Psychiatry

Ketamine yields large, clinically meaningful reductions in suicidal ideation in high‑risk patients

This systematic review and meta‑analysis pooled 21 experimental ketamine studies including 927 high‑risk individuals with significant suicidal ideation. Across trials, ketamine produced a large reduction in suicidal ideation (standardized mean difference about −1.4) of clear clinical relevance, despite low‑quality evidence. Benefits were greater in younger patients and those with more severe baseline suicidal ideation, suggesting particular utility for these groups. Common adverse events were dissociation, nausea, dizziness, headache, and anxiety, highlighting the need for monitored administration settings. The authors emphasize uncertainty about optimal dosing and long‑term effects, supporting use mainly for short‑term risk reduction within structured care pathways. 1

Targeted NIBS modalities improve hallucinations and global symptoms in treatment‑resistant schizophrenia

This network meta‑analysis synthesized 55 randomized trials of 33 non‑invasive brain stimulation modalities in 1,981 patients with treatment‑resistant schizophrenia. Low‑frequency rTMS over the left temporoparietal junction and neuronavigated continuous theta burst stimulation of left temporoparietal cortex reduced positive symptoms and auditory hallucinations versus sham. Low‑frequency rTMS over left temporoparietal junction showed particularly robust effects on auditory hallucinations (standardized mean difference about −0.78). Several NIBS approaches, including neuronavigated intermittent theta burst over left dorsolateral prefrontal cortex, also improved negative and overall symptoms. All modalities were generally well tolerated, but heterogeneity and low confidence for some outcomes indicate that guideline adoption should prioritize better‑validated protocols like LF‑rTMS‑LTPJ. 2

Atypical depression shows distinct genetic, clinical, and antidepressant‑response characteristics

In this cohort of 14,897 depressed adults, 3,098 met atypical depression criteria based on weight gain and hypersomnia during their worst episode. Atypical cases had earlier onset, greater illness severity, stronger eveningness, and less daylight exposure than non‑atypical cases. They showed higher polygenic risk scores for major depression, ADHD, bipolar disorder, neuroticism, BMI, type 2 diabetes, inflammatory markers, and insulin resistance, and lower scores for HDL cholesterol and morningness chronotype. Atypical depression was associated with poorer self‑reported effectiveness of SSRIs and SNRIs and more side effects, especially weight gain. Findings support considering atypical depression as a biologically and clinically distinct subtype, warranting tailored antidepressant choice and proactive metabolic monitoring. 3

Common mental disorders meaningfully elevate acute coronary syndrome risk

This meta‑analysis included 25 studies with over 22 million participants to quantify acute coronary syndrome risk associated with mental disorders. Depressive disorders, anxiety disorders, sleep disorders, and PTSD all showed significantly increased ACS risk, with hazard ratios around 1.4–1.6 for depression, anxiety, and sleep disorders. PTSD carried the highest risk estimate, with a hazard ratio about 2.7 and moderate certainty of evidence. Bipolar and psychotic disorders did not show statistically significant associations, but point estimates were similar and certainty was very low. Results support integrating systematic cardiovascular risk assessment and prevention into routine care for patients with depression, anxiety, sleep disorders, and PTSD. 4