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In This Issue of JAMA Psychiatry
September 2019


JAMA Psychiatry. 2019;76(9):879. doi:10.1001/jamapsychiatry.2018.3000


Esketamine has short-term efficacy for treatment-resistant depression, but its long-term effect is unknown. Daly and colleagues conducted a phase 3 multicenter, double-blind, randomized withdrawal clinical trial of continuation on esketamine nasal spray plus oral antidepressant vs switch to placebo plus oral antidepressant with 455 patients; they found that risk of relapse was significantly reduced in the esketamine arm. These results indicate that esketamine nasal spray has efficacy in reducing risk of relapse among patients with treatment-resistant depression who experienced remission or response.

Continuing Medical Education

The endocannabinoid system is implicated in psychosis, but no analysis of endocannabinoid markers is available to date. Minichino and colleagues conducted a systematic review and meta-analyses of endocannabinoid markers in 18 studies and identified significant elevation in these markers in the cerebrospinal fluid, blood, and peripheral immune cells of people with schizophrenia, with greater abnormalities in the early stage of illness. These findings indicate that there are measurable endocannabinoid marker abnormalities in psychotic disorders. In an Editorial, Volk and Lewis review the state of evidence for endocannabinoid system abnormalities in schizophrenia.


The television show 13 Reasons Why sparked criticism from suicide prevention organizations, but an association between the show and suicide among young people has not been demonstrated. Niederkrotenthaler and colleagues conducted a time-series analysis and found a significant increase in suicide among male and female individuals aged 10 to 19 years in the United States following release of the show, with no excess suicide mortality in other age groups. These findings are consistent with a contagion by media effect on suicide. In an Editorial, VanderWeele and colleagues discuss media portrayal of suicide.


Author Audio Interview

Two important secular changes in mental health have occurred over the past 2 decades. Suicides have been on the rise and opioid use disorder has skyrocketed. Using commercial claims and encounters databases, Brent and colleagues used 121 306 propensity-matched individuals with and without opioid use and found a doubling of the risk of suicide attempts among the children of parents who used opioids. These results suggest that identifying individuals with opioid use disorder should also trigger a careful assessment for risk of suicide among family members.

Benzodiazepine use in early pregnancy is associated with spontaneous abortion but the relationship with specific agents has not been examined. Using 442 066 pregnancies included in the Quebec Pregnancy Cohort, Sheehy and colleagues studied this relationship and found that the risk of spontaneous abortion was similar for exposure to short-acting and long-acting benzodiazepines, and all agents were independently associated with increased risk. These results suggest that increased risk for spontaneous abortion extends across all benzodiazepines and clinicians should carefully evaluate the risk/benefit ratio of prescribing these agents in early pregnancy.