An arrhythmia signal with antidepressants, and what still holds up

The edition in brief

Today's psychiatry edition leads on prescribing safety. A meta-analysis of about 9.6 million people links antidepressant use to a higher risk of ventricular arrhythmia and sudden cardiac death (odds ratio 1.34), significant for both SSRIs and tricyclics, though heterogeneity was very high and confounding by indication is likely; the atrial fibrillation signal was unstable. The ODDESSI cluster-randomised trial in England found Open Dialogue did not shorten time to relapse after a crisis (hazard ratio 0.95) but cut acute inpatient admissions and improved service-user experience, reframing it as a model for how care feels and how beds are used rather than for relapse. A three-arm trial found structural-connectivity-guided intermittent theta-burst stimulation beat standard 5-cm targeting on depression scores at weeks 2 and 6, with the gap gone by week 12 — promising but single-centre. A generic risperidone supplement was recorded by the FDA, an administrative manufacturing change rather than a new indication or safety action. A clinic pearl reaffirms structured metabolic monitoring for anyone on an antipsychotic. The practice-changer: a GRADE meta-analysis of 16 trials gives high-certainty evidence that long-term psychodynamic psychotherapy reduces depressive symptoms, supporting it as a real option for suitable patients.