Opparounds

Time Trends in Maternal Attention-Deficit/Hyperactivity Disorder and Medication Use in Pregnancy

Sofie Egsgaard, Hilary K. Brown, Jonathan Zipursky, Trine Munk-Olsen, Amreen Babujee, Aditi Patrikar, Mindy Lu, Simone N. Vigod · The Journal of Clinical Psychiatry · August 2026

Using health administrative data on 2,327,110 pregnancies in Ontario, Canada from 2002 to 2023, this cross-sectional time-series study tracked how often pregnant patients carried an ADHD diagnosis and how often they filled stimulant prescriptions. The proportion of pregnancies with a maternal ADHD diagnosis rose five-fold, from 0.5% in 2002 to 2.5% in 2023. Among those with ADHD, stimulant use in the year before pregnancy climbed from 21.8% to 39.8% between 2014 and 2023, and use during pregnancy itself rose from 10.1% to 20.9% over the same span, with lisdexamfetamine driving most of the recent increase. About three-quarters of patients on a stimulant discontinued it before or during the first trimester, but that still leaves a growing minority carrying a stimulant across the whole pregnancy.

Read the paper →  doi:10.4088/JCP.26m16321

Mechanisms of Change in the Treatment of Major Depressive Disorder with Metacognitive Therapy and Behavioral Activation — A Random Intercept Cross-Lagged Panel and Mediation Analyses

Anna Schaich, Marie Antia-Frese, Cora Gebauer, Gitta Schippmann, Nele Assmann, Kamila Jauch-Chara, Daniel Alvarez-Fischer, Jan Philipp Klein, Eva Fassbinder · Psychotherapy Research · July 2026

Using monthly outcome data from 122 depressed patients randomized to six months of Metacognitive Therapy (MCT) or Behavioral Activation (BA), this study modeled the temporal relationship between proposed treatment mechanisms and depressive symptoms with random intercept cross-lagged panel models. MCT produced larger reductions than BA in rumination time, dysfunctional coping, and negative metacognitions, and mediation analyses showed the mechanism doing the most work for MCT was a drop in time spent ruminating, not any single belief change. Cross-lagged modeling found mechanism variables and symptoms moving bidirectionally -- less depression also fed back into less rumination, not only the reverse.

Read the paper →  doi:10.1080/10503307.2025.2530543

Not every NSAID does the same thing to a lithium level

Nonsteroidal anti-inflammatories are the interaction most residents already screen for on a lithium panel, but the mechanism explains an exception worth knowing. NSAIDs raise lithium levels by inhibiting renal prostaglandin synthesis, which reduces renal blood flow and increases proximal tubular sodium -- and with it, lithium -- reabsorption; the effect is dose-dependent and shows up with ibuprofen, naproxen, and COX-2 inhibitors at their usual anti-inflammatory doses, typically pushing levels up 25 to 40 percent within days. Low-dose aspirin (81 mg), taken for cardiac prophylaxis, is the exception: at that dose it acts almost entirely on platelet COX-1, with minimal effect on renal prostaglandin production, so it does not meaningfully raise lithium levels the way other NSAIDs do. That distinction only holds at antiplatelet dosing -- full anti-inflammatory aspirin doses (over 3 g/day) behave like any other NSAID. So a lithium patient starting low-dose aspirin for cardioprotection doesn't need a preemptive level check, but the same patient reaching for ibuprofen for a headache does.

Reverie isn't empathy -- it's digestion

Bion's model treats the therapist's mind as an organ that can metabolize experience the patient cannot yet think. Raw, unprocessed affect and sensation -- what Bion called beta elements -- arrive in the room via projective identification, evacuated because the patient has no way to hold them. Reverie is the therapist's receptive internal state: tolerating not-knowing long enough to let that raw material sit, rather than acting on the urge to soothe, explain, or redirect it away. Through alpha function, that unprocessed material gets transformed into something that can be thought about and eventually spoken back as an interpretation. This differs from ordinary empathy -- empathy recognizes a feeling that's already formed; reverie does the prior work of turning something formless into a feeling at all. The technical task is staying with your own discomfort long enough for that transformation to happen, instead of discharging it through premature reassurance.