Opparounds

Decades After the NIH Revitalization Act: Persistent Gaps in Diversity of US Antidepressant Trials

Mathews Sajan, Ria R. Trivedi, Sohail R. Daulat, Saren Sall, Francisco A. Moreno · The Journal of Clinical Psychiatry · August 2026

Researchers searched ClinicalTrials.gov for every completed US antidepressant trial from 1993 through September 2025 and pulled demographic reporting from the 166 that had it. Race was reported in only 39% of trials and ethnicity in just 33%, more than three decades after the NIH Revitalization Act mandated inclusion of women and minorities in federally funded research. Where race and ethnicity were captured, Asian, American Indian/Alaska Native, multiracial, and Hispanic/Latino participants were all significantly underrepresented relative to US Census benchmarks (P<.001 for most groups).

Trial populations also skewed more female than the population of people who actually use antidepressants in practice, further complicating generalizability in the opposite direction.

Read the paper →  doi:10.4088/jcp.26m16436

Therapist Intrapersonal Factors and Rupture Repair: Professional Self-Doubt, Self-Compassion, and Repair Strategies in a Simulated Cultural Rupture Task

Emma Freetly Porter, Negar Aghassizadeh, Luke Ryan · Psychotherapy Research · July 2026

Using a simulated vignette in which a client challenges the therapist's cultural competence, the authors asked therapist trainees to respond in real time, then coded which repair strategies — exploration, acknowledgment, and others — each trainee reached for. Trainees higher in professional self-doubt used exploration and acknowledgment less often, the very moves that reopen a rupture for discussion rather than smoothing past it. Self-compassion, by contrast, showed no significant relationship with which repair strategies trainees used.

Trainees with more accumulated clinical training hours showed greater facility across repair strategies regardless of scenario, suggesting some of this competence is built through supervised exposure rather than fixed disposition.

Read the paper →  doi:10.1080/10503307.2026.2710325

Thiazides move a lithium level the way NSAIDs never could

Every resident learns to ask about NSAIDs before checking a lithium level, but thiazide diuretics are the interaction that actually moves the number. Thiazides block sodium reabsorption at the distal convoluted tubule, producing mild volume contraction; the kidney compensates by increasing sodium — and lithium — reabsorption further upstream in the proximal tubule, where roughly 80% of filtered lithium is already reclaimed before a thiazide is ever added.

The result is a 20 to 40 percent drop in lithium clearance, enough to push a stable level into the toxic range within one to two weeks of starting hydrochlorothiazide, with no change to the lithium dose at all. Loop diuretics act on a different nephron segment and largely spare this mechanism — furosemide shifts lithium clearance by single digits, not by a third. If a lithium patient needs a diuretic for hypertension or edema, a loop agent is the safer default; if a thiazide is unavoidable, recheck the level at 5 to 7 days, not at the next routine visit.

Follow the affect, not the agenda

Kernberg's Transference-Focused Psychotherapy names a specific triage rule for a session that's wandering: at any moment, several internalized object-relations dyads are potentially in play, but only one is affectively dominant — carrying the most live emotional charge right now, whether or not it matches what the patient says they came in to discuss.

TFP technique holds that the affectively dominant material, not the patient's stated topic, should be addressed first, because it is what is actually organizing the transference-countertransference field in real time. This runs against the instinct to follow content chronologically or to respect the patient's agenda out of politeness — a calm, well-organized narrative can be a defense precisely because it isn't where the affect lives. Locating affect dominance means tracking tone, timing, and your own countertransference pull as data about the dyad, not just the words.