30-Second Takeaway
- Accelerated rTMS shows moderate antidepressant and anxiolytic effects with domain-specific cognitive benefits and mild, transient adverse events.
- High-frequency rTMS over left DLPFC yields moderate improvement in negative symptoms of schizophrenia with ≥15 sessions at 110% motor threshold.
- Acute care for hallucinogen-related problems is strongly associated with later mania and bipolar diagnoses, warranting careful screening and counseling.
- Adolescent depression risk clusters around pubertal stage, bullying, family conflict, and maternal depression, highlighting modifiable family and school targets.
- IV ketamine, MDMA-assisted therapy, and youth irritability data support emerging, mechanism-informed approaches to treatment and prevention.
Week ending December 6, 2025
Neuromodulation, psychedelics, and developmental risk pathways: practice-adjacent updates for psychiatric care
Accelerated rTMS delivers moderate antidepressant, anxiolytic, and cognitive benefits with a favorable safety profile
Across 44 RCTs (n=1,671), accelerated rTMS (≥2 sessions/day) produced moderate antidepressant effects versus sham (Hedges g≈0.6). It also significantly improved anxiety, obsessive-compulsive symptoms, working memory, and declarative memory, suggesting domain-specific and transdiagnostic efficacy. Clinical response varied with session frequency, inter-session interval, cumulative pulses, age, and sex, implying dose- and sex-linked plasticity effects. Adverse events were generally mild and transient, supporting accelerated rTMS as a scalable option when rapid neuromodulatory dosing is desired.
High-frequency rTMS over left DLPFC moderately improves negative symptoms in schizophrenia
This meta-analysis of 23 RCTs (n=1,024) found high-frequency rTMS significantly reduced negative symptoms versus sham (pooled effect size −0.47). Benefits extended across broader schizophrenia symptom dimensions, with a smaller but significant overall effect (Hedges g −0.30). Protocols delivering ≥15 sessions at 110% motor threshold over left DLPFC were associated with the best negative symptom improvement. These data support offering targeted hf-rTMS as an adjunct in patients with prominent negative symptoms and limited pharmacologic options.
Hallucinogen-related emergency or hospital care strongly predicts later mania and bipolar disorder
In this Ontario cohort (n≈9.3 million), 7,285 people had ED or hospital care involving hallucinogens and no baseline bipolar disorder. Within three years, 1.43% of the hallucinogen-acute-care group versus 0.06% of matched controls had mania requiring acute care. After weighting, hallucinogen-related acute care was associated with a six-fold higher mania risk and nearly four-fold higher bipolar diagnosis risk. Findings may not generalize to hallucinogen users who never present for acute care, but they support careful bipolar risk assessment and counseling.
Most adolescents remained resilient post-COVID, but distinct high-risk depressive trajectories emerged
In 3,512 ABCD participants followed from before to after COVID lockdown, three depressive symptom trajectories were identified. About 86% remained resilient, 9% shifted from low to high symptoms post-pandemic, and 4.5% had chronically high symptoms. Depression-susceptible youth were more often girls and showed late/postpubertal stage, family conflict, bullying, cyberbullying, maternal depression, and polyenvironmental adversity. Results highlight pre-pandemic family and peer factors as targets for early identification and preventive intervention during large-scale stressors.
References
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Additional Reads
Optional additional studies from this edition.