Psychiatry

Observational meta-analysis links multiple psychotropics with lower suicide mortality

This systematic review pooled 48 observational studies (>6 million adults) with major psychiatric disorders comparing psychotropic treatment versus nonuse. Second-generation antipsychotics in schizophrenia showed reduced suicide mortality, including clozapine (OR 0.40, 95% CI 0.36–0.60), olanzapine (OR 0.53, 0.39–0.71), and quetiapine (OR 0.75, 0.58–0.96). Across diagnoses and 70 medications, several antidepressants, antipsychotics, and mood stabilizers also associated with lower suicide attempts or deaths, though effects varied. Within-individual comparisons generally supported protective associations, but residual confounding and indication bias remain important limitations. Findings support continuing effective pharmacotherapy in high-risk patients and argue against stopping medications solely from concern about suicide risk. 1

Working memory training shows small, nonpersistent antidepressant effects

This meta-analysis of 27 RCTs (1692 participants) evaluated working memory training (WMT) as a stand-alone intervention for depressive symptoms. WMT produced a small reduction in depressive symptoms at post-training (g=0.20, 95% CI 0.04–0.35) that did not persist at follow-up. Working memory performance improved moderately at post-training (g=0.61) and follow-up (g=0.72), and WM gains correlated with later symptom reductions. Moderator signals for baseline severity and emotional training material valence were statistically inconclusive. Current evidence supports WMT as a mechanistic probe rather than a reliable clinical augmentation strategy for depression. 2

Review supports earlier clozapine after early nonresponse in schizophrenia

This narrative review summarizes cohort, registry, and meta-analytic data on clozapine use in the first five years of schizophrenia. When introduced after early treatment failure or relapse, clozapine outperforms additional nonclozapine antipsychotic trials for response and relapse prevention. Earlier use, particularly within three years of first episode, is associated with better negative symptoms and functional outcomes. Short-term safety in early-phase patients appears similar to established profiles, with serious adverse events uncommon but requiring standard monitoring. The authors argue clozapine should be considered earlier in treatment algorithms, and system-level barriers to timely initiation should be reduced. 3

Umbrella review finds modest, variably credible effects of nature-based mental health interventions

This umbrella review synthesized 28 meta-analyses (344 studies, 91 associations) of climate-related and nature-based mental health interventions. Only 10 associations (11%) reached moderate credibility; most psychosocial interventions targeting climatic impact drivers had low or very low evidence. Nature-based interventions not directly addressing climate stress showed moderate evidence for reducing tension, fatigue, confusion, negative affect, and for increasing positive affect, vigor, and well-being. Benefits on negative affect were larger in older people and in settings with lower tree cover, better health care, and lower systemic climate vulnerability. Robust evidence for interventions that specifically mitigate mental health harms from climate impact drivers is currently lacking, representing an important research gap. 4