The edition · Psychiatry
Caring letters did not move suicide deaths, and brain scans did not beat a clinical history
A 227,000-veteran analysis found no mortality signal for caring letters after crisis-line contact, a multimodal relapse model was no better than clinical risk factors, and theta-burst stimulation helped late-life depression only by week 12.
The edition in brief
Today's psychiatry edition. Among 227,502 US veterans who contacted a crisis line, those sent nine caring letters over a year had a 12-month suicide rate of 0.29% against 0.27% in a historical comparison group, with no difference by whether a clinician or peer signed; the comparison was observational. A German cohort of 564 people with depression tested nine data types, including MRI, genetics, blood markers and gut microbiome, for predicting relapse over two years: the best model reached about 64% balanced accuracy and relied on a few clinical risk factors, with no gain from the rest. FDA recorded a supplement to a generic olanzapine application on 14 October, an administrative action rather than new safety or efficacy data. In a sham-controlled trial in 108 adults over 60 not taking antidepressants, bilateral theta-burst stimulation missed its week-6 endpoint but was ahead at week 12, with response in 52% against 33%. The pearl sets out the clinical relapse markers that still do most of the predictive work.
Caring letters after crisis-line contact were not linked to fewer suicide deaths
Use caring contacts as an add-on, and keep safety planning, means counselling and prompt follow-up at the centre of post-crisis care.
MRI, genetics and microbiome added nothing to predicting depressive relapse
Judge relapse risk from the clinical history; current biological tests do not improve on it.
FDA recorded a supplement to a generic olanzapine application
No action needed: this is an administrative supplement to a generic olanzapine application.
The relapse markers that still do the predicting
A good episode history is still the best relapse predictor available; take it and write it down.
Theta-burst stimulation for late-life depression: a late benefit, not an early one
Theta-burst stimulation is worth discussing for older adults who cannot use antidepressants, with benefit expected by three months rather than six weeks.
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