Chris Aiken, MD
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chrisaikenmd.bsky.social
Chris Aiken, MD
@chrisaikenmd.bsky.social
Editor, Carlat Psychiatry Report.
Assist Prof, NYU & WFU medical schools.
www.chrisaikenmd.com
Posting daily updates on all things psychiatric
Here's what to know about SNT #TMS:
▪ Brought full recovery to 80% with refractory #depression (avg 5 med failures)
▪ Works within a week
▪ Double blind was intact

More in podcast:
www.thecarlatreport.com/blogs/2-the-...

And new depression textbook (audio version out soon):
amzn.to/4p7hc6e
November 25, 2025 at 1:03 PM
#Probiotics improved sexual health in women:
pubmed.ncbi.nlm.nih.gov/40136541

Mainly sexual function on SSRIs, but also menopause, PCOD, and endometriosis.

Also improve depression, cognition, anxiety, and metabolic health in varied populations.

How to use:
chrisaikenmd.com/supplements
November 24, 2025 at 1:01 PM
▪ 10 causes of ADHD symptoms that are NOT classic ADHD
▪ 3 new med combos*
▪ 5 generic swaps for branded meds
▪ 5 research updates

All in the new Carlat Report:
www.thecarlatreport.com/ext/resource...

*eg atomoxetine-trazodone in sleep apnea, lurasidone-cycloserine in bp-depression
November 23, 2025 at 1:00 PM
Possible lithium interaction with semaglutide (Ozempic) raising #lithium levels (possibly through dehydration or increased absorption).

BOTTOM LINE: Check lithium labs before starting semaglutide, and monitor lithium level more frequently during therapy

pubmed.ncbi.nlm.nih.gov/40999647
November 22, 2025 at 1:00 PM
More tea = less #depression, with peak benefits at 6 cups/day (in large epidem studies).

This new analysis finds a similar trend for cognitive benefits, peaking at 5 cups/day.
pubmed.ncbi.nlm.nih.gov/41222998

Tea has more neuroprotectants than coffee:
chrisaikenmd.com/coffeetea
November 21, 2025 at 1:02 PM
Sleep is essential to health, but health is no better with most sleep meds.

By avoiding benzos, z-hypnotics, trazodone after age 50, people will live a little longer, have fewer falls, better cognition:
pubmed.ncbi.nlm.nih.gov/41209816

Natural ways to improve sleep:
chrisaikenmd.com/brochures
November 20, 2025 at 1:02 PM
Guanfacine improved #depression and cognition in uncontrolled trial of patients with prominent cognitive symptoms (it is a non-stimulant used for #ADHD) (2 mg qhs).
pubmed.ncbi.nlm.nih.gov/41211529

Evidence grade: Low (5/10, dramatic results)
chrisaikenmd.com/ebm
November 19, 2025 at 1:02 PM
Does smoking cause irritability in #bipolar?

Possibly, concludes Mendelian randomization study, where it accounts for 12% of the irritability:
pubmed.ncbi.nlm.nih.gov/41221021

Other studies suggest a smoking --> depression cause, perhaps through vascular health.

Evidence grade: Low (4/10)
November 18, 2025 at 1:01 PM
Curcumin (turmeric) is one of the top supplements for #depression, and in the analysis of 9 #diabetes trials it led to 3.6 lb weight loss.
www.ncbi.nlm.nih.gov/pubmed/41211...

Caution: rare liver injury, though also has liver protective effects.

How to use:
chrisaikenmd.com/supplements
November 17, 2025 at 1:02 PM
Neuromodulation =
1. TMS
2. ECT
3. Transcranial direct current stim (tDCS)
4. Deep brain stim (DBS)
5. Vagus nerve stim (VNS)
6. Magnetic stim therapy (MST) and more

Only one works in treatment resistant #schizophrenia: TMS.

From new analysis:
www.ncbi.nlm.nih.gov/pubmed/41210...

#psychiatry
November 16, 2025 at 1:01 PM
L-theanine improved insomnia and quality #sleep initiation in analysis of 11 RCTs (100-225mg BID):
www.ncbi.nlm.nih.gov/pubmed/41176...

It's a glutamatergic extract of tea with positive trials in depression, OCD, anxiety, and cognition. How to use:
chrisaikenmd.com/supplements

Art Y Wang
November 15, 2025 at 1:01 PM
The GLP-1 semaglutide (#Ozempic) failed to improve mood and executive functioning in this, the first RCT of a GLP-1 for major #depression:
www.sciencedirect.com/science/arti...

Weight loss was significant (all subjects were overweight/obese).

Evidence grade Moderate (8/10):
chrisaikenmd.com/ebm
November 14, 2025 at 1:01 PM
Updates on TMS for depression in podcast interview with Owen Muir @owenmuir.bsky.social

1. How to explain TMS to patients:
www.thecarlatreport.com/blogs/2-the-...

2. TMS vs Antidepressants in Teens:
www.thecarlatreport.com/blogs/2-the-...

#depression #psychiatry #therapy #pmhnp #mentalhealth
November 14, 2025 at 1:35 AM
Lithium improved bone repair and density in new animal study, in line with recent human findings of a lower risk of osteopenia with #lithium:
www.ncbi.nlm.nih.gov/pubmed/41194...

(In contrast, SSRI and SNRI antidepressants have osteopenia risks).

#psychiatry #pmhnp #bipolar #depression
November 13, 2025 at 1:02 PM
Sleep deprivation = more impulsive and risk-taking, and new RCT finds it makes us
▪ Chase immediate gains
▪ But more chaotic decision-making, unable to sustain a strategy

pubmed.ncbi.nlm.nih.gov/41206488

Evidence: Moderate (6/10)

A patient-podcast on CBT-insomnia:
pocketpsychpod.com/how-to-sleep
November 12, 2025 at 1:01 PM
New data on Acetaminophen (Tylenol) --> #Autism/#ADHD:

▪ No evidence of causal link in analysis of 9 systemic reviews
▪ When compared to outcomes in unexposed siblings, the small associations disappeared, suggesting other (eg, genetic) factors explain it:

www.bmj.com/content/391/...
November 11, 2025 at 1:01 PM
Keto and Mediterranean diets compared for mood in health subjects:
▪ Medit better for #depression
#Keto better for impulsivity, weight
www.ncbi.nlm.nih.gov/pubmed/41197...

How to use Medit for mood:
chrisaikenmd.com/antidepressa...

Evidence: Low (small, high drop-out, not blinded, 3-mth RCT)
November 10, 2025 at 1:17 PM
"How to get the best night's #sleep: What the science says" a nice podcast from Nature journal:
cms-resources.apps.public.k8s.springernature.io/springer-cms...

They focus on light at night. These blue-light blockers improved sleep quality in two RCTs:
chrisaikenmd.com/darktherapy

#therapy
November 9, 2025 at 1:00 PM
Saffron improved premenstrual syndrome with a moderate effect size (0.4-0.8) in meta-analysis of 7 randomized trials:
pubmed.ncbi.nlm.nih.gov/41151539

Saffron also improved #depression and #sleep quality in recent large trials.

How to use it:
chrisaikenmd.com/supplements

#naturalhealth
November 8, 2025 at 1:00 PM
FDA approved lumateperone (Caplyta) aug in #major depression:
▪ 42 mg qhs
▪ Effect size 0.6 (good for class)
▪ Lower risk of EPS, akathisia, and metabolic risks within class, but sedating

I'll need to update this table from my book, Difficult to Treat Depression, about to go to press.

#psychiatry
November 7, 2025 at 1:01 PM
From ChatGPT's internal audit. Each week
▪ 1.2 million (0.15%) express suicidal intent
▪ 560,000 (0.07%) have signs of emergency mania/psychosis

New algorithm performs better those who use it for therapy, but still veers off in suicide conversations 1 in 10 times:
pubmed.ncbi.nlm.nih.gov/41167716
November 6, 2025 at 1:02 PM
Probiotics may help #autism, from meta-analysis of 8 small RCTs:
pubmed.ncbi.nlm.nih.gov/41139591

Bigger impact over > 3 mth and in younger children.

(Gut health is implicated in autism, but confidence limits in analysis barely positive)

How to use them:
chrisaikenmd.com/supplements

#therapy
November 5, 2025 at 1:01 PM
#Sleep deprivation linked to worse outcomes in this first-of-its kind study of surgeons:
pubmed.ncbi.nlm.nih.gov/41117395

Evidence grade low (4/10):
chrisaikenmd.com/ebm

Photo: Weird Al. #psychiatry #surgery #medicine
November 4, 2025 at 1:02 PM
Night owls procrastinate more in college, and have more #depression/anxiety, concludes new cross-sectional study:
www.ncbi.nlm.nih.gov/pubmed/41140...

Evidence grade low (3/10)

They benefit from blue-light blockers glasses and dawn simulators; how to use them: chrisaikenmd.com/darktherapy
November 3, 2025 at 1:01 PM
New #therapy for #depression, Dynamic Interpersonal Therapy, had better long-term effects than CBT or med:
pubmed.ncbi.nlm.nih.gov/41135204

Focuses on attachment, mentalization, and recurring patterns in relationships.

Evidence grade moderate 7/10
chrisaikenmd.com/ebm

#psychology #psychiatry
November 2, 2025 at 1:01 PM