Suicide prevention rethought from India, and exercise earns its place in perinatal care

The edition in brief

Today's psychiatry desk opens with a JAMA Psychiatry viewpoint by Indian authors arguing that global suicide prevention has been shaped by high-income evidence and misses the pathways that dominate in low- and middle-income countries: acute distress, interpersonal crisis and access to means rather than a diagnosed mental illness reaching its end point. For Indian psychiatrists, this is less news than confirmation, and it matters for how prevention is staged. A multicentre Dutch trial protocol sets out the first adequately powered test of 1 Hz rTMS over the pre-supplementary motor area as an add-on to exposure and response prevention in OCD that has not responded to first-line treatment; 201 of a planned 250 patients are enrolled, and results are not due until late 2026 at the earliest, so the honest position today is that adjunctive rTMS for OCD remains unproven rather than established. A meta-analysis of aromatherapy in menopause reports improvements across vasomotor, sleep and mood outcomes, including depression (SMD -0.57, 95% CI -0.85 to -0.28), but with GRADE certainty of low to very low throughout and substantial heterogeneity, so it belongs in the conversation about adjuncts, not in a treatment plan. The day closes with the clearest actionable finding: a meta-analysis of 17 randomised trials of standalone physical activity in pregnancy and after birth, in which prevention-oriented antenatal programmes were associated with lower depressive symptom scores (SMD -0.52, 95% CI -0.75 to -0.30, I-squared 46%), with a smaller and far more heterogeneous postpartum signal. Certainty is low, the effect is on symptom scores rather than diagnosed depression, and the practical reading is that structured exercise is worth prescribing specifically rather than mentioning in passing.