Journal of Clinical Psychiatry最新文献

{"title":"Idiopathic Hypersomnia: Recognition and Management in Psychiatric Practice.","authors":"Craig Chepke, Ruth M Benca, Andrew J Cutler, Andrew D Krystal, Nathaniel F Watson","doi":"10.4088/JCP.24nr15718","DOIUrl":"10.4088/JCP.24nr15718","url":null,"abstract":"<p><p><b>Objective:</b> This review of the relationship between idiopathic hypersomnia and psychiatric disorders describes considerations in recognizing and managing complaints of excessive daytime sleepiness (EDS) in patients in psychiatric clinical practice.</p><p><p><b>Data Sources:</b> Terms including \"idiopathic hypersomnia\" and \"psychiatric\" were used to search PubMed and Embase for English-language publications of human studies from inception to July 2024.</p><p><p><b>Study Selection:</b> Articles were manually screened for relevance to idiopathic hypersomnia pathophysiology, diagnosis, and treatment and EDS in psychiatric populations. Reference lists of identified articles were manually searched for additional relevant publications.</p><p><p><b>Data Extraction:</b> Formal data charting was not performed.</p><p><p><b>Results:</b> A total of 119 articles were included. Idiopathic hypersomnia is a central sleep disorder with the primary complaint of EDS, diagnosed prevalence of 0.037%, and estimated population prevalence up to 1.5%. Other prominent symptoms include sleep inertia, long sleep time, autonomic nervous system dysfunction, brain fog, and cognitive complaints. A high proportion of patients with idiopathic hypersomnia experience psychiatric comorbidities, including mood disorders and attention-deficit/hyperactivity disorder. Assessing individuals with psychiatric disorders and complaints of hypersomnolence can pose diagnostic challenges. Diagnosis and treatment may be complicated by possible exacerbation of EDS by psychiatric medications and, conversely, exacerbation of psychiatric symptoms by idiopathic hypersomnia treatments.</p><p><p><b>Conclusions:</b> Psychiatric clinicians are more likely to encounter patients with idiopathic hypersomnia than would be expected given its overall prevalence due to increased rate of psychiatric symptom comorbidity in this population. Recognizing and managing idiopathic hypersomnia for individuals with psychiatric conditions may lead to improvements in treatment outcome for patients.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detecting Tardive Dyskinesia Using Video-Based Artificial Intelligence.","authors":"Anthony A Sterns, Joel W Hughes, Bradley Grimm, Loren Larsen, Fred Ma, Rakesh Ranjan, Carlene MacMillan, Bretton H Talbot, Joseph H Friedman, Owen S Muir","doi":"10.4088/JCP.25m15792","DOIUrl":"https://doi.org/10.4088/JCP.25m15792","url":null,"abstract":"<p><p><b>Objective:</b> Tardive dyskinesia (TD) is a late-onset adverse effect of dopamine receptor-blocking medications, characterized by involuntary movements primarily affecting the mouth, though other body parts may be involved. Severity of TD varies from mild to debilitating and is usually irreversible. Despite the existence of treatments such as VMAT2 inhibitors, TD remains underdiagnosed, with 40,000 patients treated of an estimated 2.6 million affected US individuals. This study demonstrates a novel, efficient, and reliable method to detect and bring TD to psychiatrists' attention using video-based artificial intelligence.</p><p><p><b>Methods:</b> Individuals taking antipsychotic medications were enrolled in Study 1 (n = 46) between March and November 2018, in Study 2 (n = 136) between May 2023 and May 2024, and in Study 3 (n = 174) between July 2023 and May 2024. Participants completed video assessments. A vision transformer machine-learning architecture was evaluated by calculating the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity compared with a reference standard of the trained raters' evaluation of TD on the Abnormal Involuntary Movement Scale.</p><p><p><b>Results:</b> The algorithm reached an AUC of 0.89 in the combined validation cohort across Studies 1, 2, and 3. The model demonstrated strong and reliable levels of agreement, outperforming human raters.</p><p><p><b>Conclusion:</b> Our algorithm reliably detected suspected TD, reaching higher sensitivity and specificity than trained raters using the standard assessment. The algorithm can be used to monitor patients taking antipsychotic medications, allowing scarce resources to assess identified patients for a conclusive diagnosis by psychiatrists.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient Ketamine Prescribing Practices in Psychiatry in the United States: A Nationwide Survey Study.","authors":"Rachel M Pacilio, Sagar V Parikh, Jamarie Geller","doi":"10.4088/JCP.25m15809","DOIUrl":"https://doi.org/10.4088/JCP.25m15809","url":null,"abstract":"<p><p><b>Background:</b> Ketamine is an increasingly popular tool for the treatment of psychiatric disorders. Initially available in controlled studies at academic institutions, it is now being offered widely in the community, but little is known about how treatment is actually being delivered and if there are undetermined safety concerns. The aim of this study is to assess ketamine prescribing practices among clinics across the United States.</p><p><p><b>Methods:</b> An online survey was sent to all community-based ketamine clinics with publicly available email addresses collected from 4 ketamine clinic databases (n = 484) between September and November 2023. Public ketamine clinic websites (n = 473) were also reviewed for information regarding the credentials of prescribers in June 2024.</p><p><p><b>Results:</b> A total of 126 (26% response rate) of the clinics responded to the survey request, and 119 were included in analyses. All included respondents (100%) report utilizing ketamine for treatment-resistant depression, with many also prescribing ketamine for treatment naive (72.3%), bipolar (78.9%), and subclinical depression (59.7%) in addition to nondepressive conditions at significant rates. Over 80% of clinics utilize maintenance ketamine treatment, with a substantial portion doing so for prolonged periods. A variety of ketamine formulations are regularly prescribed, and over 40% of clinics provide ketamine for at-home use. Based on website review, fewer than 30% of ketamine clinics reviewed are run by psychiatric physicians and over 25% are run by nonphysician providers.</p><p><p><b>Conclusions:</b> There is significant variability in ketamine treatment in the community including indications for therapy, duration of treatment courses, formulation of ketamine prescribed, and setting of use. There is a need for increased oversight and more specific practice guidelines to ensure ketamine is being used safely, appropriately, and effectively.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Adolescent Suicidal Events by Residual Depressive Symptoms After Intensive Treatment.","authors":"Muruga A Loganathan, Stephen Buerkert, Gabriela Lange Valenga, Graham J Emslie, Sunita M Stewart","doi":"10.4088/JCP.24m15462","DOIUrl":"10.4088/JCP.24m15462","url":null,"abstract":"<p><p><b>Objective:</b> Adolescents with a history of depression are at a high risk of recurrent suicidal ideation (SI) and attempts. To enhance risk prediction, we examined the association of individual residual symptoms of depression to suicidal events (suicide attempts, emergency room visits, and inpatient hospitalization) 6 months after discharge from treatment.</p><p><p><b>Methods:</b> A retrospective post hoc analysis of patients aged 12-18 years examined depression symptoms at admission and discharge. Patients in an intensive treatment program (December 2013-September 2022) received psychosocial and medication management. The Quick Inventory of Depressive Symptomatology, Adolescent Version, assessed depressive symptoms at entry and discharge (n <i>=</i> 1,029), and suicidal events postdischarge were tracked (n <i>=</i> 736). Analysis of variance analyzed symptom severity changes, and logistic regression used residual symptoms and controls (age, sex, previous attempt, and nonsuicidal self-injury) to predict suicidal events.</p><p><p><b>Results:</b> Sad mood, view of self, and SI improved the most, while mood and sleep disturbance were most prevalent at discharge. Sleep disturbance (odds ratio [OR] = 2.09, 95% CI, 1.24-3.53, <i>P</i> < .01) and SI (OR = 2.22, 95% CI, 1.26-3.90, <i>P</i> < .01) were the strongest predictors of hospitalization, and, together with anhedonia (OR = 1.40, 95% CI, 1.02-1.93, <i>P</i> < .05), they consistently predicted suicidal events during follow-up.</p><p><p><b>Conclusion:</b> Residual sleep disturbance, SI, and anhedonia after treatment indicated risk post discharge and might inform continuity of care planning. These findings encourage further research about the relationships between specific residual symptoms and suicidal events.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Based and Evidence-Informed Treatments: A Naturalistic Study of the Impact of Treatment Type on Engagement in Posttraumatic Stress Disorder.","authors":"Melanie Arenson, Baylee Crone, Ranon Cortell, Elisabeth Carlin","doi":"10.4088/JCP.24m15567","DOIUrl":"10.4088/JCP.24m15567","url":null,"abstract":"<p><p></p><p><p><b>Objective:</b> Evidence-based psychotherapies (EBPs) have revolutionized posttraumatic stress disorder (PTSD) treatment, but research suggests more limited engagement and effectiveness in naturalistic settings, relative to randomized controlled trials. Some clinics therefore offer additional evidence-informed options (eg, Skills Training in Affective and Interpersonal Regulation, Acceptance and Commitment Therapy, and Mindfulness Based Stress Reduction), but little research has compared outcomes within a naturalistic setting.</p><p><p><b>Methods:</b> We completed a retrospective chart review of 480 Veterans presenting to a trauma-focused clinic within a Veterans Affairs Medical Center during 2019. All variables were extracted from the VA medical record. We used logistic or linear regression models, χ², and analysis of variance to examine treatment outcomes differences.</p><p><p><b>Results:</b> In the year following intake, 71.87% (n = 345) engaged with treatment, and 45.42% (n = 218) received an adequate dose of at least 1 treatment; of those who engaged with treatment, 63.19% received an adequate dose of at least 1 treatment. Veterans attended an average of 8.40 sessions and 1.39 episodes of care. At the person level<i>,</i> rates of engagement and receipt of an adequate dose did not differ by treatment type (odds ratio [OR] = 1.52, <i>P =</i> .17; OR= 1.52, <i>P =</i> .17, respectively). However, those who planned to and/or received at least 1 EBP attended a significantly greater number of total sessions (11.82) relative to those that planned to and/or received evidence-informed psychotherapy (EIP; 7.31; <i>b =</i> 1.69, <i>P =</i> .04). Within episodes of care<i>,</i> rates of engagement did not differ by treatment type (OR = 1.39, <i>P</i> = .14). However, those who planned to and/or received EBP were more likely to receive an adequate dose of treatment (OR = 1.44, <i>P</i> = .04) and attended a significantly greater number of sessions per episode (7.60), relative to EIP (6.00).</p><p><p><b>Discussion:</b> These data highlight differences in treatment engagement and receipt of an adequate dose of treatment based on intervention-level factors within an active PTSD specialty clinic, which can aid decision-making for patients and providers. Future research is needed to investigate predictors of treatment engagement and outcomes.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autism Spectrum Disorder, 2: Observations on the Imprecision of the Numerical Value of Risk when Examining Predictors of Risk in Regression.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.25f15918","DOIUrl":"10.4088/JCP.25f15918","url":null,"abstract":"<p><p>Hundreds of genes and more than a hundred environmental exposures have been identified as potential causes, mediators, or markers of risk for autism spectrum disorder (ASD). The findings for the environmental exposures, almost all occurring during pregnancy, have emerged from regression analyses in observational studies. The risk estimates are most often presented as odds ratios (ORs), sometimes as hazard ratios (HRs), and rarely as relative risks. This article uses gestational exposure to antidepressant drugs and risk of ASD in offspring as a background to explain how estimates of ASD risk in observational studies are commonly interpreted and why and when the usual interpretations are wrong, often very wrong. The article provides discussions on crude and adjusted estimates, ORs and HRs, individual studies and meta-analyses, strategies that help address confounding by unmeasured and unknown variables, and a detailed discussion on the imprecision of the numerical value of the adjusted estimate. The article explains how the value of an OR is not set in stone; different procedures and approaches in analysis of the same data result in different OR values. The article also explains how to evaluate an individual patient's risk when multiple risk factors are present that may or may not be independent of each other. Finally, the article suggests the presence of an elephant in the room: risk factors that, though independent, may saturate mechanisms that mediate the outcome; so, when simultaneously present, their individual ORs may suggest falsely lower values of risk. This suggestion could explain why ASD is uncommon in the population although the risk factors for ASD are common and many. It is important to be aware of the issues considered in this article when attempting to understand the field, counsel patients, communicate research findings to peers and the public, and frame policy.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Posttraumatic Stress Disorder in a Class of Its Own? Longitudinal Comparison to Other Conditions Following Trauma and Life Stress Exposure.","authors":"Ashley L Greene, Holly F Levin-Aspenson, Scott Feltman, Stephen Long, Madeleine Moore, Camilo Ruggero, Sean A P Clouston, Evelyn J Bromet, Benjamin J Luft, Roman Kotov","doi":"10.4088/JCP.24m15591","DOIUrl":"10.4088/JCP.24m15591","url":null,"abstract":"<p><p><b>Objective:</b> Posttraumatic stress disorder (PTSD) is defined by the assumption that qualifying traumatic events lead to a syndrome distinct from other internalizing disorders, while stressful life events play a prominent role in etiologic theories of major depressive disorder (MDD). We examined whether the environmental etiology of PTSD and MDD are distinct by evaluating the relative contributions of traumatic and stressful life events to both conditions. Harmful alcohol use and physical limitations served as noninternalizing comparators expected to show weaker associations with environmental factors.</p><p><p><b>Methods:</b> Longitudinal cohort study of World Trade Center disaster responders who completed annual assessments of mental health and physical functioning from July 1, 2002, to December 31, 2020. Psychiatric diagnoses were ascertained in clinical interviews. Multivariate regression and multilevel modeling quantified the percentage of variance in psychopathology and physical limitations attributable to trauma versus life stress.</p><p><p><b>Results:</b> 11,153 responders (mean age on September 11, 2001: 37.5 years; 91% male) completed 61,244 visits. The combined environmental effect of 9/11-trauma and life stress on PTSD and MDD was nearly identical (14.3% and 14.8% of between person variability), but much weaker for alcohol use and physical limitations (0.8% and 9.1%). Life stress explained the most variance in all diagnoses and symptoms across longitudinal and cross-sectional analytic strategies.</p><p><p><b>Conclusions:</b> In the longest study to date coexamining the environmental etiology of PTSD and MDD, trauma and life stress contributed to both conditions. Considering a spectrum of exposures from stressful life events to trauma and integrating knowledge across internalizing conditions may advance understanding and treatment of stress related psychopathology.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of a Randomized Controlled Trial Examining the Efficacy of Intranasal Oxytocin to Enhance Alcohol Behavioral Couple Therapy.","authors":"Julianne C Flanagan, Paul J Nietert, Barbara S McCrady, Stacey Sellers, Anjinetta Yates-Johnson, Sarah T Giff, Shannon R Forkus","doi":"10.4088/JCP.24m15627","DOIUrl":"10.4088/JCP.24m15627","url":null,"abstract":"<p><p><b>Objective:</b> This study examined the efficacy of intranasal oxytocin (40 IU), compared to matching placebo (saline), when combined with Alcohol Behavioral Couple Therapy (ABCT) for the treatment of alcohol use disorder (AUD).</p><p><p><b>Methods:</b> This 12-week clinical trial (2018-2024) utilized a double-blind, randomized, placebo-controlled design. Enrollment occurred from May 2019 to April 2023. Participants were romantic couples (N = 96 dyads; n = 49 oxytocin, n = 47 placebo) consisting of an identified patient (IP) with current AUD per <i>DSM-5</i> and their partner. Dyads in which both partners had AUD were eligible, and both partners in each dyad were randomized to the same drug condition (ie, placebo or oxytocin). Participants were observed in their medication self-administration 30 minutes prior to ABCT therapy sessions. Primary outcome measures were alcohol consumption (percent days drinking and percent days heavy drinking; Time Line Follow-Back) and relationship functioning (Dyadic Adjustment Scale-Short Form).</p><p><p><b>Results:</b> All IPs and 50% of partners met diagnostic criteria for AUD; 62 IPs (64.5%) met criteria for severe AUD. Findings from the intent-to-treat analyses indicate that IPs and partners in both conditions evidenced substantial improvements in alcohol consumption and alcohol problem severity but not relationship functioning. No group differences emerged in alcohol consumption, alcohol problem severity, or relationship functioning at end of treatment. Participants completed an average of 10.2 ABCT sessions (SD = 3.5). There were no group differences in the number of medication doses administered or adverse events.</p><p><p><b>Conclusions:</b> Oxytocin was safe and tolerable but did not provide additional benefit beyond ABCT at the end of treatment. Alternative strategies are necessary to understand oxytocin's potential to facilitate different domains of AUD recovery.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03046836.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Risk of First Onset of Many Cardiovascular Disorders in Antidepressant-Treated Women Veterans: Encouraging Findings but Concerns Remain.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.25com15886","DOIUrl":"https://doi.org/10.4088/JCP.25com15886","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant Medication Prescription and Incident Cardiovascular Disease in Women Veterans.","authors":"Jennifer A Sumner, Paul A Dennis, Carlos A Alvarez, Aaron Perkins, Jean C Beckham, Ramin Ebrahimi","doi":"10.4088/JCP.24m15647","DOIUrl":"https://doi.org/10.4088/JCP.24m15647","url":null,"abstract":"<p><p><b>Objective:</b> Antidepressants are commonly prescribed, yet understanding of consequences for cardiovascular disease (CVD) risk is less well-developed. We examined associations of antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], other antidepressants) with incident CVD in women Veterans, a population with a high psychiatric and CVD risk burden.</p><p><p><b>Methods:</b> Using Veterans Health Administration (VHA) electronic health records, we identified women Veterans who were VHA patients from January 1, 2000, to December 31, 2019. Exclusion criteria included <12 months of baseline data before index visit, prior CVD or antidepressant prescription, and no encounters after index visit. Antidepressant prescriptions were documented in pharmacy data. Our primary outcome was an incident CVD composite, comprising first-onset ischemic heart disease, stroke, atrial fibrillation/flutter, heart failure/ cardiomyopathy, and pulmonary hypertension based on diagnostic codes.</p><p><p><b>Results:</b> Women Veterans (N = 609,546) had a mean age of 41.3 years. During mean follow-up of 8.8 years, 40.1% of women were prescribed SSRIs, 18.2% SNRIs, and 38.6% other antidepressants; 9.2% developed CVD. Marginal structural modeling was used to de-confound associations of antidepressants with incident CVD, accounting for demographics, VHA engagement, traditional CVD risk factors, and psychiatric disorders. SSRIs, SNRIs, and other antidepressants (vs no antidepressants) were associated with lower incidence of the CVD composite, as well as ischemic heart disease and stroke (relative risk: 0.27-0.76). Additionally, the inverse association between antidepressants and CVD was larger for women with major depressive disorder, posttraumatic stress disorder, and anxiety disorders.</p><p><p><b>Conclusion:</b> As antidepressants are widely prescribed in the VHA and beyond, these results are encouraging for patients receiving this care.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}