Psychiatry Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped psychiatry practice.

Treatment-Resistant Depression

New mechanisms, new hope

Augmentation → STAR*D (2006) → IV ketamine → esketamine (SustainTM) → psilocybin → TMS/DBS

Earlier, not last resort

Oral-first/last-resort → PROACTIVE → paliperidone LAI → early LAI → time-to-relapse

Beyond SSRIs

Talk therapy → SSRI (sertraline/paroxetine) → MDMA-assisted (MAPS) → stellate ganglion → ketamine

Breaking the cycle

Lifetime prescribing → harm recognition → tapering → EMPOWER → deprescribing guides

Not just a childhood condition

Childhood-only → adult prevalence → stimulant safety → CV risk debates → diagnosis validity