Chris Aiken, MD

@chrisaikenmd

Editor, Carlat Psychiatry Report. Assist Prof, NYU & WFU medical schools. Never received pharma funding. Posting daily research to learn, discuss, debate.

New York, NY

Joined June 2022

927Following

8KFollowers

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Chris Aiken, MD@chrisaikenmd · Jun 25, 2022

A daily dose of practice-changing research from the editor of the Carlat Psychiatry Report

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Chris Aiken, MD@chrisaikenmd · Jul 23

New risks/benefits with clozapine in July Carlat, where Dr. Leung of Mayo Clinic shares the rating scale they use to follow patients: chrisaikenmd.com/clozapinesidee… And one for other antipsychotics: chrisaikenmd.com/antipsychotics… Full issue: thecarlatreport.com/articles/5400-…

chrisaikenmd's tweet image. New risks/benefits with clozapine in July Carlat, where Dr. Leung of Mayo Clinic shares the rating scale they use to follow patients:
chrisaikenmd.com/clozapinesidee…

And one for other antipsychotics:
chrisaikenmd.com/antipsychotics…

Full issue:
thecarlatreport.com/articles/5400-…

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Chris Aiken, MD@chrisaikenmd · Jul 17

Pramipexole surpassed amantadine/ quetiapine in new RCT of 150 with treatment resistant #depression as aug: pubmed.ncbi.nlm.nih.gov/40659070 Quetiapine (100 mg) and pramipexole (0.375 mg) underdosed, See 7/4 post for better study of pramipexole in TRD at 2.5 mg/day.

chrisaikenmd's tweet image. Pramipexole surpassed amantadine/ quetiapine in new RCT of 150 with treatment resistant #depression as aug:
pubmed.ncbi.nlm.nih.gov/40659070

Quetiapine (100 mg) and pramipexole (0.375 mg) underdosed, See 7/4 post for better study of pramipexole in TRD at 2.5 mg/day.

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Chris Aiken, MD@chrisaikenmd · 15 h

ECT was more effective and better tolerated in older (≥ 85) than younger patients in this Swedish registry analysis: pubmed.ncbi.nlm.nih.gov/40640071 They controlled for severity and psychotic features, which also predict ECT response in depression.

chrisaikenmd's tweet image. ECT was more effective and better tolerated in older (≥ 85) than younger patients in this Swedish registry analysis:
pubmed.ncbi.nlm.nih.gov/40640071

They controlled for severity and psychotic features, which also predict ECT response in depression.

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Chris Aiken, MD@chrisaikenmd · Jul 24

Should you use naltrexone oral or XR injectable? New analysis finds both work for alcohol and opioid use disorders, but patients are 1.5-2 times more likely to stay in treatment with injectable: pubmed.ncbi.nlm.nih.gov/40660643 What's you're experience?

chrisaikenmd's tweet image. Should you use naltrexone oral or XR injectable? New analysis finds both work for alcohol and opioid use disorders, but patients are 1.5-2 times more likely to stay in treatment with injectable:
pubmed.ncbi.nlm.nih.gov/40660643

What's you're experience?

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Chris Aiken, MD@chrisaikenmd · Jul 23

Brexpiprazole (Rexulti) rejected for PTSD by FDA's advisory panel, voting 10:1. Why? ▪ Only 1 out of 2 phase III trials positive (large phase II trial also positive) ▪ Antipsychotic only tested as first-line, sertraline-combo, but risky meds better reserved for non-response.

chrisaikenmd's tweet image. Brexpiprazole (Rexulti) rejected for PTSD by FDA's advisory panel, voting 10:1. Why?

▪ Only 1 out of 2 phase III trials positive (large phase II trial also positive)
▪ Antipsychotic only tested as first-line, sertraline-combo, but risky meds better reserved for non-response.

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Chris Aiken, MD@chrisaikenmd · Jul 21

There are three diets with #antidepressant potential: Nordic, Japanese, and Mediterranean. Only the Mediterranean is supported by RCTs, and this new cross-sectional study adds evidence to the Nordic: ncbi.nlm.nih.gov/pubmed/40620153 An antidepressant diet: chrisaikenmd.com/antidepressant…

chrisaikenmd's tweet image. There are three diets with #antidepressant potential: Nordic, Japanese, and Mediterranean.

Only the Mediterranean is supported by RCTs, and this new cross-sectional study adds evidence to the Nordic:
ncbi.nlm.nih.gov/pubmed/40620153

An antidepressant diet:
chrisaikenmd.com/antidepressant…

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Chris Aiken, MD@chrisaikenmd · Jul 20

High-salt intake is linked to depression. New 15-yr study is best designed yet, following 276,138 people who were free from depression at start; ncbi.nlm.nih.gov/pubmed/40623639 Doubt we’ll see definitive proof - RCTs would be unethical in humans - but animal studies have provided that.

chrisaikenmd's tweet image. High-salt intake is linked to depression. New 15-yr study is best designed yet, following 276,138 people who were free from depression at start;
ncbi.nlm.nih.gov/pubmed/40623639

Doubt we’ll see definitive proof - RCTs would be unethical in humans - but animal studies have provided that.

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Chris Aiken, MD@chrisaikenmd · Jul 19

Last year, TMS beat aripiprazole augmentation in treatment resistant depression, but what about cognitive symptoms? The two had similar cognitive outcomes, though TMS was better by a non-significant degree: ncbi.nlm.nih.gov/pubmed/40633778

chrisaikenmd's tweet image. Last year, TMS beat aripiprazole augmentation in treatment resistant depression, but what about cognitive symptoms?

The two had similar cognitive outcomes, though TMS was better by a non-significant degree:
ncbi.nlm.nih.gov/pubmed/40633778

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Chris Aiken, MD@chrisaikenmd · Jul 19

More time outdoors = less depression. It’s a common truism, but this study suggests it is only true for night owls ncbi.nlm.nih.gov/pubmed/40623646 Nigh owls do benefit from morning light and evening darkness. Learn how to get that with a dawn simulator: chrisaikenmd.com/dawnsimulator

chrisaikenmd's tweet image. More time outdoors = less depression.

It’s a common truism, but this study suggests it is only true for night owls
ncbi.nlm.nih.gov/pubmed/40623646

Nigh owls do benefit from morning light and evening darkness. Learn how to get that with a dawn simulator:
chrisaikenmd.com/dawnsimulator

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Chris Aiken, MD@chrisaikenmd · Jul 19

Daridorexant (Quviviq) improved all sleep outcomes in new, phase III RCT of mild sleep apnea, without causing daytime fatigue: pubmed.ncbi.nlm.nih.gov/40660750 These orexin antagonists are generally safer than traditional hypnotics. #psychiatry #neurology #pmhnp

chrisaikenmd's tweet image. Daridorexant (Quviviq) improved all sleep outcomes in new, phase III RCT of mild sleep apnea, without causing daytime fatigue:
pubmed.ncbi.nlm.nih.gov/40660750

These orexin antagonists are generally safer than traditional hypnotics.

#psychiatry #neurology #pmhnp

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Chris Aiken, MD@chrisaikenmd · Jul 19

Can too much power turn someone into a narcissist? Is artificial intelligence mirroring us all into a little narcissism? Our Carlat podcast explores it. PART 1 thecarlatreport.com/blogs/2-the-ca… PART 2

chrisaikenmd's tweet image. Can too much power turn someone into a narcissist?

Is artificial intelligence mirroring us all into a little narcissism?

Our Carlat podcast explores it.

PART 1
thecarlatreport.com/blogs/2-the-ca…

PART 2

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Chris Aiken, MD@chrisaikenmd · Jul 18

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Chris Aiken, MD@chrisaikenmd · Jul 15

Mystical experiences mediate the antidepressant effects of psilocybin, concludes new, small trial: pubmed.ncbi.nlm.nih.gov/40590216 The trial is small, and not definitive, but in-line with earlier findings including the pivotal escitalopram vs. psilocybin trial.

chrisaikenmd's tweet image. Mystical experiences mediate the antidepressant effects of psilocybin, concludes new, small trial:
pubmed.ncbi.nlm.nih.gov/40590216

The trial is small, and not definitive, but in-line with earlier findings including the pivotal escitalopram vs. psilocybin trial.

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Chris Aiken, MD@chrisaikenmd · Jul 14

Are stimulants safe in pregnancy? Study of 11,075 identifies new risk of preterm birth (30% higher): pubmed.ncbi.nlm.nih.gov/40364699 Methylphenidate has a risk of cardiac malformations (3:1,000 exposed births). But, need to balance against risks of car accidents etc in untreated ADHD.

chrisaikenmd's tweet image. Are stimulants safe in pregnancy? Study of 11,075 identifies new risk of preterm birth (30% higher):
pubmed.ncbi.nlm.nih.gov/40364699

Methylphenidate has a risk of cardiac malformations (3:1,000 exposed births). But, need to balance against risks of car accidents etc in untreated ADHD.

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Chris Aiken, MD@chrisaikenmd · Jul 13

Mediterranean diet treats depression, but can focusing on it worsen eating disorders (ED)? Possibly, but it is assoc w/ 75% lower ED risk in new study (causation unclear): pubmed.ncbi.nlm.nih.gov/40605615 What's your take? A diet for depression: chrisaikenmd.com/antidepressant…

chrisaikenmd's tweet image. Mediterranean diet treats depression, but can focusing on it worsen eating disorders (ED)?

Possibly, but it is assoc w/ 75% lower ED risk in new study (causation unclear):
pubmed.ncbi.nlm.nih.gov/40605615

What's your take?

A diet for depression:
chrisaikenmd.com/antidepressant…

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Chris Aiken, MD@chrisaikenmd · Jul 12

New analysis finds antidepressants cause withdrawal (WD) symptoms with only a small effect size: pubmed.ncbi.nlm.nih.gov/40632531 Limitations: ▪ Short-term (avg 5 mth Rx) ▪ Only 1 trial of med w/high WD risk (paroxetine); 40% involved meds with low WD risks (vortioxetine, agomelatine)

chrisaikenmd's tweet image. New analysis finds antidepressants cause withdrawal (WD) symptoms with only a small effect size:
pubmed.ncbi.nlm.nih.gov/40632531

Limitations:
▪ Short-term (avg 5 mth Rx)
▪ Only 1 trial of med w/high WD risk (paroxetine); 40% involved meds with low WD risks (vortioxetine, agomelatine)

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Chris Aiken, MD@chrisaikenmd · Jul 12

What to know about FDA's change on XR stimulants: ▪ < age 6 = higher serum levels, more side effects/weight loss ▪ For ADHD < age 6, behavior/family therapy is first-line, and instant-release stimulants preferred over XR, methylphenidate preferred over amphetamine

chrisaikenmd's tweet image. What to know about FDA's change on XR stimulants:
▪ &lt; age 6 = higher serum levels, more side effects/weight loss
▪ For ADHD &lt; age 6, behavior/family therapy is first-line, and instant-release stimulants preferred over XR, methylphenidate preferred over amphetamine

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Chris Aiken, MD@chrisaikenmd · Jul 10

Does propranolol treat #anxiety? There are surprisingly few trials of it, so this randomized placebo controlled trial - though small - is a welcome addition, where it augmented sertraline in panic (20mg/d): pubmed.ncbi.nlm.nih.gov/40615929 #psychiatry #pmhnp

chrisaikenmd's tweet image. Does propranolol treat #anxiety? There are surprisingly few trials of it, so this randomized placebo controlled trial - though small - is a welcome addition, where it augmented sertraline in panic (20mg/d):
pubmed.ncbi.nlm.nih.gov/40615929

#psychiatry #pmhnp

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Chris Aiken, MD@chrisaikenmd · Jul 9

Most seizures meds worsen cognition, but can levetiracetam (Keppra) improve it? These 6 RCTs tested it in cognitive decline, where it brought small gains in visual-spatial and executive functioning (125-500mg BID): pubmed.ncbi.nlm.nih.gov/40608289 (levetiracetam may treat mania & TD)

chrisaikenmd's tweet image. Most seizures meds worsen cognition, but can levetiracetam (Keppra) improve it?

These 6 RCTs tested it in cognitive decline, where it brought small gains in visual-spatial and executive functioning (125-500mg BID):
pubmed.ncbi.nlm.nih.gov/40608289

(levetiracetam may treat mania &amp; TD)

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Chris Aiken, MD@chrisaikenmd · Jul 8

Light therapy treats bipolar depression in all seasons, but should you give it at 12pm or 8am? Both had similar benefits and manic risk in new RCT: pubmed.ncbi.nlm.nih.gov/40608475 Raise gradually to prevent mania (from 7.5-15min to 45-60min over 4-10 wk) How to chrisaikenmd.com/lighttherapy

chrisaikenmd's tweet image. Light therapy treats bipolar depression in all seasons, but should you give it at 12pm or 8am?

Both had similar benefits and manic risk in new RCT:
pubmed.ncbi.nlm.nih.gov/40608475

Raise gradually to prevent mania (from 7.5-15min to 45-60min over 4-10 wk)

How to
chrisaikenmd.com/lighttherapy

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