The edition · Psychiatry
Antidepressants differ on QT, but none raised early cardiac events
Plus what the cannabis–violence data mean for routine assessment, evidence for psychodynamic therapy in schizophrenia, and when rapid relapse is not a stopping effect.
The edition in brief
Today's psychiatry edition leads on antidepressant cardiac safety. An individual-participant-data network meta-regression of double-blind trials found that specific antidepressants differ in their effect on the QT interval — escitalopram and amitriptyline prolonged it most, venlafaxine and vortioxetine least — yet a larger aggregate analysis found no association between antidepressant use and early major cardiovascular events or non-suicidal sudden death. The message is to match the drug to the patient's cardiac risk, not to avoid antidepressants. A meta-analysis links cannabis use with roughly double the odds of perpetrating violence and a higher risk of victimisation, an association that supports routine assessment of cannabis use rather than any causal claim. A randomised trial offers rare empirical support for a manualised psychodynamic psychotherapy added to usual care in schizophrenia-spectrum disorders, improving psychosocial functioning at two and three years. On the regulatory desk, an administrative generic risperidone supplement changes nothing clinically. The practice-changer comes from pooled paliperidone discontinuation trials: rapid relapse was not over-represented among those who stopped treatment, arguing against a purely pharmacological rebound and for risk stratification by baseline severity when de-prescribing.
Antidepressants differ on the QT interval, but none raised early cardiac events
Choose the antidepressant by the patient's cardiac risk — favour a lower-QT agent where the QTc is borderline — rather than avoiding treatment over cardiac fears.
Cannabis use linked with roughly double the odds of perpetrating violence
Ask about cannabis use routinely in psychiatric assessment, as both a risk marker and a modifiable target — without treating use as evidence of dangerousness.
A psychodynamic therapy for schizophrenia shows functional gains at three years
For persistent functional and interpersonal difficulties in schizophrenia, structured psychotherapy is worth considering alongside established psychosocial treatments.
A generic risperidone supplement clears the FDA — administrative, not clinical
No action needed — this is an administrative generic supplement, not a safety or labelling change.
Before a QT-prolonging psychotropic, check the ECG and the electrolytes
Identify the at-risk patient — long QTc, low electrolytes, interacting drugs — before starting a QT-prolonging psychotropic, and correct what is modifiable.
Rapid relapse after stopping an antipsychotic may not be a stopping effect
When de-prescribing an antipsychotic, stratify by baseline severity and monitor more closely in severely ill patients, rather than assuming stopping itself triggers rapid relapse.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for psychiatry, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free