Reading of the Week: GLP-1 Receptor Agonists for Obesity & Alcohol – the New Lancet Study; Also, Drs. Liao and Fombonne on Autism Overdiagnosis

May 7, 2026 / / 0 Comments

From the Editor

It could be lifesaving for those with diabetes. And many others are taking GLP-1 receptor agonists, ranging from people with medical conditions such as obesity to those who have cosmetic interests. GLP-1 receptor agonists are having a moment. Could they also be helpful for patients with substance problems? Some small studies suggest yes.

In a major new Lancet study, Dr. Mette Kruse Klausen (of Copenhagen University) and her co-authors attempt to answer that question. They report on a RCT involving patients with both obesity and alcohol use disorder. 108 Danish participants were randomized to the GLP-1 receptor agonist semaglutide or placebo. At six months, adults taking semaglutide reported five heavy drinking days in the previous months (down 41%) compared to nine days in the placebo group. “To our knowledge, this RCT is the first to show that once-weekly semaglutide reduces heavy drinking days and WHO drinking-risk levels in treatment-seeking patients with alcohol use disorder and comorbid obesity.” We consider the paper, the accompanying editorial, and its implications.

In this week’s other selection, a Viewpoint paper from JAMA Pediatrics, Drs. Lester Liao (of McGill University) and Eric Fombonne (of the Oregon Health & Science University) write on autism and overdiagnosis. “Diagnostic practices geared to accessing resources, incorrect diagnostic practices, increased attention, changes to diagnostic criteria and thresholds, and fundamental cultural shifts have contributed.”

DG

Continue reading

Reading of the Week: Psychedelics vs Antidepressants – the New JAMA Psych Paper; Also, US Psilocybin Use and Hahn on the Work of Mental Illness

April 30, 2026 / / 0 Comments

From the Editor

“Trump signs order to accelerate access to psychedelic drug treatments”

– Reuters, 18 April 2026

Last week, the U.S. president signed an executive order easing the way for more research on psychedelics for mental illness. It’s another example of the enthusiasm that many – policymakers, politicians, patients, families, members of the public – have for these drugs. Past work has indicated some effectiveness in treating depression. But how much of it can be explained by placebo? Psychedelics are, after all, challenging to study, in part because of difficulties with blinding (people can figure out whether they receive a psychedelic or placebo).

Dr. Zachary J. Williams (of the University of California, Los Angeles) and his co-authors attempt to shed light on this issue with a new, smart study published in JAMA Psychiatry. In it, they did a meta-analysis, comparing the effectiveness of psychedelic-assisted therapy (PAT) and open-label traditional antidepressants (TADs) for the treatment of major depression, drawing on 24 studies. “These findings suggest that PAT is no more effective than TADs under equal-unblinding conditions for the treatment of depression and highlight the potential role of blinding integrity.” We consider the paper and its implications.

And, on the topic of psychedelics, Dr. Kevin H. Yang (of the University of California, San Diego) and his co-authors look to quantify the number of people using psilocybin in the United States. In a priority data letter for The American Journal of Psychiatry, they used data from the National Survey on Drug Use and Health, a survey with more than 59 000 respondents. “With approximately 8 million individuals estimated as having used in the past year, naturalistic psilocybin use is sufficiently prevalent that psychiatrists are likely to encounter patients who use it outside of clinical settings.”

And in the third selection, an essay from The Globe and Mail, Brandon Hahn writes personally about his experiences with mental illness, noting public intolerance and tolerance – and meaningful gestures. “Sometimes support looks like red tape and a pile of forms. Sometimes it looks like a chair that faces the window while holding a hand.”

DG

Continue reading

Reading of the Week: MST vs ECT – the New Lancet Psychiatry Paper; Also, the First AI Drug Prescriber and Dr. Taglienti on Her Cancer & Her Career

April 23, 2026 /

From the Editor

He began to respond to ECT and felt less depressed than he had in many years. But as the treatments continued, my patient noticed gaps in his memory including family vacations when his children were young. “Those memories are precious.” He stopped ECT and, soon after, was deeply depressed again. 

Smaller studies suggest that Magnetic Seizure Therapy (MST) – where alternating magnetic fields induce seizures – offers relief to patients without the cognitive problems of ECT. In a new study published by The Lancet Psychiatry, Dr. Daniel M. Blumberger (of the University of Toronto) and his co-authors add to the literature with the largest randomized trial comparing these convulsive therapies conducted and the first non-inferiority clinical trial to address efficacy. The study involved 239 participants with depression. “MST showed non-inferior efficacy relative to… ECT in achieving remission of depression, and a more favourable cognitive safety profile.” We consider the paper and its implications.

Should patients receive prescriptions from an AI prescriber? In the second selection, from JAMA, Dr. Daniel G. Aaron (of the University of Utah) and Christopher Robertson (of Boston University) look at a new Utah program allowing AI to prescribe medications without physician involvement. They are cool to the idea. “Although AI offers the promise of increased efficiency and expanded access, the evasion of legal obligations by early movers raises profound concerns. Incorporating AI into modern health care must be evidence based and responsible.”

And in the third selection, Dr. Jenna Taglienti (of Hofstra University) writes personally about her cancer in JAMA. As a psychiatrist and a residency program director, she finds meaning in her work – but illness helps her gain perspective. “Medicine can have extraordinary meaning. But it cannot substitute for being present in your own life.”

DG

Continue reading

Reading of the Week: Mirtazapine for Methamphetamine – the New JAMA Psych Study; Also, Patients & AI and Delgaram-Nejad on His Meds

April 16, 2026 /

From the Editor

He occasionally used cannabis in his 20s and did not try crystal methamphetamine until after his 35th birthday. He readily admits to problematic use, undermining his relationship and leading to the loss of his job. In my office, he describes his desperation and asks: Is there a medication that could help?

In the first selection, a new paper published in JAMA Psychiatry, Rebecca McKetin (of the University of New South Wales) and her co-authors attempt to answer that question. In an impressive new study, they report the results of a phase 3, parallel-group, double-blind, placebo-controlled RCT involving 344 people with moderate or severe methamphetamine use disorder and a trial of mirtazapine or placebo. “The results of this randomized clinical trial confirm that mirtazapine can be used in routine clinical practice to facilitate a reduction in methamphetamine use among people with a moderate to severe methamphetamine use disorder.” We consider the paper and its implications.

In the second selection, Shaddy K. Saba and Dr. William B. Weeks (both of New York University) write on AI and patients. In a commentary for JAMA Psychiatry, the authors observe that an increasing number of patients are turning to AI and argue that clinicians need to become actively involved. “The question is not whether AI is good or bad for mental health: like many other patient behaviors, it can be both and depends on context. The question for clinicians is whether to help patients navigate its use.”

Finally, in the third selection from Schizophrenia Bulletin, Oliver Delgaram-Nejad – who has schizophrenia – discusses his decision to stop medication. Reviewing his episodes of psychosis, he argues that antipsychotics are too problematic for him. “I have weighed the benefits and risks, and navigated the rather painful tension, of remaining on an antipsychotic and living with the side effects versus accepting the risk of relapse and reclaiming my energy.”

DG

Continue reading

Reading of the Week: Cannabis – the New Lancet Psych Paper; Also, the Skepticism of Joel Paris and Mania & the Law

April 9, 2026 /

From the Editor

What do you say to your patient when he insists that cannabis is helping him with his mental disorder? What is the evidence?

Of course, many papers have been published on the topic. That said, Jack Wilson (of The University of Sydney) and his co-authors contribute nicely to the literature with their new systematic review and meta-analysis – arguably the most comprehensive to date – published in Lancet Psychiatry. 54 RCTs were included, involving almost 2 500 participants, including those with depression and PTSD. “Given the scarcity of evidence, the routine use of cannabinoids for the treatment of mental disorders and substance use disorders is currently rarely justified.” We discuss the paper and its implications.

What happens to your view of our field after five decades spent treating tens of thousands of patients, leading major institutions, and authoring dozens of books and papers? In a new episode of Quick Takes, Dr. Joel Paris, former chair of the Department of Psychiatry at McGill University and a self-proclaimed skeptic, discusses the past, present, and future of psychiatry. Never one to shy away from sharing his controversial views, Dr. Paris dives into his thoughts on the DSM system (he’s not a fan) and what he sees as “fads and facilities” – such as the overdiagnosis of adult ADHD, trauma, and autism. “Over time, my perspective on psychiatry has changed in the direction of greater skepticism.”

Finally, in the third selection from The Canadian Journal of Psychiatry, Drs. Kenya A. Costa-Dookhan and Andrew Lustig (both of the University of Toronto) discuss what to do when a patient doesn’t meet criteria for an involuntary admission but isn’t well. Drawing on a case involving a patient experiencing a manic episode, they offer three strategies. “When mania outruns the law, our task is to accompany our patients with clarity, compassion, and collective integrity, not toward cure, but toward the next opportunity for care.”

DG

Continue reading

Reading of the Week: Psychotic Prompts & AI – from JAMA Psych; Also, Lithium Landscape and Dr. Cooke on Growing Up

April 2, 2026 /

From the Editor

Patients, including those with psychosis, may turn to AI chatbots for advice. What are they told? And are they encouraged to seek care?

In a research letter that was recently published in JAMA Psychiatry, Dr. Elaine Shen (of Columbia University) and her co-authors attempt to answer these questions. Using three versions of ChatGPT, they provided 79 statements indicative of positive psychotic symptoms and 79 that were neutral. The responses were then rated by two reviewers. With the free version of ChatGPT – what most people use – psychotic prompts had 43-fold higher cumulative odds of receiving a less appropriate rating than control prompts. We consider the study and its implications.

Lithium has fallen out of fashion; a recent Canadian paper found declining prescriptions in Alberta. In a new American Journal of Psychiatry commentary, Dr. Robert M. Post (of George Washington University) and his co-authors make the case for the old mood stabilizer. They offer several arguments, including that it is a disease-modifying agent. “Clinicians, patients, and the public should be educated about the unique assets of lithium, such that conventional treatment paradigms of bipolar disorder emphasize the greater and earlier use of the drug to achieve a more benign course of illness and less cognitive dysfunction.”

Finally, in the third selection from JAMA, Dr. Emma M. Cooke (of Harvard University) writes about medical school rotations. Now an internist, she remembers the common med school question: “what do you want to do when you grow up?” She mulls her responses – and the simplicity of the question. “For everyone in medicine, not just medical students, our choice of specialty is just a single data point in what makes us who we are.”

DG


Continue reading

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

March 12, 2026 /

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

Continue reading

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

Continue reading

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

Continue reading

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

Continue reading