The Journal of Clinical Psychiatry
February 5, 2025
David A Bender, Sandeep M. Nayak, Joshua S. Siegel et al.
3 citations
Practitioners who oversee psychedelic therapy sessions slightly prefer an 'emotive' approach—one that emphasizes human and spiritual elements—over a 'neuromodulatory' approach that focuses on biological drug effects. A survey of 40 qualified respondents from at least 4 countries, 11 U.S. states, and 16 institutions found no consensus on many psychological support strategies. Four key themes emerged: the importance of trust, the role of spirituality, creating an emotional setting, and conceptualizing negative experiences. Practitioners trained at the Multidisciplinary Association for Psychedelic Studies or the California Institute of Integral Studies showed a significantly stronger emotive preference than those trained elsewhere.
The Journal of Clinical Psychiatry
July 7, 2025
Angela T H Kwan, Moiz Lakhani, Joshua D. Rosenblat et al.
2 citations
In a global pharmacovigilance analysis of adverse event reports from the World Health Organization's VigiBase database, esketamine was associated with higher reporting odds for suicidal ideation compared to lithium (5.13 times) and fluoxetine (3.34 times), while ketamine showed lower reporting odds for suicidal ideation, suicide attempt, and completed suicide relative to both reference drugs. Both drugs had lower reporting odds for suicide attempts and completed suicides. The authors caution that causality cannot be determined from these observational data.
The Journal of Clinical Psychiatry
January 27, 2025
Kristin Clemens, Amanda Teeple, Maryia Zhdanava et al.
2 citations
Among employed adults with treatment-resistant depression, esketamine nasal spray plus an oral antidepressant led to larger reductions in work productivity loss and related costs than quetiapine extended release plus an oral antidepressant. By week 8, total work productivity loss decreased by 30.3 percentage points with esketamine versus 17.3 with quetiapine, a difference of 13.0 percentage points. Weekly cost savings were $363 for esketamine and $207 for quetiapine. By week 32, reductions were 45.3 and 32.5 percentage points, respectively, with weekly cost savings of $543 versus $390. The results suggest greater benefits for both patient well-being and employer perspectives.
The Journal of Clinical Psychiatry
January 8, 2025
Ali Abdolizadeh, Brett D. M. Jones, Maryam Hosseini Kupaei et al.
2 citations
A systematic review of treatments for suicidality among psychiatric inpatients aged 18–65 found that intravenous ketamine produced the most consistent rapid reduction in suicidality among 14 pharmacologic trials. Among 35 nonpharmacologic trials—including chronotherapy, neurostimulation, and psychotherapies—results were mixed, with some interventions showing potential benefit, especially for mood, personality, and trauma-related disorders. Many studies had methodological limitations such as nonrandomized designs and lack of control groups. The review calls for larger, well-designed trials to confirm effectiveness.
The Journal of Clinical Psychiatry
August 25, 2024
Mark A Frye, Balwinder Singh, Scott Breitinger et al.
2 citations
A man with alcohol use disorder (AUD) maintained sobriety while taking an SSRI and naltrexone, but stopped the SSRI to take part in a psilocybin ceremony, after which he relapsed to alcohol use. The case examines factors that likely contributed to the relapse, including the discontinuation of the SSRI, the context of the psilocybin experience, and the absence of structured follow-up care.
The Journal of Clinical Psychiatry
May 9, 2022
Richard J. Zeifman, Dengdeng Yu, Nikhita Singhal et al.
2 citations
correction
In a meta-analysis of patient-level data on psychedelics and suicidality, two serious adverse events occurred that the original study authors deemed unrelated to the drug. One participant in a very low-dose psilocybin condition (1 mg/70 kg) completed suicide 11 days after administration, having reported boredom and left the session early. Another participant attempted suicide about two months after an active psilocybin dose (21–25.2 mg/70 kg), following a partner's sudden death and subsequent methamphetamine and crack cocaine use, with a brief psychotic episode. These events highlight the need for close monitoring of all participants during and after psychedelic therapy trials.
The Journal of Clinical Psychiatry
January 21, 2026
Matheus G Marques, Aysegul Özerdem, Simon Kung et al.
1 citation
For treatment-resistant depression (TRD), a panel of 10 psychiatrists reached strong consensus on recommending augmentation with second-generation antipsychotics, transcranial magnetic stimulation, and ketamine/esketamine as next-step treatments after three failed antidepressant trials. Treatment preferences shifted to include nonaugmentative antidepressants and electroconvulsive therapy depending on patient characteristics such as metabolic disease and age. The findings underscore the importance of tailoring TRD treatment strategies to individual patient factors beyond conventional guideline tiers.
The Journal of Clinical Psychiatry
September 17, 2025
Liliana Patarroyo-Rodriguez, Vanessa K. Pazdernik, Jennifer L. Vande Voort et al.
1 citation
Ketamine and esketamine reduced long-term emergency department visits for suicidality among individuals with treatment-resistant depression. Further research with longer follow-up is needed to determine whether these benefits depend on mood state or reflect an independent mechanism.
The Journal of Clinical Psychiatry
August 3, 2023
Ayana Jordan
1 citation
Alcohol and tobacco are legal but carry well-documented risks of misuse and disease, with alcohol dependence also contributing to opioid overdoses that kill 130 people daily. Despite growing awareness of the opioid epidemic, most Americans do not receive FDA-approved addiction medications. Effective medications exist for alcohol use disorder, and medications for opioid use disorder have validated benefits. Recently, psychedelic compounds like psilocybin have shown potential for alleviating depression, anxiety, alcohol use disorder, and opioid withdrawal symptoms. A comprehensive, integrated public health approach is essential for treating substance use disorders.
The Journal of Clinical Psychiatry
February 23, 2021
Avinash Hosanagar, Joseph Cusimano, Rajiv Radhakrishnan
1 citation
Psychedelics are being studied as treatments for psychiatric disorders. The FDA has granted Breakthrough Therapy Designations for MDMA-assisted psychotherapy for PTSD and for psilocybin with psychotherapy for treatment-resistant depression and major depressive disorder. Clinical trials are also exploring psychedelics for eating disorders, cognitive impairment, and substance use disorders. This review covers evidence for psilocybin, LSD, MDMA, and ayahuasca. Open-label studies of psilocybin for obsessive-compulsive disorder, depression, and substance use disorders show promising results. Randomized controlled trials of psilocybin for depression and anxiety in advanced cancer found that high-dose psilocybin produced large decreases in depression and anxiety, increased quality of life, and decreased death anxiety, with about 80% of participants sustaining the response at 6-month follow-up.
The Journal of Clinical Psychiatry
June 10, 2026
Jacob T. Steinle, Suraj Shankar, Joshua S. Siegel et al.
After adjusting for preexisting psychiatric conditions, the link between hallucinogen use and psychosis disappears. Among 273,466 people with substance-related hospital admissions, psychosis diagnoses were more common after hallucinogen-related admissions (16.4%) than after other substance admissions (6.6%). However, once clinical characteristics were accounted for, the increased risk became nonsignificant (hazard ratio 0.97). This suggests that observed associations between hallucinogens and psychosis are largely due to underlying mental health vulnerabilities, not a direct causal effect. The findings inform psychedelic policy by indicating that population-level data on hallucinogen safety may reflect preexisting risk factors.
The Journal of Clinical Psychiatry
June 3, 2026
Martin Johnson, Pau Aceves Baldo, Emilio Arbe et al.
In a small open-label trial, ten women with postpartum depression received up to three escalating doses of inhaled GH001 (a synthetic form of 5-MeO-DMT) on a single day. Depressive symptoms, measured on the Montgomery-Asberg Depression Rating Scale, dropped by an average of 35.4 points from a baseline of 36.7 by day 8, and all participants met criteria for both response and remission. Improvements were first noted two hours after the final dose. The treatment was well tolerated, with only mild to moderate side effects, most commonly headache. These preliminary findings suggest GH001 may produce rapid and substantial antidepressant effects in postpartum depression, but larger controlled trials are needed.
The Journal of Clinical Psychiatry
May 13, 2026
Andrew van der Vaart, Jeffrey LaPratt, Kimberly Swartz et al.
A single 25-mg dose of a synthetic psilocybin formulation, combined with psychological support, rapidly and durably reduced chronic suicidal ideation and depressive symptoms in 20 adults with major depressive disorder who had not responded to at least two prior antidepressant treatments. Suicidal ideation scores dropped significantly by week 1, remained reduced at week 3 (the primary endpoint), and were still lower at week 12, when 70% of participants had minimal or no suicidal ideation. Depressive symptoms also improved substantially. No serious adverse events occurred. The findings are preliminary and require confirmation in larger randomized trials.
The Journal of Clinical Psychiatry
May 4, 2026
Samuel T. Wilkinson, Brandon Kitay, Matthew Macaluso et al.
Adding cognitive behavioral therapy to esketamine treatment reduces suicidal ideation more than esketamine alone in people with major depression and suicidal thoughts. In a randomized trial of 93 patients, 72% completed the study, meeting feasibility goals. Those who received 16 weeks of CBT plus esketamine showed greater improvement on three measures of suicidal ideation than those receiving esketamine with usual care: a mean difference of -1.91 on the Beck Scale for Suicidal Ideation, -0.33 on the Clinician Global Improvement Scale for Suicide Severity, and -3.77 on the depression rating scale. No difference was found on the Columbia-Suicide Severity Rating Scale or in suicide-related events.
The Journal of Clinical Psychiatry
October 13, 2025
Pim B. van der Meer, Sebastiaan O Verboeket, Arjen J. C. Slooter et al.
NMDA receptor antagonists like ketamine may help treat catatonia. This systematic review evaluated the efficacy and safety of ketamine and esketamine for catatonia, finding that the available evidence suggests these drugs could be beneficial, but the data are limited and further research is needed to confirm their role.
The Journal of Clinical Psychiatry
September 3, 2025
Kristina T. Kumpf, Samuel T. Wilkinson, Bo Hu et al.
In a multisite randomized trial comparing cognitive effects of intravenous ketamine and electroconvulsive therapy (ECT) in patients with treatment-resistant depression, those receiving six ketamine treatments showed superior cognitive functioning after a three-week treatment course compared with those receiving nine ECT sessions. No significant differences in cognitive task performance were associated with response to either treatment. Among responders followed for up to six months, no group differences emerged. Subjective memory measures were mixed: both groups improved on the Squire Memory Complaint Questionnaire, with ketamine recipients reporting greater functional gains, while ketamine-treated patients reported improvements on a global self-evaluation of memory but ECT-treated patients reported a decline. Within the ketamine group, improvements in executive functioning and cognitive flexibility survived adjustment for changes in depression, suggesting partial independence of cognitive and mood effects.
The Journal of Clinical Psychiatry
April 2, 2025
Adriana Feder, Oneysha Brown, Sarah B. Rutter et al.
Combining six ketamine infusions with a brief exposure-based psychotherapy, written exposure therapy (WET), produced large and durable reductions in PTSD symptoms for patients with chronic, severe PTSD. In an open-label trial, 13 of 14 patients completed treatment. PTSD symptom severity, measured by the CAPS-5, dropped from an average of 41.6 before treatment to 20.8 at 12 weeks, a large-magnitude improvement. Nine patients (69%) were treatment responders, and eight (61.5%) maintained improvement up to six months. The authors suggest the combined treatment may be effective but call for larger randomized controlled trials to confirm efficacy and synergy.
The Journal of Clinical Psychiatry
February 11, 2025
correction
This is a correction notice for a previously published article. It identifies the original article by its DOI but provides no new findings, arguments, or data.
The Journal of Clinical Psychiatry
April 5, 2023
Albert Yeung, Guy Sapirstein, Laura D Crain et al.
Treatment-resistant depression (TRD) is most commonly defined by at least two prior treatment failures with adequate dose and duration, though consensus is lacking. A clinical case illustrates a patient with long-standing depression and inadequate treatment response, where persistent self-criticism appears to drive unrelenting symptoms, intense anger, self-doubt, and self-disapproval. The article explores potential causes of self-criticism, its impact on depression and help-seeking, and plausible treatment approaches.
The Journal of Clinical Psychiatry
September 1, 2015
Annette van Schagen, Jaap Lancee, Izaäk W De Groot et al.
Imagery rehearsal therapy (IRT) reduces nightmare frequency, nightmare distress, and general psychiatric symptoms in patients with a range of psychiatric disorders. In a trial of 90 patients, those who received six individual IRT sessions added to their usual treatment showed moderate improvements compared with those receiving treatment as usual alone. The benefits were largely sustained three months later. IRT involves patients changing the script of a nightmare into a new dream and practicing it during the day.
The Journal of Clinical Psychiatry
October 1, 2009
Daphne Simeon, David S Kozin, Karina Segal et al.
Chronic depersonalization/derealization triggered by drugs presents a uniform syndrome indistinguishable from non-drug-triggered cases, except that drug-triggered cases show more improvement over time. An internet survey of 394 adults with chronic depersonalization compared those whose onset was initiated by drugs (196 participants) versus those whose onset was not (198 participants). Cannabis, hallucinogens, and ecstasy were the most common precipitating drugs. Both groups reported similar illness course, impairment, suicidality, and limited treatment response. The drug-initiated group showed significantly greater improvement over time, but the groups did not differ in overall depersonalization severity or in reported effectiveness of psychotherapy or pharmacotherapy.