The edition · Psychiatry
A year of VNS in the hardest depression, and stimulation for later life
The RECOVER trial of vagus nerve stimulation missed its primary endpoint but showed durable gains on symptoms, function and quality of life in markedly treatment-resistant depression; magnetic seizure therapy matched ultrabrief ECT in bipolar depression with less memory loss; and bilateral theta-burst stimulation helped late-life depression by week 12.
The edition in brief
Today's psychiatry edition is weighted towards neuromodulation and depression. The RECOVER trial of adjunctive vagus nerve stimulation in markedly treatment-resistant depression (N=493, averaging more than 13 prior antidepressant trials) did not separate from sham on its prespecified primary endpoint, but active stimulation beat sham on symptom, function and quality-of-life measures, and over 80% of those who benefited at 12 months retained it at two years. A pilot trial (CORRECT-BD) found magnetic seizure therapy and right unilateral ultrabrief ECT produced similar remission in bipolar depression, with less worsening of autobiographical memory after magnetic seizure therapy (7.1% vs 22.2%). A World Psychiatry umbrella review maps risk and protective factors for psychosis, with the largest modifiable population attributable fractions for childhood adversity (about 41%), Toxoplasma gondii exposure (about 20%) and daily cannabis use (about 13%). On the regulatory desk, a generic manufacturer gained approval for asenapine maleate, widening access rather than changing indications. A clinic pearl restates metabolic monitoring for patients on second-generation antipsychotics. The practice-changer: a sham-controlled trial of bilateral theta-burst stimulation for late-life depression, negative at week 6 but significant by week 12 (response 52% vs 33%), offering a non-drug option for older adults not on antidepressants.
VNS in markedly treatment-resistant depression: negative primary, durable secondary gains
Reserve VNS for the most refractory depression; when a response appears, the data support continuing it, as benefit proved durable over two years.
Magnetic seizure therapy matches ultrabrief ECT in bipolar depression, with less memory loss
Magnetic seizure therapy showed ECT-like remission in bipolar depression with less autobiographical memory loss in this pilot, worth following rather than adopting.
A fresh atlas of what raises, and lowers, psychosis risk
Use the atlas to guide counselling and case-finding: childhood adversity, heavy cannabis use and the high-risk state are the modifiable factors with the largest potential impact.
Generic asenapine maleate gains US approval
Treat the generic asenapine approval as an access and cost development, not a change in how the drug is used or monitored.
Keep the metabolic watch on second-generation antipsychotics
Run and act on the baseline-and-regular metabolic panel for every patient on a second-generation antipsychotic, concentrating effort in the first months.
Theta-burst stimulation for late-life depression works, but slowly
Consider bilateral TBS as a non-drug option for late-life depression, counselling patients that benefit may take about twelve weeks to appear.
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