Opparounds

Efficacy and Safety of the Neuroplastogen TSND-201 for the Treatment of PTSD: A Randomized Clinical Trial

Jones A, Warner-Schmidt J, Kwak H, et al. · JAMA Psychiatry · February 2026

This phase 2 trial randomized 65 adults with PTSD to four once-weekly oral doses of TSND-201 (methylone, a novel "neuroplastogen") or placebo. By day 64, the active-drug group showed a 9.64-point greater reduction in CAPS-5 scores than placebo, with a response rate of 57.1% versus 19.2% and a remission rate of 32.1% versus 11.5%.

The intermittent, once-weekly oral dosing schedule is itself notable — a much lower logistical burden than IV or intranasal protocols requiring in-clinic monitoring each visit.

Read the paper →  doi:10.1001/jamapsychiatry.2025.4625

Therapeutic Alliance and Suicidal Ideation During Therapy and the Role of Racial/Ethnic Identity

Davis KA, Castonguay LG, Janis RA, et al. · Psychotherapy Research · June 2026

Using structural equation modeling on 1,099 university counseling-center clients across sessions, this study looked at within-client fluctuation rather than just between-client averages: when a client rated the alliance as stronger than their own usual level, their suicidal ideation subsequently decreased; sessions with higher-than-usual SI were linked to lower alliance ratings.

Marginalized clients showed lower average alliance and higher average SI overall, but the alliance-SI relationship itself did not differ by racial or ethnic marginalization status.

Read the paper →  doi:10.1080/10503307.2026.2674016

Metoclopramide Is a D2 Antagonist Wearing a GI Label

Metoclopramide blocks dopamine D2 receptors in the nigrostriatal pathway by the same mechanism as a first-generation antipsychotic, and it carries an FDA black-box warning for tardive dyskinesia — yet it is prescribed by gastroenterology, emergency medicine, and OB services without ever crossing a psychiatrist's medication reconciliation. Contemporary data put the true TD risk below 1%, well under the 1-10% older guidelines implied, but the risk concentrates in exactly the patients psychiatry already worries about: those on a standing antipsychotic, older adults, and diabetics with gastroparesis needing repeat dosing.

A patient who develops new orofacial dyskinesia or akathisia while on both an antipsychotic and "just some Reglan for nausea" has two dopamine antagonists on board, not one — and the metoclopramide is easy to miss because it lives on the GI or ED medication list, not the psychiatric one. Ask about it explicitly when a stable patient on a low-dose antipsychotic suddenly develops new EPS.

An Interpretation That Explains Everything Leaves the Patient Nothing to Discover

There's a version of interpretive technique that mistakes completeness for skill — the therapist links the transference, the childhood material, and the current symptom into one tidy, fully-formed statement. This is a saturated interpretation, and it tends to produce compliance or blankness rather than insight, because it does the patient's associative work for them and leaves no gap for their own discovery.

The alternative isn't vagueness — it's a partial, well-timed interpretation that names a pattern without closing off what it means, trusting the patient to fill in the rest. A useful test: if your interpretation could stand as a complete paragraph in a case write-up, it was probably too saturated to say out loud; the ones that actually move treatment forward are often a single sentence with room left in it.