Sunday, September 13, 2026

Opparounds

🔬Psychiatric Research Article

Dialectical Behavior Therapy Versus Serotonin Reuptake Inhibitor Treatment for Suicidal Behavior in Borderline Personality Disorder: A Randomized Controlled Trial

Brodsky BS, Galfalvy H, Mann JJ, et al. · American Journal of Psychiatry · December 2025

This trial randomized adults with borderline personality disorder and recent suicidal behavior to six months of dialectical behavior therapy or six months of an SSRI with clinical management. DBT outperformed SSRI treatment at reducing suicide-related events — attempts, and suicide-related hospitalizations or ED visits — over the study period.

The SSRI arm, meanwhile, was more effective at preventing new-onset major depressive disorder at six months — a genuine trade-off, not a clean win for either arm.

💡 Why it matters

Head-to-head evidence that structured psychotherapy, not medication, should anchor treatment for suicidality specifically in BPD — antidepressants still have a role, but for comorbid depression, not as the primary intervention for suicide risk.

Read the paper → doi:10.1176/appi.ajp.20240298

🩺General Medicine Article

Efficacy and Target Engagement of Dopamine Agonist Pramipexole for Anhedonic Depression: A Randomized Placebo-Controlled Trial

Ventorp F, Asp M, Olsson S, et al. · Nature Medicine · July 2026

This 85-participant RCT repurposed pramipexole — a dopamine agonist developed for Parkinson's disease and restless legs syndrome — as a treatment for anhedonia in mood disorders. Compared with placebo, pramipexole produced a significant reduction in anhedonia scores (SHAPS), was well tolerated, and showed genuine target engagement, with benefits holding up at follow-up.

💡 Why it matters

Anhedonia is often the most treatment-resistant symptom of depression, and this is a brain-body crossover finding — a neurology drug repurposed for the symptom standard antidepressants leave behind — worth knowing as an augmentation option for treatment-resistant, anhedonia-predominant cases.

Read the paper → doi:10.1038/s41591-026-04465-9

💊Psychiatric Fact

The SSRI-Triptan Warning Outran Its Own Evidence

The FDA's 2006 alert on combining triptans with SSRIs or SNRIs for serotonin syndrome risk is still routinely used to deny migraine patients an effective abortive — but the evidence behind it never held up. A University of Washington review of over 61,000 patients on both drug classes across 28 years found zero cases meeting diagnostic criteria for serotonin syndrome, and subsequent expert reviews have concluded the available evidence does not support restricting co-prescription.

This matters clinically because roughly a quarter of triptan users are also on an SSRI or SNRI for comorbid depression or anxiety, and reflexively withholding either drug over this interaction denies real treatment for a warning current evidence doesn't support. The correct response to a migraine patient asking for a triptan while stable on an SSRI is not automatic refusal — it's ordinary serotonin-syndrome vigilance, the same as for any serotonergic combination, not a special veto.

🛋️Psychotherapy Teaching Pearl

Missing-Links Analysis: Before Assuming "Won't," Rule Out "Can't"

When a DBT patient fails to do an agreed-upon behavior — skip a skill they said they'd use, miss a session, not fill out a diary card — the reflex is to chain-analyze the emotional or motivational barrier. Missing-links analysis is the step that comes first: systematically checking whether every link in the behavioral chain leading to the target behavior was actually present, treating the gap as a possible skill or capability deficit rather than a motivational one.

Did the patient know what to do, know when to do it, have the skill rehearsed enough to access it under emotional arousal, and have the opportunity to do it? Skipping this step and moving straight to "what got in the way emotionally" can turn a genuine capability gap into a moralized conversation about willingness.

🗒️ Vignette

A patient repeatedly failed to use a distress-tolerance skill during arguments with her partner despite endorsing it as helpful in session. Rather than chain-analyzing motivation, the therapist ran a missing-links check and discovered the patient had only ever practiced the skill seated, alone, in a quiet room — she had never rehearsed it standing, mid-conflict, with adrenaline running.

The barrier wasn't willingness; it was that the skill had never been generalized to the conditions it needed to work under. Behavioral rehearsal in session, standing and role-playing the argument, closed the gap that a motivational conversation never would have found.