognitive impairment, and reduced treatment response. Studies involving metformin, pioglitazone, glucagon-like peptide-1 (GLP-1) receptor agonists (such as liraglutide and semaglutide), and sodium–glucose cotransporter 2 (SGLT2) inhibitors (such as empagliflozin) have demonstrated improvements in depressive symptoms, metabolic parameters, and neuroinflammatory markers in individuals with mood disorders. Mechanistic evidence suggests that these agents may exert neuroprotective effects by enhancing insulin signaling, reducing oxidative stress, and improving mitochondrial and synaptic function. Nevertheless, the available studies are limited by small sample sizes and short follow-up durations. Targeting IR represents a promising translational approach for improving both metabolic and psychiatric outcomes in BD. Future research should prioritize mechanistic studies and randomized controlled trials designed to clarify optimal dosing, treatment duration, and patient selection, as bridging psychiatry and endocrinology through metabolic interventions could redefine treatment paradigms for bipolar disorder.
Digital mental health technologies are increasingly embedded in routine psychiatric care, yet many patients, clinicians, and health systems lack the skills and confidence required to use these tools safely and effectively. Digital mental health literacy has emerged as an enabling capability, shaping whether digital innovations enhance or undermine access, equity, and quality of care. This review synthesizes existing frameworks and evaluates initiatives addressing digital mental health literacy among patient education initiatives aimed at promoting digital mental health literacy, with a focus on relevance to psychiatric practice. Recent work conceptualizes digital mental health literacy as a multidimensional construct encompassing functional, communicative, critical, and translational competencies. Studies consistently demonstrate that individuals with serious mental illness experience substantial gaps in foundational digital skills despite widespread device ownership, placing them at risk of digital exclusion as services increasingly digitize. Programmatic initiatives documented in the literature have shown improvements in digital skills, confidence, and readiness to engage with digital mental health resources. Implementation challenges however continue to persist, including variability in program scope, limited standardization of outcome measures, and insufficient integration into routine clinical workflows. Digital mental health literacy is now a foundational prerequisite for equitable and effective digital psychiatric care. Integrating literacy-focused programs into mental health services may mitigate digital exclusion and support the adoption of digital tools. Future efforts should prioritize scalable, equity-oriented models and align digital mental health literacy initiatives with clinical practice, implementation science, and health system priorities.
The German Digital Healthcare Act (DiGA) established a framework for prescribing and reimbursing digital health applications. However, despite high prescription rates, adherence for mental health applications remain low. This review systematically analyzed the functional landscape of all approved mental health DiGAs. Using the standardized MIND evaluation framework, we benchmarked the design features, engagement strategies, and technical capabilities of DiGAs against leading commercial “wellness” apps to identify specific barriers to retention. Our analysis of 30 DiGAs and 29 matched commercial apps reveals a distinct functional dichotomy. DiGAs currently exclude severe mental illnesses such as bipolar disorder or schizophrenia. Moreover, they frequently lack native mobile interfaces, with 12 DiGAs (43.3
A systematic review was conducted to synthesize the efficacy, safety, and tolerability of psychedelics including ketamine, MDMA, ayahuasca, LSD, DMT, ibogaine, and psilocybin in the treatment of PTSD. Among 5,155 studies identified, 42 studies met criteria and were included in our systematic review. Ketamine consistently produced rapid symptom improvement that attenuated in single-dose trials; but, persisted when repeated or in conjunction with psychotherapy. Studies using MDMA was associated with substantial and durable PTSD symptom improvement in controlled settings. Data for ayahuasca, DMT, LSD, ibogaine, and psilocybin were preliminary but suggested potential benefits. Safety was assessed in most studies and were overall well tolerated with transient autonomic changes being the most common adverse effects. While MDMA and ketamine currently have the most developed evidence that supports their potential therapeutic roles in PTSD, findings should be interpreted cautiously given heterogeneity across study designs including sample size, sample make-up, protocols, and reporting. Other compounds show early promise but remain investigational. Large sample sizes and methodological rigorous studies with standardized objective endpoints and long-term safety follow-up are needed before these psychedelic-assisted interventions can be widely implemented or recommended in clinical practice.
