What are the recent updates in psychiatry for 2025?

From the Guidelines

As of 2025, the most significant update in psychiatry is the recommendation to consider nonpharmacologic treatments, such as psychological interventions and exercise, as first-line treatments for major depressive disorder (MDD), alongside second-generation antidepressants, due to their similar benefits and lower risks of adverse events 1.

Recent Updates in Psychiatry

The field of psychiatry has undergone significant changes in recent years, with a focus on personalized and technologically advanced approaches to mental health care. Some of the key updates include:

• The use of nonpharmacologic treatments, such as psychological interventions and exercise, as first-line treatments for MDD, as recommended by the American College of Physicians 1
• The approval of rapid-acting antidepressants, such as esketamine nasal spray, as second-line treatments for MDD, with a typical regimen involving twice-weekly administration for the first month, followed by weekly maintenance doses 2
• The development of biomarker-based diagnostic tools for conditions like schizophrenia and bipolar disorder, which analyze patterns of brain activity and structure to improve diagnostic accuracy and guide treatment selection 2
• The incorporation of microbiome-targeted interventions in psychiatric care, including specific probiotic strains and dietary recommendations, to enhance treatment outcomes for mood and anxiety disorders 3 ### Treatment Decision Making The management of MDD has been updated to include a more personalized approach, taking into account patient preferences and values. The 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline recommends the use of shared decision making and measurement-based care to guide treatment selection 2, 3. The guideline also includes updated algorithms to assist with clinical decision making, including guidance for initial screening, evaluation, and treatment of uncomplicated depression, as well as treatment of patients who are not initially responsive to care or have complicating factors.

Key Takeaways

• Nonpharmacologic treatments, such as psychological interventions and exercise, are recommended as first-line treatments for MDD, alongside second-generation antidepressants 1
• Rapid-acting antidepressants, such as esketamine nasal spray, are approved as second-line treatments for MDD, with a typical regimen involving twice-weekly administration for the first month, followed by weekly maintenance doses 2
• Biomarker-based diagnostic tools and microbiome-targeted interventions are being incorporated into psychiatric care to improve diagnostic accuracy and treatment outcomes 2, 3
• A personalized approach to treatment, taking into account patient preferences and values, is recommended, using shared decision making and measurement-based care to guide treatment selection 2, 3

From the FDA Drug Label

RECENT MAJOR CHANGES Warnings and Precautions, Tardive Dyskinesia (5.6)10/2019 Warnings and Precautions, Use in Patients with Concomitant Illness (5.14)Removed 4/2020 Warnings and Precautions, Anticholinergic (antimuscarinic) Effects (5.14)4/2020

The recent updates in psychiatry for 2025 are not explicitly mentioned in the provided drug labels. However, based on the available information from 4, there were recent major changes to the warnings and precautions section of the drug label, including updates on tardive dyskinesia and anticholinergic effects.

• Tardive Dyskinesia: updated in 10/2019
• Anticholinergic (antimuscarinic) Effects: updated in 4/2020 These updates may be relevant to clinical practice, but they do not provide a comprehensive overview of recent updates in psychiatry for 2025.

From the Research

Recent Updates in Psychiatry

There are no recent updates in psychiatry for 2025 available in the provided studies. However, the studies provide information on various topics related to psychiatry, including combination pharmacotherapy for bipolar disorder 5, the efficacy of psychotherapies and pharmacotherapies for mental disorders in adults 6, combining pharmacotherapy and psychotherapy for major depression 7, 8, and formulating treatment of major psychiatric disorders using an algorithmic approach 9.

Combination Pharmacotherapy

• Combination pharmacotherapy for bipolar disorder is commonplace, with about one-fifth of patients receiving four or more psychotropic medications 5.
• The efficacy of combination pharmacotherapy for bipolar disorder is not well-studied, with few systematic studies examining the efficacy and safety of two or more medications for any given phase of illness 5.

Psychotherapies and Pharmacotherapies

• The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults is limited, with most effect sizes for target symptoms being small 6.
• A meta-analytic evaluation of the effect sizes reported by the largest meta-analyses per disorder yielded a standardized mean difference (SMD) of 0.34 for psychotherapies and 0.36 for pharmacotherapies compared with placebo or treatment-as-usual (TAU) 6.

Treatment of Major Depression

• Combining pharmacotherapy and psychotherapy for major depression can result in a superior enduring effect compared to antidepressants alone 7, 8.
• Sequential addition of treatments, particularly psychotherapy after nonremission to antidepressant medication, is the best-supported method of combination, improving remission rates and reducing relapse and recurrence in the long term 8.

Algorithmic Approach to Treatment

• An algorithmic approach to formulating pharmacotherapy for major psychiatric disorders has been proposed, based on which combination of changed activities by brain cell-types is dominant for any particular condition 9.
• The algorithm uses a list of available drugs, including clemastine, dantrolene, erythropoietin, fingolimod, fluoxetine, lithium, memantine, minocycline, pioglitazone, piracetam, and riluzole, to formulate therapy with combinations of drugs 9.