Reading of the Week: Personalized Antidepressant Treatment – the New JAMA Study; Also, Social Media Use & Adolescent Well-Being

March 12, 2026 / / 0 Comments

From the Editor

Some patients with depression don’t show improvement. Among the reasons why: they may stop treatment too early. For decades, research on improving outcomes has included biomarkers, trying to better pair illness with treatment. But what about following patient preferences in care decisions? Can this help bolster medication compliance and thus improve outcomes?

In a new, compelling paper that was just published in JAMA, Dr. Andrea Cipriani (of the University of Oxford) and his co-authors attempt to answer these questions. They describe a study involving 540 participants in 47 sites. Participants were randomized to receive either the usual care or care using the PETRUSHKA tool, “a web-based clinical decision-support system combining clinical and demographic predictors with patient preferences to personalize antidepressant treatment.” The results are impressive. “Compared with usual care, participants with MDD whose antidepressant was selected using the PETRUSHKA tool had a reduced risk by approximately 40% of discontinuing their antidepressant during the first 8 weeks of treatment.” We consider the paper and its implications, as well as the accompanying Editorial.

The impact of social media on children and adolescents is much discussed; recently, Australia banned youth who are under 16 years of age from using platforms like Instagram. In this week’s other selection, from JAMA Pediatrics, Ben Singh (of the University of South Australia) and his co-authors analyzed social media’s association with well-being. They describe a cohort study of more than 100 000 Australian adolescents who were followed for three years. They found: “a U-shaped association emerged where moderate social media use was associated with the best well-being outcomes, while both no use and highest use were associated with poorer well-being.”

Note: there will be no Readings for the next two weeks.

DG

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Reading of the Week: ECT in Ontario – the New CJP Study; Also, Alcohol & Influencers, and Jayaraman on Chekhov’s Guns

March 5, 2026 /

From the Editor

It’s the most effective treatment for those with treatment-resistant depression. Older studies, including one from Quebec, suggest that it’s much less used than in the past. Is ECT going the way of the dodo bird?

In a new Canadian Journal of Psychiatry study, Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors attempt to answer that question. They drew on 17 years of data, tapping several administrative databases from Ontario, covering more than 450 000 treatments. They offer some good news. “We found that while ECT use generally increased over time, there were notable differences between biological sexes, age groups, and geographic regions.” We consider the paper and its implications.

In the second selection, a research letter published in JAMA Pediatrics, Scott I. Donaldson (of Rutgers University) and his co-authors connect social media content with the desire to drink among young people. Drawing on survey data, they analyzed the impact of lifestyle influencers. “This experimental evidence adds to a growing body of research showing that exposure to alcohol-promoting content, particularly on social media, is associated with alcohol-promoting attitudes and behaviors in young adults.” 

Finally, in the third selection, Pranav Jayaraman (of Texas Tech University) writes about diagnoses and patients in Academic Psychiatry. The medical student discusses the temptation to reduce experiences to simple diagnoses. “As I seek to serve patients through psychiatry, a field often facing provider capacity and time constraints, the desire to pinpoint a single cause and address it with a straightforward solution is understandable but can also be limiting.”

DG

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Reading of the Week: Adolescent Mental Health With Papers on School-Based Mindfulness, Firearms & Youth Suicide, and GenAI

February 26, 2026 /

From the Editor

The MYRIAD Trial was ambitious, involving more than 8 300 adolescents at 84 schools, with the aim of preventing depression and improving mental well-being by teaching mindfulness through a universal school program. The only catch? There was no difference in outcomes at one year.

Would it be possible to identify adolescents who would benefit from mindfulness? Christian A. Webb (of Harvard University) and his co-authors attempt to answer that question, using AI. And so, a longstanding objective, prevention, was joined with a modern method, machine learning. In the first selection, a paper from JAMA Psychiatry, the authors detail a secondary analysis using two complementary machine learning approaches and the MYRIAD Trial data. “This study found that analyses using machine learning identified a subgroup of participants with a statistically detectable but clinically trivial differential intervention response. These findings highlight the substantial challenges in achieving clinically useful personalization in universal school-based prevention programs.” We consider the paper and its implications.

In the second selection, from the Journal of the American Academy of Child & Adolescent Psychiatry, Alison Athey (of Johns Hopkins University) and her co-authors evaluate the impact of child access prevention laws on youth suicide deaths by firearms. They drew on more than 30 years of mortality data from the Centers for Disease Control and Prevention. “Laws that require families to store firearms unloaded and secured in a locking device appear to effectively prevent youth suicide deaths and firearm-related youth deaths by accident and homicide.”

And in this week’s third selection, Dr. Scott Monteith (of Michigan State University) and his co-authors write about generative AI and adolescents for The British Journal of Psychiatry. They note a surge in use – some 80% of British teens use generative AI – and consider problems, from cyberbullying to mental healthcare. “There is a need to increase awareness of how GenAI may have a negative impact on the mental health of teenagers.”

DG

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Reading of the Week: Coffee & Dementia Risk – the New JAMA Paper; Also, Mental Healthcare and Till on Her Son & His Illness

February 19, 2026 /

From the Editor

Many of us enjoy drinking coffee before a busy afternoon clinic. Is that cup of java actually healthy? Do caffeinated beverages like coffee and tea reduce the risk of dementia?

Smaller studies have suggested that they do reduce risk; a meta-analysis of coffee drinkers had a similar finding. In an impressive, new JAMA paper, Yu Zhang (of Harvard University) and his co-authors attempt to answer these questions. They report on a prospective cohort study involving almost 132 000 people, looking at dementia risk with a follow-up period up to 43 years. They found a reduction of about 18%. “Greater consumption of caffeinated coffee and tea was associated with lower risk of dementia and modestly better cognitive function, with the most pronounced association at moderate intake levels.” We consider the paper and its implications.

A cup (or two) a day keeps the doctor away?

It’s the paradox of modern psychiatry. Our medications and therapies have never been better, yet access remains poor and quality is uneven, in part because there is no mental health “system.” So, what can be done? In the second selection, from the podcast series Quick Takes, I sit down with Dr. Paul Kurdyak. In addition to being the longest serving ED psychiatrist at CAMH, he is the Vice-President, Medical, of Ontario Health’s Mental Health and Addictions Centre of Excellence. “Good systems just work. They don’t need to be navigated.”

And in the third selection, Madeline Till, a psychotherapist, writes about the struggles of her son, who has schizophrenia. In a New York Times essay, she wonders whether it would be easier if he had cancer. “More than anything else I have ever wanted, I want to stop this revolving door. I want schizophrenia to be treated with the same urgency, seriousness and continuity as any other life-threatening illness.”

DG

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Reading of the Week: Cannabis, with Papers from CMAJ and JAMA; Also, Carroll on Legalization

February 12, 2026 /

From the Editor

With more and more countries legalizing cannabis, we must wonder about the health implications. This week’s Reading offers three selections.

How does legalization (and increased use) affect mental health? Is there more psychosis? In the first selection, just published in CMAJ, Dr. Daniel T. Myran (of the University of Toronto) and his co-authors analyzed data from 12 million people born in Ontario, Canada, to attempt to answer those questions. They looked at diagnoses of psychosis-related disorders and years of birth, finding those born in the early 2000s were about twice as likely to have been diagnosed with a psychotic disorder by age 20. “The incidence of psychotic disorders has increased in more recent birth cohorts.” We consider the paper and its implications.

In a recent US survey, 20% of respondents reported using CBD in the last year – which is often assumed to be safer than THC. In the second selection from JAMA Internal Medicine, Jeffry Florian (of the US Food and Drug Administration) and his co-authors analyzed liver enzymes of healthy participants randomized to CBD or placebo. “In this randomized double-blinded placebo-controlled trial, 5.6% of healthy adults administered CBD 5 mg/kg/d for up to 28 days experienced liver enzyme level elevations greater than 3 times the upper limit of normal.”

Finally, in the third selection, Dr. Aaron E. Carroll (of Indiana University) writes about cannabis legalization. While arguing that there are successes with this policy change, he also worries about long-term consequences. He writes that reforms are needed, from better regulation to more education. “The real lesson here isn’t even about cannabis. It’s about our capacity to learn and adapt.”

DG

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Reading of the Week: AI Scribes in Primary Care – the New JAMA Psych Paper; Also, Antidepressant Prescribing and the Life & Death of Carol Sauer

February 5, 2026 /

From the Editor

More physicians are turning to AI scribes to free up time. But what is the impact on clinical care?

In a new JAMA Psychiatry paper, Victor M. Castro (of Harvard University) and his co-authors attempt to answer that question by looking at scribes in primary care. In a cohort study drawing on more than 20 000 routine annual visits, they compared documentation and management of neuropsychiatric symptoms. “Incorporation of AI ambient scribes in primary care was associated with greater levels of neuropsychiatric symptom documentation but lesser likelihood of documented management of psychiatric symptoms.” We consider the paper and its implications.

In the second selection, a letter published in The Canadian Journal of Psychiatry, Dionzie Ong (of the University of British Columbia) and her co-authors consider antidepressant prescribing and evidence, focusing on citalopram and escitalopram. “Preferential prescribing of escitalopram and claims of superiority are not supported by science.”

Finally, in the third selection, Washington Post reporter Dana Hedgpeth writes about the life and death of Carol Sauer, who spent years experiencing homelessness. She had graduated from high school, attended university, and held jobs until 2000, when she became ill. A person who read her death notice on social media comments: “I cried thinking about her. This beautiful woman sitting for 20 years at a bus stop and nobody could make a difference… It’s a reminder of the power and responsibility we have to help those who are homeless and mentally ill.” 

DG

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Reading of the Week: Yoga for Opioid Withdrawal? The New JAMA Psych Paper; Also, MAOIs & History, and AI-Associated Psychosis

January 29, 2026 /

From the Editor

Yoga is increasingly recognized as having a role in the treatment of those with mood and anxiety problems. But what about substance misuse?

In the first selection, from JAMA Psychiatry, Suddala Goutham (of the National Institute of Mental Health and Neurosciences, Bengaluru, India) and his co-authors attempt to answer that question in a new, early-stage randomized clinical trial. In the study, 59 men were randomized to yoga and buprenorphine or buprenorphine alone. “Those receiving yoga alongside standard buprenorphine treatment achieved withdrawal stabilization 4.4 times faster than controls (median, 5 vs 9 days) and showed significant improvements in heart rate variability, anxiety, sleep, and pain measures.” We consider the study and its implications.

In the second selection, from The Journal of Clinical Psychiatry, Vincent Van den Eynde (of Radboud University) and his co-authors write about the MAOI class of antidepressants. In a commentary paper, they argue that these medications are underappreciated. “We thus emphasize the need for renewed attention to the classic MAOIs in clinical practice and research.”

And in the third selection, Dr. Joseph M. Pierre (of the University of California, San Francisco) and his co-authors write about AI-associated psychosis for Innovations in Clinical Neuroscience. They discuss what they suggest is the first journal-published case report, detailing the struggles of a practicing medical professional. “Although multiple pre-existing risk factors may be associated with psychosis proneness, the sycophancy of AI chatbots together with AI chatbot immersion and deification on the part of users may represent particular red flags for the emergence of AI-associated psychosis.”

DG

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Reading of the Week: Tobacco, with Papers from JAMA and NEJM

January 22, 2026 /

From the Editor

The waiting room was filled with patients to see, so I concentrated on his history of alcohol misuse and opioids, and I glossed over his nicotine use. But does the path to sobriety in fact start with smoking cessation?

In a new JAMA Psychiatry paper, Michael J. Parks (of the National Institutes of Health) and his co-authors attempt to answer that question. They looked at whether smoking cessation increased sustained remission from substance use disorder (SUD) over time. They describe a longitudinal survey cohort study of more than 2 600 participants from the United States, followed for four years, finding that quitting cigarettes increased the odds of recovery from other SUDs by 30%. “In this cohort study, smoking cessation was linked to better SUD recovery outcomes, and it could improve overall health among the millions of US adults with a current SUD.” We discuss the paper and its implications.

In the second selection from The New England Journal of Medicine, Simon Gilbody (of the University of York) and his colleagues write about the challenges of tobacco in low- and middle- income countries. They note that 80% of tobacco users are in such countries, yet cessation programs aren’t prioritized, particularly absent for those with mental health conditions. “Therapeutic nihilism (the belief that no intervention will work) impedes change and is unjustified in this instance.”

And, in the third selection from JAMA Oncology, Dr. Chadi Nabhan (of the University of South Carolina) writes about his patient and lung cancer. He describes the incredible draw of tobacco – including as a way for his patient to cope with loneliness and isolation. “The cigarette was more than a source of nicotine.”

DG

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Reading of the Week: The Best of 2025

January 15, 2026 /

From the Editor

Welcome 2026.

It’s our tradition that the New Year starts with a review of the best papers of the past year. So, as we enter the first weeks of 2026, let’s look back at 2025.

The list is hardly exhaustive, and many great papers aren’t listed here. But there is an important thread that runs through all of them: they tie into our clinical work. These 10 papers selected are interesting, informative, and – yes – relevant.

They cover everything from AI to antidepressant withdrawal. And, yes, we touch on sex, too.

DG



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Reading of the Week: Antidepressants & Side Effects – the New Lancet Paper; Also, Medical Cannabis & Addiction, and AI Hallucinations

December 18, 2025 /

From the Editor

What are the physical side effects of antidepressants? In a new, impressive Lancet study, Toby Pillinger (of King’s College London) and his co-authors attempt to answer that old question with a new approach: the first systematic review and meta-analysis. They drew on 168 RCTs that measured physical health effects of antidepressants, including almost 59 000 participants and comparisons of 30 antidepressants. “We found strong evidence that antidepressants differ markedly in their physiological effects, particularly for cardiometabolic parameters.” We consider the paper and its implications.

How safe is cannabis for those taking it for medical purposes? Dr. Beth Han (of NIMH) and her colleagues report findings from a US survey in a new JAMA Psychiatry brief report, focusing on cannabis use disorder (CUD). They report that cannabis use wasn’t less addictive when used for medical reasons. “Clinicians should consider addiction risk before recommending medical cannabis and, if they do, should monitor for CUD emergence.”

The BMJ runs humorous articles in its Christmas issue. The journal doesn’t disappoint this year. Dr. Roberto A. Correa Soto (of the Universidad de los Andes) and his co-authors write about AI hallucinations and doctor BS (yes, you read that correctly). Frankly, the paper is worth reading for the profanity alone. “Both doctors and large language models (LLMs) are driven to produce misinformation – ‘bullshit’ and ‘hallucinations’ – owing to a shared pressure to provide answers, prioritising the appearance of competence over accuracy.”

There will be no Readings for the next three weeks. 

DG

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