Psychiatry has no processes of clinical practice improvement. Each clinician is on their own, making it up as they go along according to their biases.
The shortage is of the quality of care that arises from understanding patients.
The shortage is of the quality of care that arises from understanding patients.
There are unfortunately no diagnostic solutions to institutional maladies in mental healthcare. If there is scarcity of relational care and no collaborative conceptualization and treatment planning, no tweaks to diagnostic language will substitute for what is actually needed.
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Psychotropic Deprescribing Council retweeted
Can universal help for teens about mental health make them more depressed?
A trial of 12,166 students in 153 English schools randomized them to:
• YAM, a 5-session program led by trained facilitators
• A 6-session teacher-led mental health literacy program (the Guide)
• Usual mprove depressive symptoms. The Guide program increased help-seeking and knowledge.
But at 9 to 12 months, depressive symptoms were worse in both programs than with usual practice (SMD 0.08 and 0.09).
Effects are small, but consider rolling this out universally to millions of kids. From the authors: "these kinds of programmes may encourage rumination and self-labelling in such a way that it increases emotional distress."
Ref: 10.1192/bjp.2026.10667
A trial of 12,166 students in 153 English schools randomized them to:
• YAM, a 5-session program led by trained facilitators
• A 6-session teacher-led mental health literacy program (the Guide)
• Usual mprove depressive symptoms. The Guide program increased help-seeking and knowledge.
But at 9 to 12 months, depressive symptoms were worse in both programs than with usual practice (SMD 0.08 and 0.09).
Effects are small, but consider rolling this out universally to millions of kids. From the authors: "these kinds of programmes may encourage rumination and self-labelling in such a way that it increases emotional distress."
Ref: 10.1192/bjp.2026.10667
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We do know that psychiatric drugs, particularly antipsychotics, tend to derange metabolic functioning. How about carefully reducing to the lowest effective dose before adding another drug? Why is this not standard procedure in psychiatric drug treatment?
Terrific game changing news for people with severe mental illness who now have 20 yearr reduced lifespan.
New weight loss drugs dramatically reduce mortality & may even improve psych symptoms.
BUT terrible news: Ridiculously expensive & often inaccessible.
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Psychotropic Deprescribing Council retweeted
The thing that helped the most is time, or to be generous, time on the first antidepressant. Here's another terrific study, CO-MED, that suggest that mechanism if irrelevant and that that more drugs have more side effects. No one wants to talk about it.
psychiatryonline.org/doi/10.1176/ap…
psychiatryonline.org/doi/10.1176/ap…
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Psychotropic Deprescribing Council retweeted
@jack_goulder No history of psychiatry is complete without examination of the role of primary care in psychiatric diagnosis & treatment for the last 35 years. Powers-that-be claimed antidepressants were so safe & effective, no specialist training needed. Made billion$ for pharma.
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"No placebo arm" is traditional in psychiatry research. You'd think the researchers wanted to find significant results for their experimental arm.
In 2017, the VA ran a large RCT (VAST-D) in 1,522 veterans with depression.
Three arms:
(1) adding the antipsychotic Abilify (aripiprazole)
(2) adding the NDRI Wellbutrin (bupropion)
(3) switching to Wellbutrin.
Abilify did statistically better, but the raw numbers are not . Groups started with QIDS of 16.5–17 and ended 8.9-10.1.
Some took this to mean adding an antipsychotic beats Wellbutrin. There was no placebo arm, so we can't know whether any of these would do better than time and attention.
The authors: "augmentation with aripiprazole resulted in a statistically significant but only modestly increased likelihood of remission."
Also the meds had side effects:
• Abilify akathisia (14.9% vs 4.3%), sedation (14.5% vs 7.2%), weight gain (25.2% vs 5.2%).
• Wellbutrin anxiety (24.3% vs 16.6%), irritability (6.3% vs 1.4%).
Ref: Mohamed et al., 2017. JAMA, 318(2), 132–145.
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Psychotropic Deprescribing Council retweeted
We learned nothing from the disastrous #OxyContin tragedy.
Big Pharma/Venture Capital/Biotech startups are pouring billions prematurely hyping ketamine/psilocybin/MDMA.
Long term efficacy unclear & safe only in highly controlled/very expensive settings.
Result will surely be massive increase in very dangerous street use.
Big Pharma/Venture Capital/Biotech startups are pouring billions prematurely hyping ketamine/psilocybin/MDMA.
Long term efficacy unclear & safe only in highly controlled/very expensive settings.
Result will surely be massive increase in very dangerous street use.
Researchers are optimistic about psychedelic drugs as potential treatments for depression and mood disorders, despite pushback having stalled the field
go.nature.com/4e1WDEM
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As usual in psychiatric, the findings neglect the environments that might foster these attitudes in teens, such as interpersonal behaviors handed down in families, regional alcoholism, & neighborhood political leanings.
Fascinating findings show how teenage psych symptoms predict adult political preferences
1)Teenage depression/anxiety》Later left voting
2)Conduct disorder》Later right voting
Possible Mechanism
1)Depression/Anxiety may stimulate empathy
2)Acting out indicates early lack of it.
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Psychotropic Deprescribing Council retweeted
Week 7 of the Symptom Patterns Series (Series 4)
Mixed and Overlapping Patterns
Some withdrawal symptoms may fit one recognizable pattern. Others may span several — or fit none of them neatly.
Earlier weeks described patterns involving threat and arousal, autonomic symptoms, movement, and changes in thinking, sensing, and self-experience. In practice, these patterns can overlap.
A person’s picture may include fear and a racing heart (threat/arousal) alongside tremor and difficulty keeping still (motor). Or digestive upset and light-headedness (autonomic) alongside mental fogginess (thinking) and sound sensitivity (sensory).
Appearing together does not mean sharing one cause.
Some symptoms are harder to place — flu-like feelings, skin symptoms, or new intolerances. Others, such as what some people call “benzo belly,” may overlap several areas rather than fitting one pattern. Naming them does not explain their cause.
Overlap is not a flaw — it is part of the picture. These patterns are a shared language for patients and clinicians. They are not diagnoses and do not establish why symptoms occur.
New or changing symptoms deserve individual medical evaluation.
thebenzotaperdoctor.com/post/mixed-and…
#BenzoWithdrawal #NervousSystem #Neuroscience
Mixed and Overlapping Patterns
Some withdrawal symptoms may fit one recognizable pattern. Others may span several — or fit none of them neatly.
Earlier weeks described patterns involving threat and arousal, autonomic symptoms, movement, and changes in thinking, sensing, and self-experience. In practice, these patterns can overlap.
A person’s picture may include fear and a racing heart (threat/arousal) alongside tremor and difficulty keeping still (motor). Or digestive upset and light-headedness (autonomic) alongside mental fogginess (thinking) and sound sensitivity (sensory).
Appearing together does not mean sharing one cause.
Some symptoms are harder to place — flu-like feelings, skin symptoms, or new intolerances. Others, such as what some people call “benzo belly,” may overlap several areas rather than fitting one pattern. Naming them does not explain their cause.
Overlap is not a flaw — it is part of the picture. These patterns are a shared language for patients and clinicians. They are not diagnoses and do not establish why symptoms occur.
New or changing symptoms deserve individual medical evaluation.
thebenzotaperdoctor.com/post/mixed-and…
#BenzoWithdrawal #NervousSystem #Neuroscience
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New psychiatric diagnosis for people who become physiologically dependent on a prescribed opioid: complex persistent opioid dependence (CPOD). But not addicted - that's opioid use disorder (OUD).
hmpgloballearningnetwork.com/site/pcn/qa/op…
hmpgloballearningnetwork.com/site/pcn/qa/op…
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You, too, propofol? "Have you ever noticed that some of your critically ill patients become agitated & confused when their propofol infusions are being tapered or discontinued?"
Managing Propofol Withdrawal psychiatrist.com/pcc/manifestat…
Managing Propofol Withdrawal psychiatrist.com/pcc/manifestat…
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This makes too much sense.
If we want to be evidence-based, as we should, then any clinical trial must follow the same scientific method: if "symptom relief" in the intervention group is high, but not higher than "placebo" (and we can argue what that placebo is or should be in various patient populations), then we can't call this intervention effective.
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Psychotropic Deprescribing Council retweeted
Dr. Ostacher, a recent article in Nature:
"What the field has not built, with equivalent rigor, is a science of what happens when the treatment stops."
Kim, B. (2026). The neuropsychopharmacology of treatment discontinuation. Neuropsychopharmacology. doi.org/10.1038/s41386…
"What the field has not built, with equivalent rigor, is a science of what happens when the treatment stops."
Kim, B. (2026). The neuropsychopharmacology of treatment discontinuation. Neuropsychopharmacology. doi.org/10.1038/s41386…
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Psychotropic Deprescribing Council retweeted
It would be great to have RCTs, but they're not a prerequisite for calling it "science." It's also worth remembering WHY we don't have RCTs--not because there's nothing worth investigating, but because of lack of funding. Most of science is done without RCTs, and for now we have to do our best to make inferences with available data. But it's also more than "conjecture and clinical experience."
The underlying biology aligns with with the clinical experience of many patients needing to taper to very low doses (ie hyperbolic dose occupancy curves) although the mechanistic picture is incomplete (here is where I plug @BShapiroMD and I's recent paper that you've seen as a next step). There is observational data as well, and much of what we do in psychiatry is based on observational data.
The fact that we know this issue affects many patients should prompt us to call for more research, but it shouldn't make us dismiss whatever evidence we do have. Good science is about making inferences with limited data, and we can't afford to sit back and wait for "perfect" data--too many patients are suffering for that!
The underlying biology aligns with with the clinical experience of many patients needing to taper to very low doses (ie hyperbolic dose occupancy curves) although the mechanistic picture is incomplete (here is where I plug @BShapiroMD and I's recent paper that you've seen as a next step). There is observational data as well, and much of what we do in psychiatry is based on observational data.
The fact that we know this issue affects many patients should prompt us to call for more research, but it shouldn't make us dismiss whatever evidence we do have. Good science is about making inferences with limited data, and we can't afford to sit back and wait for "perfect" data--too many patients are suffering for that!
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In many studies, the quality of the relationship between a patient and their doctor or therapist has emerged as a prominent factor for good outcomes.
the quality of the relationship between a patient and their therapist was one of the strongest predictors of treatment outcome in a psilocybin study
not everyone needs a therapist in the room, obviously, but for people with TRD or PTSD... they likely do.
frontiersin.org/journals/pharm…
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Psychotropic Deprescribing Council retweeted
📢 I am very happy to report that my new paper on why psychotherapies should not be used as standard treatment for #POTS is accepted for publication. 🎉
Only the abstract is published so far; full paper to follow.
frontiersin.org/journals/neuro…
Only the abstract is published so far; full paper to follow.
frontiersin.org/journals/neuro…
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Psychotropic Deprescribing Council retweeted
"Diagnostic revision may correct error; it may also threaten identity, access to support and self-understanding, fall unequally on particular groups, or become a mechanism for rationing" pubmed.ncbi.nlm.nih.gov/42920509/ From @DrMariosAdamou et al. De-diagnosis is a rising topic.
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Psychotropic Deprescribing Council retweeted
Great piece explaining current profusion of diagnostic fads & obstacles to corrective "de-diagnosis".
3 causes:
1)Demand led self-diagnosis rather than careful clinical evaluation 2)Identity-conferring rather than descriptive labeling 3)Self-reinforcing rather correctable
3 causes:
1)Demand led self-diagnosis rather than careful clinical evaluation 2)Identity-conferring rather than descriptive labeling 3)Self-reinforcing rather correctable
"Diagnostic revision may correct error; it may also threaten identity, access to support and self-understanding, fall unequally on particular groups, or become a mechanism for rationing" pubmed.ncbi.nlm.nih.gov/42920509/ From @DrMariosAdamou et al. De-diagnosis is a rising topic.
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Psychotropic Deprescribing Council retweeted
Some therapists work to develop their clinical skill.
Some work to build their online brands.
It’s probably good to recognize the difference.
Some work to build their online brands.
It’s probably good to recognize the difference.
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So under-researched, post-partum conditions are relegated to psychiatry, the last resort for unusual behaviors, instead of being addressed by gynecological endocrinology. Why are women treated this way?
4 thoughts re post partum disorders:
1)Crucial psychs get better training- but even more for Peds & Ob/Gyn MDs & nurses
2)Single screening not enough-must be every visit 3)4 week criterion is arbitrary-screen symptoms for 3 months
4)Way under-researched
Read this useful review:
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