The American journal of psychiatry最新文献

{"title":"Low-Dose Buprenorphine Significantly Prolonging the Antisuicidal Effects of Ketamine Infusion in Major Depressive Disorder: Relationship Between Antidepressant and Antisuicidal Effects.","authors":"Wei Hao, Luying Tan","doi":"10.1176/appi.ajp.20260656","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260656","url":null,"abstract":"","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"appiajp20260656"},"PeriodicalIF":14.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Dose Buprenorphine Following Ketamine Treatment for Suicidal Ideation in Major Depressive Disorder: Response to Letters.","authors":"Jason M Tucciarone, Igor D Bandeira, Alan F Schatzberg","doi":"10.1176/appi.ajp.20260834","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260834","url":null,"abstract":"","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"appiajp20260834"},"PeriodicalIF":14.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buprenorphine Following Ketamine for Suicidal Ideation: A Bridge to Care from the Emergency Department.","authors":"Ynhi T Thomas, Lindsay Maguire, Brandon J Warrick, Matthew Byerly, Manish K Jha","doi":"10.1176/appi.ajp.20260540","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260540","url":null,"abstract":"","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"appiajp20260540"},"PeriodicalIF":14.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine Extension or Buprenorphine Maintenance?","authors":"Yi Yin, Li Jiang, Zhican Liu","doi":"10.1176/appi.ajp.20260563","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260563","url":null,"abstract":"","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"appiajp20260563"},"PeriodicalIF":14.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buprenorphine After Ketamine for Suicidal Ideation: Durability, Specificity, and Confounding.","authors":"Aistė Lengvenytė, Emilie Olié, Philippe Courtet","doi":"10.1176/appi.ajp.20260564","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260564","url":null,"abstract":"","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"appiajp20260564"},"PeriodicalIF":14.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Effect of Positive Childhood Experiences on the Risk of Psychiatric Disorders in Early Adulthood.","authors":"Jennifer Murphy, Colm Healy, David Mongan, Mary Clarke, Ian Kelleher, Agnes Higgins, Brian O'Donoghue, Ciaran Shannon, Ciaran Mulholland, Mary Cannon, David R Cotter","doi":"10.1176/appi.ajp.20260007","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260007","url":null,"abstract":"<p><strong>Objective: </strong>While the negative impacts of traumatic childhood experiences are well established, less is known about whether positive childhood experiences (PCEs) contribute to long-term mental health. The aim of this study was to estimate the effect of PCEs on the risk of psychiatric disorders in early adulthood.</p><p><strong>Methods: </strong>Participants included 3,499 children from the Avon Longitudinal Study of Parents and Children. Eligible participants were nonrandomly exposed to PCEs (e.g., \"school enjoyment\" or \"feeling safe in neighborhood\") between ages 0 and 17, measured as a score ranging from 0 to 10. Inverse probability weighting (IPW) was used to account for the likelihood of PCE exposure conditional on confounders. The effect of PCE score on risk of psychiatric disorders at age 24, using IPW- and confounder-adjusted estimates, is reported. Subgroup analysis of individual disorders was subsequently conducted.</p><p><strong>Results: </strong>In unweighted analyses, each one-unit increase in the PCE score was associated with a 12% decrease in the odds of psychiatric disorder (odds ratio=0.88, 95% CI=0.82, 0.95). In the IPW- and confounder-adjusted model, this effect was retained (odds ratio=0.89, 95% CI=0.82, 0.95). Robust associations between PCEs and lower odds of depressive disorder (odds ratio=0.84, 95% CI=0.76, 0.93) and generalized anxiety disorder (odds ratio=0.91, 95% CI=0.84, 0.99) were found. The findings for PCE score and psychotic disorder were inconclusive.</p><p><strong>Conclusions: </strong>The findings indicate that PCEs are associated with reduced odds of meeting criteria for psychiatric disorders in early adulthood, particularly depression. Further research should explore PCEs as a potential preventive strategy that might reduce the burden of psychiatric disorders in early adulthood.</p>","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"appiajp20260007"},"PeriodicalIF":14.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of rTMS vs. Pharmacotherapy in Late-Life Treatment-Resistant Depression: An Observational Study of Individual Participant Data From Two Randomized Clinical Trials.","authors":"Erin Adler, Daniel M Blumberger, Eric J Lenze, Patrick J Brown, Jordan F Karp, Helen Lavretsky, Taeho Greg Rhee, Benoit H Mulsant, Tyler S Kaster","doi":"10.1176/appi.ajp.20260398","DOIUrl":"https://doi.org/10.1176/appi.ajp.20260398","url":null,"abstract":"<p><strong>Objective: </strong>The authors compared the effectiveness and tolerability of repetitive transcranial magnetic stimulation (rTMS) versus pharmacotherapy augmentation and switching strategies in older adults with late-life treatment-resistant depression (LL-TRD).</p><p><strong>Methods: </strong>This observational study used individual participant data from 758 participants age 60 or older with LL-TRD from two randomized controlled trials: an rTMS trial of once-daily bilateral treatment for 4-6 weeks, and a pharmacotherapy trial comparing aripiprazole augmentation, bupropion augmentation, and switch to bupropion. Restriction, propensity score weighting, and regression adjustment were used to account for differences in trial design and eligibility criteria. The primary outcome was the Montgomery-Åsberg Depression Rating Scale (MADRS) 10 weeks after treatment initiation.</p><p><strong>Results: </strong>After accounting for differences in participant characteristics, rTMS was associated with lower MADRS scores than aripiprazole augmentation (difference: 4.16 points, 95% CI=2.32, 6.00), bupropion augmentation (difference: 6.08 points, 95% CI=4.06, 8.09), and switch to bupropion (difference: 6.36 points, 95% CI=4.55, 8.17). rTMS was also associated with a higher response rate (defined as reduction ≥50% in MADRS score from baseline to week 10) than aripiprazole augmentation (adjusted odds ratio [AOR]=3.83, 95% CI=1.08, 13.56), bupropion augmentation (AOR=4.87, 95% CI=1.15, 20.68), and switch to bupropion (AOR=4.02, 95% CI=1.12, 14.47). Participants who received rTMS were significantly more likely to experience headache than those who received pharmacotherapy.</p><p><strong>Conclusions: </strong>This analysis suggests that rTMS for LL-TRD may be superior to pharmacotherapy and supports the use of rTMS earlier in the treatment algorithms for LL-TRD.</p>","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"appiajp20260398"},"PeriodicalIF":14.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The RECOVER Trial of Vagus Nerve Stimulation in Markedly Treatment-Resistant Depression: Critical Findings, Lessons Learned, and Future Directions.","authors":"Charles R Conway, Harold A Sackeim, A John Rush, Mark Bunker, Charles Gordon, Christopher L Kriedt, Scott T Aaronson","doi":"10.1176/appi.ajp.20251339","DOIUrl":"10.1176/appi.ajp.20251339","url":null,"abstract":"<p><p>This review summarizes the RECOVER trial's key findings and their clinical and research implications. RECOVER was a 12-month triple-blind randomized trial in adults with markedly treatment-resistant major depressive disorder (N=493; at least four failed trials in the current episode) that compared adjunctive active and sham vagus nerve stimulation (VNS) in effects on symptoms, function, and quality of life (QoL). Durability of benefit during the second year of active VNS was also evaluated. Participants had profoundly treatment-resistant illness, averaging 13.3 lifetime antidepressant treatments and a duration of 17.8 years for the current episode. The prespecified primary outcome (percent time in Montgomery-Åsberg Depression Rating Scale response) did not differentiate the treatment groups, while other outcomes for symptoms (Quick Inventory of Depressive Symptomatology-Clinician Rated: 39.6% vs. 30.7%; Clinical Global Impressions improvement scale: 53.8% vs. 39.8%), function (item 6 on the Work Productivity and Activity Impairment Questionnaire: 43.3% vs. 37.5%), and QoL (7-item subset of the Quality of Life Enjoyment and Satisfaction Questionnaire: 45.4% vs. 37.1%) and a tripartite metric combining these three outcome domains significantly favored active stimulation. Over 80% of participants who achieved meaningful benefit in symptom, function, or QoL measures after 12 months of active VNS retained these benefits at the 18- and 24-month assessments, demonstrating remarkable durability in participants expected to relapse at high rates. Approximately 30% of participants without benefit at 12 months improved meaningfully in the second year. In markedly treatment-resistant depression, adjunctive active VNS was more effective, in multiple measures, than a sham intervention administered over the course of 1 year. Continued treatment with active VNS was associated with durable improvement. Challenges and optimal methods for evaluating outcomes in samples with markedly treatment-resistant depression are discussed.</p>","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"708-720"},"PeriodicalIF":14.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized Connectivity-Guided Versus Conventional Targeting of Accelerated Theta-Burst Stimulation in Depression: A Randomized, Double-Blind, Parallel-Design Trial.","authors":"Mingzhu Li, Zijia Wu, Xuefeng Lu, Andrew Zalesky, Xinle Cheng, Yuyanan Zhang, Robin F H Cash, Fang Jin, Shidong Jia, Yang Xiao, Gangliang Zhong, Xiao Zhang, Weihua Yue, Zhengyi Yang, Tianzi Jiang, Hao Yan","doi":"10.1176/appi.ajp.20251084","DOIUrl":"10.1176/appi.ajp.20251084","url":null,"abstract":"<p><strong>Objective: </strong>Scalp-based repetitive transcranial magnetic stimulation targeting the left dorsolateral prefrontal cortex (DLPFC) does not account for interindividual variability. This trial was designed to determine whether individualized connectivity-guided intermittent theta-burst stimulation (iTBS) improves antidepressant outcomes compared with 5-cm targeting.</p><p><strong>Methods: </strong>In this single-center, randomized, double-blind, three-arm trial (February 2023-March 2025), adults ages 18-65 years with major depressive disorder or bipolar II depression (≥1 antidepressant failure) were randomly assigned to receive 20 sessions of iTBS over 2 weeks using robotic neuronavigation with one of three targeting strategies: 5-cm rule, functional connectivity (FC)-guided targeting showing negative resting-state connectivity with the subgenual anterior cingulate cortex (sgACC), or structural connectivity (SC)-guided sites defined by probabilistic tractography to the sgACC. The primary outcome was percentage reduction in 17-item Hamilton Depression Rating Scale (HAM-D) score at week 2. Secondary outcomes included HAM-D score reduction at weeks 6 and 12, response or remission, self-reported symptoms, performance on a cognitive battery, and adverse events.</p><p><strong>Results: </strong>Of 123 randomized participants, 119 were included in the modified intention-to-treat analyses (5-cm, N=40; SC-guided, N=39; FC-guided, N=40). SC-guided iTBS produced significantly greater HAM-D score reduction than the 5-cm rule at week 2 (least squares mean difference [LSMD]=8.79 percentage points, 95% CI=2.19, 15.40; Cohen's d=0.70). At week 6, both SC-guided and FC-guided groups showed significantly greater improvement than the 5-cm group (SC-guided LSMD=12.87 percentage points, 95% CI=6.21, 19.54; Cohen's d=1.03; and FC-guided LSMD=9.41 percentage points, 95% CI=2.84, 15.98; Cohen's d=0.75). By week 12, between-group differences were no longer significant. Adverse events were comparable across groups, with no seizures or mania.</p><p><strong>Conclusions: </strong>SC-guided iTBS produced promising preliminary evidence of improved antidepressant response compared with 5-cm targeting, supporting sgACC-based connectivity-guided precision neuromodulation in depression.</p>","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"775-784"},"PeriodicalIF":14.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148715252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Convergent Network Localization of Brain Stimulation Targets for Trait Anxiety.","authors":"Shan H Siddiqi, Julian Klingbeil, Ryan Webler, Ian H Kratter, Daniel M Blumberger, Michael D Fox, Mark S George, Jordan H Grafman, Alvaro Pascual-Leone, Andrew R Pines, R Mark Richardson, Pratik Talati, Fidel Vila-Rodriguez, Jonathan Downar, Tamara Hershey, Kevin J Black","doi":"10.1176/appi.ajp.20250198","DOIUrl":"10.1176/appi.ajp.20250198","url":null,"abstract":"<p><strong>Objective: </strong>Transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) can modulate brain circuits, and certain stimulation targets may relieve or exacerbate anxiety. The objective of this study was to localize circuit-based stimulation targets that modify anxiety by integrating causal sources of information, including lesion, TMS, and DBS datasets.</p><p><strong>Methods: </strong>The authors leveraged a series of natural experiments across multiple datasets (N=936). First, patients with incidental brain lesions (N=451) and TMS-treated individuals with incidental variability in stimulation location for depression (N=111) were analyzed. Functional connectivity of these sites was estimated using a normative connectome. Next, a TMS dataset (N=300) with a common set of stimulation coordinates but individual variability in brain connectivity was analyzed. Finally, the authors examined subthalamic DBS locations in patients with Parkinson's disease (N=74).</p><p><strong>Results: </strong>Similar brain circuits were derived from lesions associated with greater anxiety and TMS sites that decreased anxiety (spatial r=0.68). In an independent TMS dataset (N=300), individualized TMS site connectivity to this circuit was significantly correlated with treatment-induced anxiety change. In Parkinson's disease, overlap of subthalamic DBS (N=74) sites with the anxiety circuit significantly predicted greater anxiety increases, confirming network involvement despite the circuit being derived independently of DBS. The circuit was associated significantly with trait anxiety versus state anxiety in two datasets that measured both. The peak proposed TMS target for anxiety was in the right superior frontal gyrus.</p><p><strong>Conclusions: </strong>This study identified a convergent anxiety circuit across lesions, TMS, and DBS. This provides a potential therapeutic target for brain stimulation and represents a generalizable approach for identifying stimulation targets across neuropsychiatric conditions.</p>","PeriodicalId":520786,"journal":{"name":"The American journal of psychiatry","volume":" ","pages":"785-796"},"PeriodicalIF":14.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}