In 2023, The Journal of Clinical Psychiatry’s (JCP) top 10 most-read articles captured the attention of readers worldwide with coverage of groundbreaking developments and insights into mental health.
This collection of articles covered a wide range of topics, from innovative treatments for schizophrenia and Alzheimer’s disease to the potential benefits of hot yoga classes to lift depression. The topics they present hint at a growing interest by psychiatrists and other mental health professions to understand the latest advancements in the field. Readers were drawn to these pieces for their cutting-edge research, practical insights into drug efficacy and side effects, and exploration of novel therapeutic approaches.
Here are this year’s most read JCP articles. Click the headlines to access the full stories.
Schizophrenia, a severe mental health condition, greatly affects life quality and can shorten lifespan. Traditional treatments have used antipsychotics to manage dopamine levels, but these can cause movement disorders. Newer drugs are less likely to have this side effect, yet only one-third of patients find them effective. Persistent symptoms and side effects are common. The good news presented in this paper is that recent breakthroughs in treatment focus on more precise dopamine control, paving the way for a more effective approach in managing schizophrenia.
This study provided an update to the recommended dosage range for olanzapine, a medication used for schizophrenia. Researchers looked at how the drug’s levels in the blood relate to its effectiveness and side effects. Their literature review focused studies that looked at the drug’s impact on dopamine receptors in the brain. Findings suggest an ideal blood level for olanzapine is between 20 and 40 ng/mL. At this range, patients typically see the best results with manageable side effects, like weight gain. Interestingly, even higher levels of the drug were generally well-tolerated, indicating that dosage reductions might not be needed if patients respond well and tolerate the drug.
The literature on long-term benzodiazepine treatment shows two contrasting views. On one hand, patients trying to quit long-term use report a range of severe symptoms during and after use, from physical issues to emotional disturbances. About one-third can’t stop using them. On the other hand, studies on the drug’s effectiveness show stable, problem-free treatment for anxiety disorders, with no increase in dosage or loss of effect over time. As this study makes clear, there is a lack of in-depth research on the long-term negative impacts. It could be that the differences in reports may be down to a small number of patients that are highly sensitive to these drugs. Having clear guidelines for prescribing benzodiazepines would help clarify their safety and best use.
This study provides a comprehensive exploration of solriamfetol as a new treatment option for adults with ADHD, especially for those who don’t respond well to current treatments. Involving 60 adults with ADHD, participants were randomly given either solriamfetol or a placebo for six weeks, with researchers tracking their symptoms and overall functioning. The findings? Solriamfetol was generally well-received, with minimal impact on heart rate or blood pressure. While some side effects like decreased appetite and insomnia were more common compared to the placebo, overall, solriamfetol showed promising results. The drug regiment delivered significant improvements in ADHD symptoms and executive functioning, with better scores on various tests measuring attention, behavior, and overall mental health.
In the ongoing Cross Talk series, JCP shows how bringing together different medical experts can lead to better solutions for tough clinical challenges. This Cross Talk featured two expert clinicians from Massachusetts General Hospital/Harvard Medical School discussing a 42-year-old woman who lived with “cognitive strain” and anxiety since her teens. Despite various hospital stays and medications, her symptoms of anxiety, dissociation, and mood changes persisted. One expert recommended a psychopharmacological approach while the other outlined a psychotherapeutic strategy.
Current treatment guidelines for major depressive disorder (MDD) suggest some benefit for using lithium as an additional treatment when two antidepressants fail or partially work. Studies show that lithium increases the success rate of treating MDD, especially in treatment-resistant cases. However, its effectiveness may be lower if a person doesn’t respond to multiple antidepressants. Identifying the right patients early is key. Despite its proven benefits, this paper makes the case for more research on combining lithium with newer antidepressants. Further evidence suggests that lithium therapy may be especially beneficial for patients with severe depression and for lowering suicide risk. When prescribing lithium, the authors urge a complete checkup of thyroid and kidney function and adjusting dosage based on blood tests.
Drugs can have different half-lives depending on how they are distributed in the body, broken down, and cleared. Factors like age, other medications, and liver or kidney health can affect a drug’s half-life. For medications that quickly leave the body (short half-lives), patients require more frequent dosing to keep a steady level in the blood. That means a higher risk of withdrawal symptoms when it comes time to stop treatment. Half-life also determines how long it takes for a drug to reach stable levels in the body and how long it remains after stopping it. This detailed explainer helps mental health professionals understand how to take half-life into account to prescribe drugs effectively for each individual patient.
This recently published study caused quite a stir by suggesting weekly sessions of hot yoga may be as good – or perhaps better – than medication for managing moderate-to-severe depression. Over eight weeks, participants were either assigned to heated yoga classes twice a week or placed on a waitlist. An impressive 60 percent of the yogis experienced a significant reduction in depression symptoms (more than 50 percent decrease), compared to only 6.3 percent of the waitlisters. On average, participants attended about 10 yoga classes during the study period. The authors suggested that upping the frequency would lead to even better results.
As part of Chittaranjan Andrade, MD’s ongoing series of research explainers, this article explored standardized mean difference (SMD) as a way to measure the difference between two groups. In order to make things simple, Andrade suggests converting SMDs into percentile scores to make them easier to grasp. For example, in a study on certain drugs for Alzheimer and Parkinson diseases, the drugs showed a small statistical improvement in symptoms. But in reality, this improvement was so minor that it might not be noticeable to patients. Andrade does an excellent job showing how to convert SMDs into percentile scores using a simple table found online. Like all of his articles, this one makes it possible to quickly grasp the real-world impact of statistical findings.
And lastly, this series of six case studies caused a global sensation by suggesting that the blockbuster weight loss drug semaglutide may also help relieve the symptoms of alcohol use disorder (AUD). Despite existing FDA-approved medications for AUD, their usage remains low. Enter GLP-1 receptor agonists (GLP-1RAs), particularly semaglutide. GLP-1RAs. The article explored a retrospective chart review from an obesity clinic, where patients prescribed semaglutide for weight loss exhibited significant reductions in alcohol intake. This study paves the way for more extensive clinical trials to confirm the efficacy of GLP-1RAs in AUD treatment.
