Psychiatry

Specific adverse childhood experiences strongly predict treatment-resistant depression, beyond familial and genetic confounding

In this Swedish twin cohort, each additional adverse childhood experience increased odds of treatment-resistant depression by about 70%. Physical neglect and sexual abuse showed the strongest associations with treatment-resistant depression, with odds ratios above 5. These associations persisted in co-twin control analyses, including monozygotic twins, suggesting effects beyond shared genes and environment. Clinically, detailed ACE assessment—especially neglect and sexual abuse—may inform risk stratification, prognosis discussions, and earlier, more intensive depression treatment. Findings support incorporating trauma history into algorithms for identifying patients at high risk for antidepressant nonresponse and treatment resistance. 1

Late-onset depression in older adults portends greater cognitive deficits and higher dementia risk

Among over 75,000 adults aged 60 years or older, late-life depression with late onset showed worse cognition than depression-free controls. Late-onset depression was particularly associated with poorer fluid intelligence and visuospatial memory compared with both controls and early-onset late-life depression. Late-onset depression carried a higher hazard of incident dementia than depression-free status, even after extensive adjustment. Deficits in fluid intelligence and visuospatial memory partially mediated the association between late-onset depression and later dementia. Geriatric patients with first-episode depression warrant baseline cognitive assessment and closer longitudinal monitoring for emerging neurodegenerative disease. 2

Most psychiatry guideline recommendations lack high-certainty evidence, especially outside pharmacotherapy

This review of 24 major psychiatric guidelines identified 545 recommendations from 2014 to 2024. Only 11.6% of recommendations were rated by authors as based on high-level evidence, with wide variation between organizations. Pharmacotherapy recommendations were most likely to be high-certainty, whereas somatic assessment had none rated as high-level evidence. Almost half of all recommendations cited at least two randomized trials or a meta-analysis, yet evidence was often downgraded for quality concerns. Self-harm, autism, ADHD, prevention, patient involvement, and discontinuation were sparsely covered, highlighting key evidence and guidance gaps for clinicians. 3