2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T774,Cholesterol is a vital molecule, especially during embryonic development. Disruption of the cholesterol biosynthetic pathway can arise from pathogenic genetic variants or exposure to prescription medications. We investigated the relationship between fifteen sterol biosynthesis inhibiting medications (SBIM) prescribed during pregnancy and the incidence of autism spectrum disorders (ASD) in the resulting offspring. Our study of the Epic Cosmos database queried linked child and maternal health records for births between 2014 and 2023 with follow-up to December 2025. The study included 6,135,213 children with linked maternal health records. We evaluated the incidence of ASD associated with maternal prescription of aripiprazole, atorvastatin, bupropion, buspirone, fluoxetine, haloperidol, metoprolol, nebivolol, pravastatin, propranolol, rosuvastatin, sertraline, simvastatin, and/or trazodone during pregnancy using Cox proportional hazard modeling. We found that exposure to at least one SBIM during pregnancy was associated with a 1.47-fold (95% CI 1.45-1.49) increased risk of an ASD after adjusting for potential confounders. For each additional SBIM co-prescribed, there was a 1.33 (95% CI 1.32-1.34) times increased risk of ASD, reaching 2.33-fold risk when 4 or more SBIMs were prescribed simultaneously. In the ten years of our cohort, we identified 234,971 (3.8%) children with an ASD diagnosis. Of the children with an ASD diagnosis, 35,152 (15.0%) of the mothers were prescribed at least one SBIM during pregnancy. Notably, in our dataset, utilization of SBIM medications by pregnant women increased from 4.6% in 2014 to16.8% in 2023. In conclusion, SBIMs may be potentially harmful to the developing fetus. Given that these drugs account for over 400 million prescriptions annually in the U.S. we recommend these findings be considered before prescribing SBIM medications during pregnancy.31:T97e,Psychedelic-assisted therapy (PAT) trials have high levels of functional unblinding, which biases results when comparing PAT with blinded interventions. Because PAT is effectively always open label, treatment results should be compared with those of open-label traditional antidepressants (TADs), so potential benefits associated with patients knowing their treatment is equal between the interventions. To investigate the comparative effectiveness of PAT vs open-label traditional antidepressants (TADs; such as selective serotonin and norepinephrine reuptake inhibitors) for the treatment of major depression. PubMed was systematically searched in March 2024 for trials of PAT and open-label TADs for the treatment of major depression without comorbidity in adults without psychosis in the outpatient setting. Extraction was supplemented with data from a review and meta-analysis of antidepressant drugs to assess the open-label vs blinded TAD difference. Depression scores were extracted by 2 independent reviewers; estimates were pooled with both bayesian and frequentist mixed-effects models. Reporting follows the PRISMA guideline. Following predefined hypotheses, the mean within-arm effect from baseline to primary end point (ie, patient improvement between PAT and open-label TAD trials on the 17-item Hamilton Depression Rating Scale) was compared. To assess the potential role of blinding, the within-arm effect of blinded vs open-label trials in both PAT and TADs was also compared. Of the initially retrieved PubMed 619 records, 24 met inclusion criteria. Contrary to the first of 3 hypotheses, PAT (8 trials; 249 patients) was no more effective than open-label TAD treatment (16 open-label TAD trials; 7921 patients), with an estimated difference of 0.3 favoring open-label TADs (95% CI, -1.39 to 1.98; P = .73). Open-label TADs were associated with better outcomes than blinded treatment (144 blinded TAD trials; 31 792 patients), with an estimated difference of 1.3 (95% CI, 0.07-2.51; P = .04;), but the same difference was not observed for PAT (0.67; 95% CI, -3.08 to 1.73; P = .58). In trials of depression, PAT was not more effective than open-label TADs. Blinding made a difference for TADs, but not for PAT, confirming that PAT trials are effectively always open label. These results argue against highly optimistic narratives surrounding PAT and highlight the importance of blinding integrity.32:Tf7f, Importance Psychedelic-assisted therapy (PAT) trials have high levels of functional unblinding, which biases results when comparing PAT with blinded interventions. Because PAT is effectively always open label, treatment results should be compared with those of open-label traditional antidepressants (TADs), so potential benefits associated with patients knowing their treatment is equal between the interventions. Objective To investigate the comparative effectiveness of PAT vs open-label traditional antidepressants (TADs; such as selective serotonin and norepinephrine reuptake inhibitors) for the treatment of major depression. Data Sources PubMed was systematically searched in March 2024 for trials of PAT and open-label TADs for the treatment of major depression without comorbidity in adults without psychosis in the outpatient setting. Extraction was supplemented with data from a review and meta-analysis of antidepressant drugs to assess the open-label vs blinded TAD difference. Data Extraction and Synthesis Depression scores were extracted by 2 independent reviewers; estimates were pooled with both bayesian and frequentist mixed-effects models. Reporting follows the PRISMA guideline. Main Outcomes and Measure Following predefined hypotheses, the mean within-arm effect from baseline to primary end point (ie, patient improvement between PAT and open-label TAD trials on the 17-item Hamilton Depression Rating Scale) was compared. To assess the potential role of blinding, the within-arm effect of blinded vs open-label trials in both PAT and TADs was also compared. Results Of the initially retrieved PubMed 619 records, 24 met inclusion criteria. Contrary to the first of 3 hypotheses, PAT (8 trials; 249 patients) was no more effective than open-label TAD treatment (16 open-label TAD trials; 7921 patients), with an estimated difference of 0.3 favoring open-label TADs (95% CI, −1.39 to 1.98; P = .73). Open-label TADs were associated with better outcomes than blinded treatment (144 blinded TAD trials; 31 792 patients), with an estimated difference of 1.3 (95% CI, 0.07-2.51; P = .04;), but the same difference was not observed for PAT (0.67; 95% CI, −3.08 to 1.73; P = .58). Conclusions and Relevance In trials of depression, PAT was not more effective than open-label TADs. Blinding made a difference for TADs, but not for PAT, confirming that PAT trials are effectively always open label. These results argue against highly optimistic narratives surrounding PAT and highlight the importance of blinding integrity. 33:T4c8,Mounting evidence supports the efficacy of nonpharmacologic or psychosocial interventions for reducing behavioral and psychological symptoms of dementia (BPSD), identifies the comparative risks and benefits of psychotropic medication, and underscores the importance of deprescribing psychotropic medications. However, evidence from clinical settings indicates that uptake of nonpharmacologic interventions and potential overuse of medications remain problematic. We begin by discussing the importance of exploring potential contributors to BPSD, using person-centered language to describe BPSD, implementing holistic and person-centered care plans, measuring clinically important changes in BPSD, and considering social determinants of health when assessing and managing BPSD; we also discuss the historical context informing how clinicians manage BPSD. Next, we compare and contrast nonpharmacologic and pharmacologic approaches to managing BPSD, evaluate their individual and comparative efficacy, and describe recommendations for intervention deprescribing or deimplementation. Lastly, we discuss strengths and limitations of the current evidence supporting BPSD management as well as recommendations for future research.34:T4d9,Mounting evidence supports the efficacy of nonpharmacologic or psychosocial interventions for reducing behavioral and psychological symptoms of dementia (BPSD), identifies the comparative risks and benefits of psychotropic medication, and underscores the importance of deprescribing psychotropic medications. However, evidence from clinical settings indicates that uptake of nonpharmacologic interventions and potential overuse of medications remain problematic. We begin by discussing the importance of exploring potential contributors to BPSD, using person-centered language to describe BPSD, implementing holistic and person-centered care plans, measuring clinically important changes in BPSD, and considering social determinants of health when assessing and managing BPSD; we also discuss the historical context informing how clinicians manage BPSD. Next, we compare and contrast nonpharmacologic and pharmacologic approaches to managing BPSD, evaluate their individual and comparative efficacy, and describe recommendations for intervention deprescribing or deimplementation. Lastly, we discuss strengths and limitations of the current evidence supporting BPSD management as well as recommendations for future research.35:T4e5,A total of 5414 participants reported their daily medication and substance use in the month before pregnancy and the level of nausea and vomiting during pregnancy. Using metformin before the first pregnancy was associated with a >70% reduction in the risk for hyperemesis gravidarum (adjusted relative risk, 0.29; 95% confidence interval, 0.12-0.71; P=.007). Tobacco use was also associated with a significant reduction in the risk (adjusted relative risk, 0.51; 95% confidence interval, 0.30-0.86; P=.011). Conversely, selective serotonin reuptake inhibitors were associated with an increased risk for hyperemesis gravidarum (adjusted relative risk, 2.41; 95% confidence interval, 1.33-4.38; P=.004). The use of metformin was also associated with an 82% reduction in the risk for severe nausea and vomiting of pregnancy and hyperemesis gravidarum (adjusted odds ratio, 0.18; 0.06-0.59; P=.005) in the second pregnancy, even after adjustment for the 86% reoccurrence risk identified in this study. Conversely, the use of cannabis or selective serotonin reuptake inhibitors before the second pregnancy were each associated with increased risk (adjusted odds ratio, 3.48; 1.80-6.75; P<.001; and adjusted odds ratio, 1.84; 1.12-3.04; P=.016, respectively).36:Te24,Severe nausea and vomiting of pregnancy and hyperemesis gravidarum are associated with adverse maternal, fetal, and child outcomes. The recurrence risk is reported to be as high as 89%. Identifying an effective, safe, and affordable method to prevent hyperemesis gravidarum is critical to reducing the risk for reoccurrence and improving maternal, fetal, and child health. We recently demonstrated that a genetic predisposition to hyperemesis gravidarum is mediated by low prepregnancy levels of the emetogenic hormone, growth and differentiation factor 15, which leads to hypersensitivity to its rapid rise during pregnancy. Because metformin increases circulating levels of growth and differentiation factor 15, we hypothesized that the use of metformin before pregnancy will desensitize patients to the hormone and lower the risk for severe nausea and vomiting in pregnancy and hyperemesis gravidarum. The objective of the study was to determine whether daily use of metformin is associated with a lower risk for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. Through means of a structured questionnaire, visitors to the Hyperemesis Gravidarum Education and Research Foundation social media sites from January 2023 to September 2024 reported daily use of 32 common substances in the month before each pregnancy and the level of nausea and vomiting of pregnancy. Crude and multivariate associations between the use of each substance and severe nausea and vomiting of pregnancy and hyperemesis gravidarum in the subsequent pregnancy were estimated using a logistic regression. The final multivariate models included tobacco use and maternal age; the number and type of additional drugs used and race and ethnicity had little influence and were not retained. A total of 5414 participants reported their daily medication and substance use in the month before pregnancy and the level of nausea and vomiting during pregnancy. Using metformin before the first pregnancy was associated with a >70% reduction in the risk for hyperemesis gravidarum (adjusted relative risk, 0.29; 95% confidence interval, 0.12-0.71; P=.007). Tobacco use was also associated with a significant reduction in the risk (adjusted relative risk, 0.51; 95% confidence interval, 0.30-0.86; P=.011). Conversely, selective serotonin reuptake inhibitors were associated with an increased risk for hyperemesis gravidarum (adjusted relative risk, 2.41; 95% confidence interval, 1.33-4.38; P=.004). The use of metformin was also associated with an 82% reduction in the risk for severe nausea and vomiting of pregnancy and hyperemesis gravidarum (adjusted odds ratio, 0.18; 0.06-0.59; P=.005) in the second pregnancy, even after adjustment for the 86% reoccurrence risk identified in this study. Conversely, the use of cannabis or selective serotonin reuptake inhibitors before the second pregnancy were each associated with increased risk (adjusted odds ratio, 3.48; 1.80-6.75; P<.001; and adjusted odds ratio, 1.84; 1.12-3.04; P=.016, respectively). Prepregnancy metformin treatment may decrease the risk for severe nausea and vomiting, whereas prepregnancy cannabis use and selective serotonin reuptake inhibitors may increase the risk. Metformin, which is routinely used before and after conception, may be a safe and affordable treatment to offer patients with a history of hyperemesis gravidarum to decrease the chance of reoccurrence. Clinical trials are warranted to investigate metformin use before pregnancy to lower the risk for hyperemesis gravidarum, thereby mitigating the associated adverse maternal and offspring outcomes.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Selective Serotonin Reuptake Inhibitor: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Selective Serotonin Reuptake Inhibitor (modality). Clinician-written summaries and actionable practice insights. 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All structured fields are based solely on the paper title. Key result, sample size, age group, sex, level of evidence, and practice takeaway could not be determined.","value_numeric":null},{"paper_doi":"10.1007/s10608-026-10781-8","tag_type":"warning","value":"Study design tag is inferred from the comparative treatment framing in the title; the exact design (e.g., RCT, secondary analysis) is unconfirmed.","value_numeric":null}],"summaries":{"what_studied":"This study examined whether emotion regulation mediates or moderates treatment response in adults with primary anxiety disorders receiving either mindfulness-based stress reduction (MBSR) or escitalopram.","limitations":"Only the abstract/metadata is available; specific results, sample sizes, and outcome measures cannot be verified from the provided source text."}},{"doi":"10.1001/jamapsychiatry.2026.2405","pmid":"42584886","title":"Depression and SSRI Treatment During Pregnancy—Prioritizing Maternal Mental Health","journal_title":"JAMA Psychiatry","journal_issn":"2168-622X","published_at":"2026-08-12T00:00:00.000Z","url":"https://doi.org/10.1001/jamapsychiatry.2026.2405","source_score":43,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-17T13:33:05.710Z","updated_at":"2026-08-17T13:33:05.710Z","tags":[{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"category","value":"Psychiatry","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"condition","value":"Major Depressive Disorder","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"condition","value":"Perinatal Depression","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"warning","value":"The DOI year (2026) is consistent with the stated publication date; no discrepancy detected.","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"warning","value":"The paper does not report a specific sample size — the sample_size tag has been omitted accordingly.","value_numeric":null},{"paper_doi":"10.1001/jamapsychiatry.2026.2405","tag_type":"warning","value":"This is a narrative review (editorial/perspective in style); no systematic search strategy or meta-analytic data are reported, so the level of evidence is expert opinion rather than a formal systematic review.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates the risks and benefits of SSRI use during pregnancy for major depressive disorder (MDD), which affects ~12% of pregnant patients, with 5–6% receiving SSRI treatment; it also addresses the challenge of separating drug effects from the underlying indication in observational studies.","key_result":"Once confounding by indication is accounted for, accumulated evidence suggests SSRIs carry little or no risk for serious adverse outcomes in pregnancy; untreated or undertreated moderate-to-severe MDD is itself associated with adverse maternal, fetal, and infant outcomes.","limitations":"Evidence base relies heavily on observational studies prone to confounding by indication; fewer studies define SSRI *benefits* in pregnancy than risks; findings may not generalize across all severity levels of MDD.","practice_takeaway":"Clinicians should not default to SSRI discontinuation in pregnant patients with moderate-to-severe MDD — untreated illness carries its own fetal and maternal risks. A structured shared decision-making process, weighing risks of both untreated MDD and SSRI exposure, should guide perinatal prescribing."}},{"doi":"10.1002/pros.70229","pmid":"42542970","title":"Treatment of Hot Flashes in Men With Prostate Cancer Undergoing Androgen Deprivation Therapy","journal_title":"The Prostate","journal_issn":"0270-4137","published_at":"2026-08-02T00:00:00.000Z","url":"https://doi.org/10.1002/pros.70229","source_score":12,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-06T13:22:03.101Z","updated_at":"2026-08-06T13:22:03.101Z","tags":[{"paper_doi":"10.1002/pros.70229","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"condition","value":"Hot Flashes","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"generic","value":"clonidine","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"generic","value":"cyproterone acetate","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"generic","value":"fezolinetant","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"generic","value":"gabapentin","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"generic","value":"oxybutynin","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Acupuncture","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Alpha-2 Agonist","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Antiandrogen","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Anticholinergic","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Cognitive Behavioral Therapy","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Estrogen","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Gabapentinoid","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Progestogen","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"sample_size","value":"n=35","value_numeric":35},{"paper_doi":"10.1002/pros.70229","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"study_design","value":"Systematic Review","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"warning","value":"Fezolinetant is mentioned only as a future research direction; no efficacy data in this population are available from this review.","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"warning","value":"Level of evidence set to 2 based on systematic review design; individual included studies likely vary widely in quality and design.","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"warning","value":"Sample size tag reflects the number of included studies (n=35), not individual patients — total patient numbers are not reported in the abstract.","value_numeric":null}],"summaries":{"what_studied":"Systematic review of pharmacological and non-pharmacological interventions for hot flashes in men with prostate cancer undergoing androgen deprivation therapy (ADT), based on 35 studies identified from a PubMed search of 469 papers.","key_result":"Across all blinded pharmacological trials, hot flash frequency fell by 21%–84% (placebo effect: 19%–30%). Hormonal agents (cyproterone acetate, estrogen/derivatives) showed the greatest efficacy; acupuncture and CBT offered modest benefit; dietary supplements (Dong Quai, soy protein, Salvia officinalis, Serelys Homme) appeared ineffective.","limitations":"- Only 35 of 469 papers were included, and the overall evidence base is limited in size and quality.\n- The review does not include newer agents like fezolinetant, which have not yet been evaluated in this population.\n- Study heterogeneity in outcomes (frequency vs. quality of life) limits direct comparisons across interventions.","practice_takeaway":"For men on ADT troubled by hot flashes, hormonal agents (cyproterone acetate or estrogen) are the most effective options but carry side effect risks — discuss these trade-offs with patients. Acupuncture or CBT are reasonable non-hormonal alternatives; routine use of dietary supplements is not supported."}},{"doi":"10.1111/all.70399","pmid":"42381636","title":"Serotonin Degradation and Lipid Metabolism Regulate Human Tc2 Cell Effector Functions","journal_title":"Allergy","journal_issn":"0105-4538","published_at":"2026-07-01T00:00:00.000Z","url":"https://doi.org/10.1111/all.70399","source_score":36,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-10T13:25:34.546Z","updated_at":"2026-07-10T13:25:34.546Z","tags":[{"paper_doi":"10.1111/all.70399","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"category","value":"Immunology","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"condition","value":"Allergic Asthma","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"condition","value":"Allergic Sensitization","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"condition","value":"Type 2 Inflammation","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"generic","value":"SSRI (class)","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"modality","value":"Monoamine Oxidase Inhibitor","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"modality","value":"PPARγ Inhibitor","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"study_design","value":"Translational/Mechanistic Study with Epidemiological Cohort Analysis","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"warning","value":"Impact flag 'practice_changing' applied cautiously — findings are mechanistic and epidemiological, not from a clinical trial; prospective confirmation is needed before clinical adoption.","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"warning","value":"Sample sizes for the BAMSE cohort subgroup and the SSRI ex vivo experiments are not reported in the abstract, limiting precision of effect estimates.","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"warning","value":"Study design is mixed (mechanistic lab work + observational cohort + ex vivo); a single study_design label is an oversimplification.","value_numeric":null},{"paper_doi":"10.1111/all.70399","tag_type":"warning","value":"The SSRI cohort finding may reflect confounding by indication; mood disorders themselves can alter immune function independently of serotonin drug effects.","value_numeric":null}],"summaries":{"what_studied":"This study examined the metabolic requirements of human cytotoxic type 2 T cells (Tc2), focusing on glycolysis, fatty acid/lipid metabolism, and serotonin catabolism via MAOA, and assessed whether serotonin-modifying drugs (SSRIs, antidepressants) are linked to allergic sensitization and Tc2 function in the population-based BAMSE cohort plus ex vivo PBMC experiments.","key_result":"Tc2 cells showed elevated mitochondrial respiration, glycolysis, GLUT1, and CD36 expression. Blocking glycolysis, fatty acid metabolism, or PPARγ significantly reduced IL-4, IL-5, and IL-13 production. MAOA inhibition selectively cut type 2 cytokines without affecting IFN-γ. In the BAMSE cohort, prescribed antidepressants correlated with reduced IgE sensitization; SSRI-treated individuals had fewer IL-5+ and IL-13+ Tc2 cells and more IFN-γ-producing Tc2 cells ex vivo.","limitations":"The BAMSE cohort analysis is observational and cannot exclude confounding by indication (e.g., underlying mood disorders affecting immunity). Ex vivo PBMC stimulation may not fully reflect in vivo Tc2 biology. The study does not establish a causal mechanism linking SSRI-driven serotonin elevation to altered Tc2 function.","practice_takeaway":"Clinicians should be aware that SSRI use may be associated with reduced type 2 allergic responses, raising the possibility of repurposing serotonin-modifying drugs in allergic disease. This warrants prospective study before any practice change."}},{"doi":"10.1136/gutjnl-2026-339311","pmid":"42362221","title":"Efficacy of gut-brain neuromodulators and brain-gut behaviour therapies for irritable bowel syndrome: systematic review and network meta-analysis","journal_title":"Gut","journal_issn":"0017-5749","published_at":"2026-06-26T00:00:00.000Z","url":"https://doi.org/10.1136/gutjnl-2026-339311","source_score":15,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-14T13:24:14.727Z","updated_at":"2026-07-14T13:24:14.727Z","tags":[{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"condition","value":"Irritable Bowel Syndrome","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"modality","value":"Cognitive Behavioural Therapy","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"modality","value":"Dynamic Psychotherapy","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"modality","value":"Gut-Directed Hypnotherapy","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"modality","value":"Serotonin-Norepinephrine Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"modality","value":"Tricyclic Antidepressant","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"sample_size","value":"n=6694","value_numeric":6694},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"study_design","value":"Network Meta-Analysis","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"warning","value":"Overall certainty of evidence was rated low or very low for most comparisons; P-scores reflect relative ranking probability, not absolute efficacy certainty.","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"warning","value":"The paper is dated June 2026 but the review searched literature only to February 2026; very recent trials may not be included.","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2026-339311","tag_type":"warning","value":"The top-ranked treatment (SNRIs) had zero trials at low risk of bias — this materially limits confidence in that specific ranking despite a high P-score.","value_numeric":null}],"summaries":{"what_studied":"A network meta-analysis of 68 RCTs (6,694 adults with IBS) compared the relative efficacy of gut-brain neuromodulators (e.g., SNRIs, TCAs, SSRIs) and brain-gut behaviour therapies (e.g., CBT, dynamic psychotherapy, gut-directed hypnotherapy, disease self-management) versus waiting list control for global IBS symptoms or abdominal pain.","key_result":"SNRIs ranked first (RR 0.49, 95% CI 0.32–0.75, P-score 0.95), TCAs ranked second (RR 0.60, 95% CI 0.43–0.85, P-score 0.79), and dynamic psychotherapy/emotional processing ranked third (RR 0.62, 95% CI 0.44–0.87, P-score 0.75); CBT, disease self-management, SSRIs, and gut-directed hypnotherapy also outperformed waiting list control. No SNRI trials were at low risk of bias.","limitations":"- No SNRI trials were at low risk of bias, undermining the top-ranked finding.\n- Overall certainty of evidence was low or very low for most comparisons.\n- Possible publication bias detected in some analyses.","practice_takeaway":"TCAs remain the best-evidenced pharmacological option for IBS given their stronger trial base; SNRIs show promise but lack high-quality trial support. Behaviour therapies — especially dynamic psychotherapy/emotional processing, CBT, and gut-directed hypnotherapy — are effective and should be offered alongside or instead of medication."}},{"doi":"10.1176/appi.ajp.20251037","pmid":"42337414","title":"A Pragmatic SMART Study of Medication and CBT Sequencing in Pediatric Anxiety Disorders: A Randomized Clinical Trial","journal_title":"American Journal of Psychiatry","journal_issn":"0002-953X","published_at":"2026-06-24T00:00:00.000Z","url":"https://doi.org/10.1176/appi.ajp.20251037","source_score":32,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-13T06:22:00.526Z","updated_at":"2026-09-13T06:22:00.526Z","tags":[{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"age_group","value":"child","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"brand","value":"Prozac","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"category","value":"Psychiatry","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"condition","value":"Pediatric Anxiety Disorders","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"generic","value":"fluoxetine","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"modality","value":"Cognitive-Behavioral Therapy","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"sample_size","value":"n=316","value_numeric":316},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"study_design","value":"Sequential Multiple Assignment Randomized Trial (SMART)","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"warning","value":"Brand tag 'Prozac' added as a common proprietary name for fluoxetine; the paper itself does not use this brand name.","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"warning","value":"Racial/ethnic subgroup analyses (differential benefit by race/ethnicity) appear exploratory rather than pre-specified primary analyses — clinicians should interpret these findings cautiously.","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"warning","value":"The 'practice_changing' impact flag is applied because the study directly challenges the assumed superiority of combination or medication-first approaches, though the authors frame conclusions around patient preference rather than a definitive superiority finding.","value_numeric":null},{"paper_doi":"10.1176/appi.ajp.20251037","tag_type":"warning","value":"The SMART design involves adaptive randomization; level of evidence is assigned as '2' (high-quality RCT), but the adaptive nature and single-blind methodology are design-specific nuances worth noting.","value_numeric":null}],"summaries":{"what_studied":"This 24-week SMART trial (n=316, ages 8–17) compared initiating treatment with fluoxetine vs. exposure-based CBT for pediatric anxiety disorders, then randomized 12-week nonremitters to either optimized monotherapy or combination therapy across primary care and mental health settings.","key_result":"Youth-reported SCARED scores fell 31.7% overall; no significant difference was found between initial treatments (CBT vs. fluoxetine 24-week mean difference: 1.45, 95% CI −2.25 to 5.16) nor between combination vs. continued monotherapy in nonremitters (mean difference: −2.74, 95% CI −6.53 to 1.05). CBT followed by combination therapy separated favorably on a subset of secondary measures; racial/ethnic minority youth showed greater benefit from transitioning to combination therapy after week 12.","limitations":"Single-blind design limits blinding rigor. The study enrolled youths not currently receiving anxiety treatment, limiting generalizability to treatment-experienced populations. Racial/ethnic subgroup findings are exploratory and require cautious interpretation.","practice_takeaway":"For children and adolescents with anxiety disorders, fluoxetine and CBT produce similar symptom reductions — so clinicians and families can let patient preference guide the first treatment choice. If remission is not achieved at 12 weeks, adding the other modality is a reasonable but not clearly superior next step."}},{"doi":"10.1001/jamadermatol.2026.1437","pmid":"42307911","title":"Systemic Proteomic Alterations and Predictive Biomarkers of Paroxetine Response in Refractory Rosacea","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2026-06-17T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13276666/","source_score":12,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-25T13:25:13.805Z","updated_at":"2026-06-25T13:25:13.805Z","tags":[{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"condition","value":"Rosacea","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"generic","value":"paroxetine","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"sample_size","value":"n=24","value_numeric":24},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"study_design","value":"Secondary Analysis of Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"warning","value":"AUC confidence intervals for IGFBP2 are very wide (0.55–1.00), meaning clinical utility as a predictive biomarker is uncertain.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"warning","value":"Full text is under PMC embargo until June 17, 2027; this summary is based solely on the abstract and results excerpt.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.1437","tag_type":"warning","value":"Sample is exclusively female (n=24); results may not apply to male patients or broader rosacea populations.","value_numeric":null}],"summaries":{"limitations":"- Very small sample (n=24), all female, limiting generalizability to men and broader populations.\n- Wide confidence intervals for AUC estimates (e.g., IGFBP2 lower bound 0.55) signal substantial statistical uncertainty.\n- Exploratory/secondary proteomic analysis; findings are hypothesis-generating and require independent replication.","what_studied":"This secondary proteomic analysis, nested within a 12-week multicenter RCT (PRRERCT), investigated systemic plasma protein changes and predictive biomarkers of paroxetine (25 mg/day oral) response in 24 adult women with refractory erythematous rosacea (CEA score ≥3).","key_result":"Paroxetine significantly reduced mean CEA scores from 3.1 to 2.3 and Flushing Assessment Tool scores from 3.1 to 2.0 (P<.001). Proteomic analysis identified 497 differentially expressed proteins; candidate biomarkers OLFML3 (AUC 0.87, 95% CI 0.70–1.00) and IGFBP2 (AUC 0.80, 95% CI 0.55–1.00) showed the highest predictive value for clinical response.","practice_takeaway":"Paroxetine may improve erythema and flushing in refractory rosacea via neuro-vascular-immune pathways, but the sample is too small to change practice. OLFML3 and IGFBP2 are early candidate biomarkers worth tracking in future validation studies."}},{"doi":"10.1007/s12671-026-02895-7","pmid":null,"title":"Can Mindfulness-Based Cognitive Therapy Change the Cortical Electrical Activity of the Brain in Major Depressive Disorder?","journal_title":"Mindfulness","journal_issn":"1868-8527","published_at":"2026-06-10T00:00:00.000Z","url":"https://doi.org/10.1007/s12671-026-02895-7","source_score":5,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-06-19T13:23:19.286Z","updated_at":"2026-06-19T13:23:19.286Z","tags":[{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"category","value":"Psychology, Clinical","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"condition","value":"Major Depressive Disorder","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"generic","value":"citalopram","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"modality","value":"Mindfulness-Based Cognitive Therapy","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"sample_size","value":"n=66","value_numeric":66},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"warning","value":"All 66 participants were female; findings may not apply to male or non-binary patients with MDD.","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"warning","value":"eLORETA source localization is an inference technique — reported regional findings (insula, frontal cortex) should be interpreted with caution.","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"warning","value":"The absolute BDI-II difference between groups post-treatment (11.58 vs. 13.03) is modest; clinical significance of this gap is not explicitly discussed in the abstract.","value_numeric":null},{"paper_doi":"10.1007/s12671-026-02895-7","tag_type":"warning","value":"The study was not preregistered, which raises concern about potential outcome selection bias.","value_numeric":null}],"summaries":{"what_studied":"This RCT examined whether 8 weeks of MBCT added to citalopram 20 mg/day (MBCT+TAU, n=36) versus citalopram alone (TAU, n=30) changed depressive symptoms and cortical EEG activity (via eLORETA power spectrum density) in 66 women with MDD.","key_result":"MBCT+TAU produced greater BDI-II reduction than TAU (11.58 vs. 13.03 post-treatment; ANCOVA F(1,63)=14.17, p<0.001, partial η²=0.18). EEG showed MBCT+TAU had significantly decreased theta power and increased upper alpha and low beta power in insula and frontal regions (corrected p<0.05).","limitations":"- All-female sample limits generalizability to men.\n- Study was not preregistered, raising risk of outcome reporting bias.\n- EEG source localization (eLORETA) infers regional activity but cannot confirm precise anatomical origins.","practice_takeaway":"Adding MBCT to stable SSRI therapy produces measurable reductions in depressive symptoms and favorable EEG changes in women with MDD. Clinicians treating women with MDD on citalopram may consider MBCT as a structured adjunct to boost response."}},{"doi":"10.1038/s41386-026-02436-9","pmid":"42106476","title":"Prenatal serotonin reuptake inhibitor exposure and maternal depression symptoms are associated with altered fetal brain and placental development","journal_title":"Neuropsychopharmacology","journal_issn":"0893-133X","published_at":"2026-05-09T00:00:00.000Z","url":"https://doi.org/10.1038/s41386-026-02436-9","source_score":181,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-15T13:23:09.347Z","updated_at":"2026-05-15T13:23:09.347Z","tags":[{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"category","value":"Neurosciences","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"category","value":"Psychiatry","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"condition","value":"Fetal Neurodevelopment","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"condition","value":"Maternal Depression","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"modality","value":"Serotonin-Norepinephrine Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"sample_size","value":"n=182","value_numeric":182},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"study_design","value":"Observational Cohort Study","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"warning","value":"Clinical significance of the observed fetal structural differences is unknown; long-term neurodevelopmental follow-up data are not yet available.","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"warning","value":"Specific SSRI and SNRI agents are not individually analyzed — results reflect a mixed SRI class (59 SSRIs, 3 SNRIs), so drug-specific effects cannot be determined.","value_numeric":null},{"paper_doi":"10.1038/s41386-026-02436-9","tag_type":"warning","value":"The study cannot fully separate the effects of SRI medication from residual depression, as 29% of SRI-exposed mothers still had elevated EPDS scores during the study period.","value_numeric":null}],"summaries":{"what_studied":"This observational cohort study examined fetal brain volumes, cortical folding, and placental structure (via MRI) in 182 pregnant women (62 SRI-exposed, 120 unexposed controls) between 20–40 weeks' gestation, stratified by maternal depressive symptom severity (EPDS scores: low ≤4, moderate 5–9, high ≥10).","key_result":"SRI-exposed fetuses had smaller hippocampal volumes and reduced cortical gyrification, curvedness, and surface area compared to unexposed fetuses; among unexposed pregnancies, high maternal EPDS scores (≥10) were independently associated with smaller fetal hippocampal volumes vs. low EPDS scores. SRI-exposed placentas showed increased volume and higher diffusion microstructure, and larger placental volume correlated with larger total fetal brain volume in the SRI group.","limitations":"Observational design prevents causal inference; 29% of SRI-exposed women still had elevated depression symptoms, making it difficult to fully disentangle drug effects from ongoing maternal depression effects. Long-term neurodevelopmental outcomes of the observed structural differences are unknown.","practice_takeaway":"Both SRI exposure and untreated maternal depression appear to independently affect fetal brain development — clinicians should weigh this when counseling pregnant patients about SRI use, recognizing that untreated depression also carries fetal risk. 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Regulatory guidance (e.g., black-box warnings on antidepressants in pediatric patients) should remain the primary reference point for prescribing decisions."}},{"doi":"10.1016/j.ajog.2025.06.055","pmid":"40588059","title":"Prepregnancy metformin use associated with lower risk of severe nausea and vomiting of pregnancy and hyperemesis gravidarum","journal_title":"American Journal of Obstetrics and Gynecology","journal_issn":"0002-9378","published_at":"2025-07-01T00:00:00.000Z","url":"https://doi.org/10.1016/j.ajog.2025.06.055","source_score":52,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2025-11-22","doi":"10.1016/j.ajog.2025.06.055","days":"14","issn":"0002-9378","rank":"1","field":"Clinical Medicine","score":"52","category":"Obstetrics & Gynecology","categories":["Obstetrics & Gynecology"],"_categories":["Obstetrics & Gynecology"]},"pubmed":{"doi":"10.1016/j.ajog.2025.06.055","title":"Prepregnancy metformin use associated with lower risk of severe nausea and vomiting of pregnancy and hyperemesis gravidarum.","journal":"American journal of obstetrics and gynecology","methods":"","results":"$35","abstract":"$36","keywords":["GDF15","cannabis","growth and differentiation factor 15","hyperemesis gravidarum","metformin","morning sickness","nausea","pregnancy","prevention","selective serotonin reuptake inhibitors","vomiting"],"pubmed_id":"40588059","conclusions":"Prepregnancy metformin treatment may decrease the risk for severe nausea and vomiting, whereas prepregnancy cannabis use and selective serotonin reuptake inhibitors may increase the risk. 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Pregnancy","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2025.06.055","tag_type":"generic","value":"metformin","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2025.06.055","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2025.06.055","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2025.06.055","tag_type":"modality","value":"Biguanide","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2025.06.055","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2025.06.055","tag_type":"sample_size","value":"n=5414","value_numeric":5414},{"paper_doi":"10.1016/j.ajog.2025.06.055","tag_type":"study_design","value":"Cross-Sectional Study","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2025.06.055","tag_type":"warning","value":"Design classification is ambiguous (self-reported online survey with retrospective recall); treated here as cross-sectional.","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2025.06.055","tag_type":"warning","value":"Findings rely on self-reported prepregnancy exposures and pregnancy symptoms.","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2025.06.055","tag_type":"warning","value":"Summary is based on the provided abstract; full-methods details may add nuances.","value_numeric":null}],"summaries":{"what_studied":"An online questionnaire of 5414 visitors to a hyperemesis gravidarum foundation’s social media (Jan 2023–Sep 2024) assessed daily use of 32 substances in the month before each pregnancy and the severity of nausea/vomiting in the subsequent pregnancy, analyzed with logistic regression.","key_result":"Prepregnancy metformin use was associated with lower risk of hyperemesis gravidarum in the first pregnancy (adjusted relative risk 0.29; 95% CI 0.12–0.71; P=.007) and lower risk of severe nausea/vomiting or hyperemesis in the second pregnancy (adjusted odds ratio 0.18; 0.06–0.59; P=.005) despite an 86% recurrence risk. Tobacco use was associated with lower risk (ARR 0.51; 0.30–0.86; P=.011), whereas selective serotonin reuptake inhibitors were associated with higher risk (first pregnancy ARR 2.41; 1.33–4.38; P=.004; second pregnancy AOR 1.84; 1.12–3.04; P=.016) and cannabis use before the second pregnancy increased risk (AOR 3.48; 1.80–6.75; P<.001).","limitations":"Data were self-reported by visitors to social media sites via an online questionnaire. Multivariable models adjusted for maternal age and tobacco use; race/ethnicity and other drug variables had little influence and were not retained.","practice_takeaway":"Prepregnancy metformin use was linked to a lower risk of severe nausea/vomiting and hyperemesis gravidarum; authors suggest it may be a safe, affordable option for patients with prior hyperemesis, and they call for randomized trials. Prepregnancy SSRIs and cannabis were associated with higher risk, while tobacco use was associated with lower risk."}}],"initialOffset":16,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Selective Serotonin Reuptake Inhibitor"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Selective Serotonin Reuptake Inhibitor"}}}]]

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