The prescriber's guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression.

This article is a clinical guide which discusses the "state-of-the-art" usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion-this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy-while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward "bridging" methods that may be used to transition simply and safely from other antidepressants to MAOIs.

Mental health care 2.0.

While the COVID-19 pandemic has been a burden for our mental health, it also led to a surge in mental health care innovation. Appointments by telephone or video, as well as web- and app-based tools, have become part of a digital mental health revolution. Last year, US venture capitalists invested $5.1 billion in this area, a fivefold increase from 2019. But is this surge in activity actually leading to improvements for those with the greatest needs?

The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure.

Adverse posttraumatic neuropsychiatric sequelae (APNS) are common among civilian trauma survivors and military veterans. These APNS, as traditionally classified, include posttraumatic stress, postconcussion syndrome, depression, and regional or widespread pain. Traditional classifications have come to hamper scientific progress because they artificially fragment APNS into siloed, syndromic diagnoses unmoored to discrete components of brain functioning and studied in isolation. These limitations in classification and ontology slow the discovery of pathophysiologic mechanisms, biobehavioral markers, risk prediction tools, and preventive/treatment interventions. Progress in overcoming these limitations has been challenging because such progress would require studies that both evaluate a broad spectrum of posttraumatic sequelae (to overcome fragmentation) and also perform in-depth biobehavioral evaluation (to index sequelae to domains of brain function). This article summarizes the methods of the Advancing Understanding of RecOvery afteR traumA (AURORA) Study. AURORA conducts a large-scale (n = 5000 target sample) in-depth assessment of APNS development using a state-of-the-art battery of self-report, neurocognitive, physiologic, digital phenotyping, psychophysical, neuroimaging, and genomic assessments, beginning in the early aftermath of trauma and continuing for 1 year. The goals of AURORA are to achieve improved phenotypes, prediction tools, and understanding of molecular mechanisms to inform the future development and testing of preventive and treatment interventions.

Building the Thermometer for Mental Health.

Millions of people suffer from serious mental illness, but very few receive consistent coordinated care. Since leaving his post in 2015 after 13 years as director of the National Institute of Mental Health, co-author Tom Insel has been on a mission to use technology (such as mining your smartphone) to better understand your state of mind and treat depression, schizophrenia, and other disorders. Insel and co-author Joshua Chauvin, part of the team at a healthcare innovation company, examine the potential and pitfalls of this next digital frontier.

Digital Technologies in Psychiatry: Present and Future.

The digital revolution has reached the world of mental health. Prominent examples include the rapidly growing use of mobile health apps, the integration of sophisticated machine learning or artificial intelligence for clinical decision support and automated therapy, and the incorporation of virtual reality-based treatments. These diverse technologies hold the promise of addressing several important problems in mental health care, including lack of measurement, uneven access to clinicians, delay in receiving care, fragmentation of care, and negative attitudes toward psychiatry. Here, the authors summarize the current and swiftly changing state of digital mental health. Specifically, they highlight the current unmet needs that emerging technologies may be able to address; summarize what digital health can offer for assessment, treatment, and care integration; and describe some of the challenges and some new directions for innovations in this field. The review concludes with guidance for clinicians to integrate digital technologies into their work and to provide responsible and useful advice to their patients.

Data mining for health: staking out the ethical territory of digital phenotyping.

Digital phenotyping uses smartphone and wearable signals to measure cognition, mood, and behavior. This promising new approach has been developed as an objective, passive assessment tool for the diagnosis and treatment of mental illness. Digital phenotyping is currently used with informed consent in research studies but is expected to expand to broader uses in healthcare and direct-to-consumer applications. Digital phenotyping could involve the collection of massive amounts of individual data and potential creation of new categories of health and risk assessment data. Because existing ethical and regulatory frameworks for the provision of mental healthcare do not clearly apply to digital phenotyping, it is critical to consider its possible ethical, legal, and social implications. This paper addresses four major areas where guidelines and best practices will be helpful: transparency, informed consent, privacy, and accountability. It will be important to consider these issues early in the development of this new approach so that its promise is not limited by harmful effects or unintended consequences.

What cell biologists should know about the National Institutes of Health BRAIN Initiative.

The BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative is an ambitious project to develop innovative tools for a deeper understanding of how the brain functions in health and disease. Early programs in the National Institutes of Health BRAIN Initiative focus on tools for next-generation imaging and recording, studies of cell diversity and cell census, and integrative approaches to circuit function. In all of these efforts, cell biologists can play a leading role.