From the Pages of Psychiatric Times: March 2024

In the March issue of Psychiatric Times®, we worked with experts from multiple psychiatric areas to bring you thoughtful articles about a wide variety of psychiatric topics, from augmentation strategies for treatment-resistant depression to the role of artificial intelligence in the changing landscape of health care. Here are some highlights from the issue.

Rejecting the Accusation of a Violated STAR*D Protocol

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At the heart of this matter is the eye-popping and contentious difference in the results of 2 teams analyzing ostensibly the same data set, with one team reporting an estimated cumulative remission rate of 67% across up to 4 levels of treatment, provided sequentially over about 1 year, and the other team asserting that the actual cumulative remission rates “per protocol” analyses was only 35%. We understand the obvious dissonance raised by seeing such discrepant results reported by 2 teams analyzing the same set of data.

However, this difference is not the result of one team being the accurate conveyor of the truth and the other being caught using statistical sleight of hand. We wish to briefly address the issues raised in the Psychiatric Times cover story before turning attention to the additional points raised by Pigott et al in their commentary in this issue. Continue Reading

Augmentation Strategies for Treatment-Resistant Depression

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Many patients presenting with unipolar major depression do not achieve remission after their initial treatment. The term treatment-resistant depression (TRD) typically refers to major depression that does not remit after 2 antidepressant trials of adequate dose and duration; however, the definition has not been standardized.

Several staging models have been proposed over the years for classifying and defining TRD. The Thase and Rush Model is the most widely used in TRD. In this model, failure to respond to 1 adequate antidepressant trial from a major antidepressant class is considered stage I TRD, and those who then do not respond to a second adequate antidepressant trial (from a different class than the antidepressant used in stage I) are termed stage II TRD. Continue Reading

Mild Cognitive Impairment and Serotonin System Degeneration

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A reduction in serotonin transporter (5-HTT) in parts of the brain involved with executive function, emotion, and memory has been detected in persons with mild cognitive impairment (MCI).

In a new study comparing a group with MCI to healthy, age-matched controls, this marker of serotonin system degeneration in those with MCI and cortical deposition of amyloid-ß were both correlated with cognitive impairment associated with progression to Alzheimer disease (AD). Although the investigators emphasize that correlation of lower serotonin transporter levels with the development of MCI does not show causation, it does suggest a potential therapeutic role for serotonergic medication in early, preclinical stages of AD. Continue Reading

AI in Psychiatry: Changing the Landscape of Mental Health Care

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Computer systems that perform tasks that usually require human intelligence are known as artificial intelligence (AI). These tasks may include problem-solving, language or speech understanding, learning from experience, and even decision-making.

Large language models (LLMs) are a type of AI specifically designed for understanding and generating natural language. These models are pretrained on large amounts of diverse text data, which allow them to perform language-related tasks including translation, summarization, question answering, and text completion. Given a prompt or context, the LLM can generate fluent, coherent, human-like language responses. Continue Reading

See the full March issue of Psychiatric Times here. And be sure to stay up-to-date by subscribing to the Psychiatric Times E-newsletter.

Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at PTeditor@mmhgroup.com.