Einat Karp Barnir, Zohar Rubinstein, Rany Abend, Shaul Lev-Ran, Lia Naor, Mario Mikulincer
{"title":"Peri-traumatic consumption of classic psychedelics is associated with lower anxiety and post-traumatic responses 3 weeks after exposure.","authors":"Einat Karp Barnir, Zohar Rubinstein, Rany Abend, Shaul Lev-Ran, Lia Naor, Mario Mikulincer","doi":"10.1177/02698811251334025","DOIUrl":"10.1177/02698811251334025","url":null,"abstract":"<p><p>Emerging evidence indicates the therapeutic potential of psychedelic compounds for post-traumatic stress, yet the mechanisms mediating their effects remain unclear. Delineating the effect of psychedelics on traumatic memory formation could shed light on target therapeutic mechanisms. Here, we report on 343 adult survivors of a single, large-scale terrorist attack taking place during a festival in which different psychedelic compounds were consumed, in whom levels of anxiety and post-traumatic symptoms were assessed 3 weeks following the attack. Findings indicated that those who were under the influence of classic psychedelics during the attack reported significantly lower levels of anxiety and post-traumatic responses compared to those who were under the influence of 3,4-methylenedioxymethamphetamine and those who consumed no psychedelics. Furthermore, the protective effects of classic psychedelics for post-traumatic responses manifested more strongly among participants who did not consume additional recreational substances alongside psychedelics. These findings suggest that pharmacologic targets of classic psychedelics may modulate the formation of enduring trauma memories and confer a protective effect against the development of post-traumatic stress and anxiety responses.</p>","PeriodicalId":16892,"journal":{"name":"Journal of Psychopharmacology","volume":" ","pages":"1031-1036"},"PeriodicalIF":5.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yana Vella, Kateřina Syrová, Aneta Petrušková, Isis Koutrouli, Viera Kútna, Jan Pala, Klára Šíchová, Marek Nikolič, Vladimír Mazoch, Radek Jurok, Martin Kuchař, Zdeňka Bendová, Tomáš Páleníček
{"title":"Effects of serotonergic psychedelics on synaptogenesis and immediate early genes expression - comparison with ketamine, fluoxetine and lithium.","authors":"Yana Vella, Kateřina Syrová, Aneta Petrušková, Isis Koutrouli, Viera Kútna, Jan Pala, Klára Šíchová, Marek Nikolič, Vladimír Mazoch, Radek Jurok, Martin Kuchař, Zdeňka Bendová, Tomáš Páleníček","doi":"10.1177/02698811251338232","DOIUrl":"10.1177/02698811251338232","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that psychedelics can induce rapid and long-lasting antidepressant effects. The generally acknowledged explanation for these traits is the phenomenon of neuroplasticity, although the exact underlying molecular mechanisms remain unclear.</p><p><strong>Aims: </strong>This study investigates the effects of psilocin, lysergic acid diethylamide (LSD) and N,N-dimethyltryptamine (DMT) on synaptogenesis and immediate early genes (IEGs) expression in direct comparison with ketamine, fluoxetine and lithium after acute (1 h) and/or prolonged (24 h) treatment in vitro.</p><p><strong>Methods: </strong>Rat primary cortical cultures were treated with 10 µM psilocin, 1 µM LSD, 90 µM DMT, 1 µM ketamine, 10 µM fluoxetine and 5 mM lithium. Analysis of synaptic puncta was performed; puncta of presynaptic marker synapsin I/II, postsynaptic density protein 95 (PSD-95) and their co-localization (established synapse) were assessed 24 h after drug treatment. Next, expressions of IEGs encoding activity-regulated cytoskeleton-associated protein (<i>Arc</i>), early growth response 1 (<i>Egr1</i>), and neuronal PAS (Per-Arnt-Sim) domain protein 4 (<i>Npas4</i>) were analysed 1 and 24 h after drug treatments.</p><p><strong>Results: </strong>Psilocin increased synaptic puncta count and induced <i>Arc</i> expression. The effect to promote synaptogenesis was comparable to ketamine and lithium; ketamine additionally increased PSD-95 puncta count. LSD and DMT did not induce any significant effects. Interestingly, fluoxetine had no effect on synaptic puncta count, but upregulated <i>Egr1</i> and <i>Npas4</i>.</p><p><strong>Conclusions: </strong>Psilocin demonstrated synaptogenic effects comparable to those of ketamine and lithium, and acutely upregulated IEG <i>Arc</i> expression, adding another piece of evidence to its profile as a promising therapeutic agent.</p>","PeriodicalId":16892,"journal":{"name":"Journal of Psychopharmacology","volume":" ","pages":"1023-1030"},"PeriodicalIF":5.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychedelic-assisted psychotherapy: The need to monitor adverse events.","authors":"Krj Schruers, N K Leibold","doi":"10.1177/02698811251340929","DOIUrl":"10.1177/02698811251340929","url":null,"abstract":"<p><p>The therapeutic use of psychedelics for mental health issues holds considerable promise. However, systematic assessment of adverse events associated with these substances has received relatively little attention. Here, we discuss several considerations concerning the assessment of adverse events in psychedelic-assisted therapies. We discuss the preference for using the term \"adverse effects\" over \"side effects\", as well as the ongoing debate regarding which substances are classified as psychedelic. We also provide recommendations on when and how to assess adverse effects, for example the importance to study them in any kind of therapy involving psychedelics, and using comprehensive monitoring of a wide range of physical parameters in combination with behavioral outcomes and the individual's experience, at baseline and throughout the study. Also, sex-specific differences should be considered. Furthermore, we highlight several significant studies that have addressed these aspects. In summary, psychedelics offer great promise as a potential treatment (add-on) option in psychiatry, but more rigorous assessment of adverse effects is needed to promote safe use and implementation in clinical practice.</p>","PeriodicalId":16892,"journal":{"name":"Journal of Psychopharmacology","volume":" ","pages":"896-899"},"PeriodicalIF":5.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Are the LSD-analogs lisuride and ergotamine examples of non-hallucinogenic serotonin 5-HT2A receptor agonists?","authors":"Jan Kehler, Morten Skøtt Thomsen Lindskov","doi":"10.1177/02698811251330741","DOIUrl":"10.1177/02698811251330741","url":null,"abstract":"<p><p>The recent resurgence of classical psychedelic compounds, specifically 5-HT<sub>2A</sub> receptor agonists, as potential therapeutics has led to numerous initiatives aimed at better understanding the mechanisms underlying their effects. Psychedelic compounds are commonly known as hallucinogens. One of the major outstanding questions in the field is whether altered states of consciousness-the hallucinogenic or psychedelic experience-is a prerequisite for the therapeutic effect. As a result, several academic and commercial efforts are focused on developing 5-HT<sub>2A</sub> receptor agonists that are speculated not to have these consciousness-altering effects. However, these efforts largely rely on chemical analogs of supposedly non-hallucinogenic 5-HT<sub>2A</sub> receptor agonists, such as lisuride and ergotamine. Our review of the literature indicates that there is no basis for claiming that lisuride or ergotamine are non-hallucinogenic at relevant concentrations in the brain. This does not invalidate current efforts to produce non-hallucinogenic 5-HT<sub>2A</sub> receptor agonists for the potential benefit of patients, but it calls for caution in the reliance on animal data in the pursuit of such compounds and highlights the need for rigorous determination of target engagement in humans before claiming that 5-HT<sub>2A</sub> receptor agonists are non-hallucinogenic.</p>","PeriodicalId":16892,"journal":{"name":"Journal of Psychopharmacology","volume":" ","pages":"889-895"},"PeriodicalIF":5.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Quantitative natural language processing markers of psychoactive drug effects: A pre-registered systematic review.","authors":"Sachin Ahuja, Farida Zaher, Lena Palaniyappan","doi":"10.1177/02698811251319455","DOIUrl":"10.1177/02698811251319455","url":null,"abstract":"<p><p>Psychoactive substances used for recreational purposes have mind-altering effects, but systematic evaluation of these effects is largely limited to self-reports. Automated analysis of expressed language (speech and written text) using natural language processing (NLP) tools can provide objective readouts of mental states. In this pre-registered systematic review, we investigate findings from applying the emerging field of computational linguistics to substance use with specific focus on identifying short-term effects of psychoactive drugs. From the literature identified to date, we note that all the studied drugs - stimulants, 3,4-methylenedioxymethamphetamine (MDMA), cannabis, ketamine and psychedelics - affect language production. Based on two or more studies per substance, we note some emerging patterns: stimulants increase verbosity; lysergic acid diethylamide reduces the lexicon; MDMA increases semantic proximity to emotional words; psilocybin increases positive sentiment and cannabis affects speech stream acoustics. Ketamine and other drugs are understudied regarding NLP features (one or no studies). One study provided externally validated support for NLP and machine learning-based identification of MDMA intoxication. We could not undertake a meta-analysis due to the high degree of heterogeneity among outcome measures and the lack of sufficient number of studies. We identify a need for harmonised speech tasks to improve replicability and comparability, standardisation of methods for curating and analysing speech and text data, theory-driven inquiries and the need for developing a shared 'substance use language corpus' for data mining. The growing field of computational linguistics can be utilized to advance human behavioral pharmacology of psychoactive substances. Achieving this will require concerted efforts towards consistency in research methods.</p>","PeriodicalId":16892,"journal":{"name":"Journal of Psychopharmacology","volume":" ","pages":"940-949"},"PeriodicalIF":5.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Bălăeţ, William Trender, Annalaura Lerede, Peter J Hellyer, Adam Hampshire
{"title":"Naturalistic use of psychedelics is associated with longitudinal improvements in anxiety and depression during global crisis times.","authors":"Maria Bălăeţ, William Trender, Annalaura Lerede, Peter J Hellyer, Adam Hampshire","doi":"10.1177/02698811251346729","DOIUrl":"10.1177/02698811251346729","url":null,"abstract":"<p><strong>Background: </strong>Mental health implications of COVID-19 drug use patterns are still unclear.</p><p><strong>Methods: </strong>We used data-driven clustering in a large citizen science cohort recruited agnostically to an interest in drug-use to categorise people according to common patterns of drug use and analysed their mental health symptoms (GAD-7 and PHQ-9 items), from recruitment prior to COVID-19 restrictions in 2020 (<i>N</i> = 242,260) to three follow-ups in 2020-2022 (<i>N</i> = 68,416). Mixed effects modelling examined how mental health scores related to drug-use clusters cross-sectionally and how changes in those scores longitudinally related to changes in consumption frequencies.</p><p><strong>Results: </strong>We identified six common patterns of drug use during the COVID-19 pandemic, with cannabis cross cutting most of them. The majority of drug use clusters had worse average mental health scores relative to drug-naive individuals at all timepoints. The average mental health scores of those who used more drugs during the pandemic worsened over time relative to individual baselines. However, psychedelics and cannabis users showed average improvements in depression (β = -0.26 SD, 95% CI: -0.44, -0.08, <i>p</i> = 0.003), anxiety (β = -0.24 SD, 95% CI: -0.41, -0.06, <i>p</i> = 0.007) and overall mental health (β = -0.2 SD, 95% CI: -0.35, -0.04, <i>p</i> = 0.01) from pre-pandemic to January 2022, becoming on par with the drug-naive group. This was not the case for cannabis-only users, whose worse mental health scores persisted.</p><p><strong>Conclusion: </strong>Those who used psychedelics may have experienced some improvements in mental health across the pandemic timeframe, which supports the idea that beneficial effects on mood and anxiety associated with these substances may extend beyond controlled conditions.</p>","PeriodicalId":16892,"journal":{"name":"Journal of Psychopharmacology","volume":" ","pages":"957-967"},"PeriodicalIF":5.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clémentine Estric, Thomas Duron, Sarah Kabani, Jorge Lopez-Castroman
{"title":"Set and setting of psychedelics for therapeutic use in psychiatry: A systematic review.","authors":"Clémentine Estric, Thomas Duron, Sarah Kabani, Jorge Lopez-Castroman","doi":"10.1177/02698811251338214","DOIUrl":"10.1177/02698811251338214","url":null,"abstract":"<p><p>Psychedelics offer promising outcomes in psychiatry. However, the preparation of participants (set) and the environmental conditions of taking a psychedelic (setting) are not standardized. We describe the set and setting for therapeutic use of psychedelic drugs in people with psychiatric disorders. In this systematic review, articles were identified in the PubMed and Web of Science databases until 12 December 2023. Only clinical trials published in English or French were eligible, and studies using psychedelics for withdrawal were excluded. Sixteen domains of set and setting were assessed covering participant selection, pre- and post-session interventions, monitor presence, environmental management, and end-of-session procedure. Of 4912 articles screened, 27 articles were retained reporting on 25 studies. Thirteen of the included studies reported randomized trials, while 12 were open-label studies, on a total of 763 participants. Studies considered features of set and setting to different extents. Participant selection and the creation of a safe environment were consistently present, but articles were more heterogeneous about reporting monitor training (52%), controlling visual distractors (64%) and creating a pleasant environment (68%). Psilocybin was over-represented (47%). Many key elements were described in each study, but differences in set and setting limit comparability and reproducibility. Harmonizing these aspects would aid the interpretation of future studies and help understand the effect of psychedelics in psychiatry.</p>","PeriodicalId":16892,"journal":{"name":"Journal of Psychopharmacology","volume":" ","pages":"910-929"},"PeriodicalIF":5.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What are set and setting: Reducing vagueness to improve research and clinical practice.","authors":"Kyle Patch, William R Smith","doi":"10.1177/02698811251337372","DOIUrl":"10.1177/02698811251337372","url":null,"abstract":"<p><p>Research on the therapeutic potential of psychedelics has surged, prompting a re-examination of the role of set and setting in psychedelic-assisted therapy. Yet, these concepts are vague and typically defined over inclusively. We believe that set and setting research should be methodologically reductionist, focusing on specific components rather than set and setting as such. To that end, we propose the mechanism-first approach, which begins with specific, paradigmatic set and setting components, such as \"openness to the psychedelic experience\" or calming lighting and music. It seeks to understand the mechanisms through which these components affect psychedelic outcomes. Once the mechanisms in paradigmatic cases are understood, researchers can ask whether other mental and environmental factors play the same or similar mechanistic roles. As the process iterates over time, understanding of set and setting expands to include more components. Setting aside the vague, standard definitions of set and setting and focusing, instead, on specific components of set and setting, the mechanism-first approach encourages productive research agendas, focused on specific projects that are mutually informative. To defend it, we outline the problems with standard definitions of set and setting, describe the mechanism-first approach in detail, illustrate it by considering its implications for selected, active research projects, and respond to objections to our approach.</p>","PeriodicalId":16892,"journal":{"name":"Journal of Psychopharmacology","volume":" ","pages":"900-909"},"PeriodicalIF":5.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12354155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Niall M McGowan, James J Rucker, Rachel Yehuda, Manish Agrawal, Nadav Liam Modlin, Hollie Simmons, Agata Tofil-Kaluza, Shriya Das, Guy M Goodwin
{"title":"Investigating the safety and tolerability of single-dose psilocybin for post-traumatic stress disorder: A nonrandomized open-label clinical trial.","authors":"Niall M McGowan, James J Rucker, Rachel Yehuda, Manish Agrawal, Nadav Liam Modlin, Hollie Simmons, Agata Tofil-Kaluza, Shriya Das, Guy M Goodwin","doi":"10.1177/02698811251362390","DOIUrl":"https://doi.org/10.1177/02698811251362390","url":null,"abstract":"<p><strong>Background: </strong>Post-traumatic stress disorder (PTSD) is a debilitating condition for which there are few efficacious treatments. Psilocybin is being studied for use in treatment-resistant depression but has not yet been investigated in PTSD.</p><p><strong>Aims: </strong>The trial's primary outcome was to investigate the safety and tolerability of single-dose psilocybin in participants with PTSD.</p><p><strong>Methods: </strong>This was a Phase 2, nonrandomized, open-label, multicenter trial. Secondary outcomes were changes in PTSD symptoms (Clinician-Administered PTSD Scale for DSM-5 (CAPS-5); PTSD Checklist for DSM-5 (PCL-5)), functional impairment (Sheehan Disability Scale; SDS) and quality of life (EQ-5D-5L index score).</p><p><strong>Results: </strong>Amongst the 22 participants enrolled (63.6% female; mean (SD) age, 39.0 (7.91) years), there was a total of 117 treatment-emergent adverse events (TEAEs); 70 (59.8%) were reported on administration day, of which 64/70 (91.4%) resolved by the end of the next day. TEAEs commonly included headache (<i>n</i> = 11; 50.0%), nausea (<i>n</i> = 8; 36.4%), crying (<i>n</i> = 6; 27.3%) and fatigue (<i>n</i> = 6; 27.3%). There were no serious TEAEs or TEAEs leading to study withdrawal. Pre-post comparisons indicated a clinically meaningful change from Baseline in mean CAPS-5 total score at Week 4 (-29.9 (14.06)) and Week 12 (-29.5 (15.43)), which was associated with the intensity of psychedelic experience on Day 1. PCL-5 scores showed symptom reduction was rapid and sustained until Week 12. SDS total score and EQ-5D-5L index score showed similar improvements.</p><p><strong>Conclusions: </strong>Psilocybin at a dose of 25 mg, administered with psychological support, may be safe, well-tolerated and associated with symptomatic improvement in adults with PTSD. Further investigation is warranted.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov Identifier: NCT05312151(https://clinicaltrials.gov/study/NCT05312151).</p>","PeriodicalId":16892,"journal":{"name":"Journal of Psychopharmacology","volume":" ","pages":"2698811251362390"},"PeriodicalIF":5.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dose-response efficacy and safety of lumateperone in bipolar depression: A preliminary meta-analysis of randomized controlled trials.","authors":"Chih-Wei Hsu, Yu-Kang Tu, Kuo-Chuan Hung, Chih-Sung Liang, Ping-Tao Tseng, Yang-Chieh Brian Chen","doi":"10.1177/02698811251364389","DOIUrl":"https://doi.org/10.1177/02698811251364389","url":null,"abstract":"<p><strong>Background: </strong>The optimal lumateperone dose for bipolar depression remains uncertain.</p><p><strong>Aims: </strong>To examine its dose-response relationship for efficacy and safety.</p><p><strong>Methods: </strong>We systematically searched major databases to 1 July 2025. Efficacy outcomes included change in depression severity, global illness severity, quality of life, responder, and remitter rates. Safety outcomes included all-cause dropout, discontinuations due to adverse event (AE), treatment-emergent AE, mania, suicidality, extrapyramidal symptoms, body weight, lipid profile, and fasting glucose. A one-step dose-response meta-analysis generated effect sizes, reported as standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Three randomized controlled trials involving 1454 patients showed that a 42-mg daily dose of lumateperone significantly improved depressive symptoms (SMD = -0.26; 95% CI: -0.51, -0.02), Clinical Global Impression-Bipolar-Severity (CGI-BP-S) overall bipolar illness (SMD = -0.31; 95% CI: -0.45, -0.16), CGI-BP-S bipolar depression (SMD = -0.33; 95% CI: -0.48, -0.17), quality of life (SMD = 0.22; 95% CI: 0.07, 0.36), and responder rate (RR = 1.27; 95% CI: 1.05, 1.53), but not remitter rate (1.06; 95% CI: 0.81, 1.38). Compared with placebo, discontinuation due to AE significantly increased at the 42 mg dose (RR = 3.12; 95% CI: 1.68, 5.80), but not at 28 mg (1.58; 95% CI: 0.25, 9.89). Moreover, dropout rates (42 mg RR = 1.15; 95% CI: 0.76, 1.73) and other safety outcomes did not exhibit a dose-response trend.</p><p><strong>Conclusions: </strong>Preliminary evidence suggests that 42 mg daily of lumateperone may provide clinical benefit in bipolar depression, yet the higher rate of AE-related discontinuation warrants caution in practice. However, current data remain limited, requiring further studies to establish the optimal dosing range balancing efficacy and safety.</p>","PeriodicalId":16892,"journal":{"name":"Journal of Psychopharmacology","volume":" ","pages":"2698811251364389"},"PeriodicalIF":5.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}