Comment

The tension between gold-standard double-blind randomized controlled trials and the overt psychoactive effects of psychedelics increases the risk of extrapolation fallacy, with potentially harmful downstream consequences.

People with lived experience of mental health conditions have historically been excluded from meaningful participation in psychiatric genetic and genomic research. This Comment outlines five key actions that the US National Institute of Mental Health, the largest funder of mental health research, can take to more effectively center people with lived experience in genetic and genomic research.

Youth mental health trajectories are inherently complex, and current tools cannot reliably forecast who will deteriorate, recover or relapse. This Comment discusses why digital measurement-based care offers a scalable, evidence-based solution for continuous and adaptive care, and proposes five recommendations to address the structural and behavioral conditions needed for digital measurement-based care to become routine practice.

Psychedelic-assisted therapy shows promise for mental health treatment but faces regulatory, methodological and safety challenges. In this Comment, we propose using artificial intelligence and virtual reality to simulate similar experiences to those produced by traditional psychedelic compounds for use in psychedelic-assisted therapy modalities.

Genomic studies of attention-deficit/hyperactivity disorder (ADHD) have advanced the understanding of its neurobiology but are still constrained by one of the most pronounced Eurocentric biases in psychiatric genetics. Expanding ADHD genomics to under-represented populations, particularly in Latin America, offers a unique opportunity to yield transformative discoveries by capturing the genetic diversity of admixed individuals. We call for a global, coordinated effort to prioritize diversity in ADHD research, not only to foster innovation in precision psychiatry but also to ensure that these advancements benefit all populations equitably.

Data science competitions offer a collaborative, inclusive approach to tackling the complexity of brain health research. This Comment explores the challenges faced by competition organizers and how they can harness diverse expertise to address data heterogeneity, assess modeling strategies and translate findings into practice.

Collaborations between neuroscientists and traditional medical practitioners can strengthen the scientific foundations of traditional medicine and enrich neuroscience with culturally grounded insights. Such partnerships, built on mutual learning, can promote more equitable and context-sensitive mental health research.

A behavioral healthcare workforce — concordant in race, ethnicity, lived experience, language, and geography with the populations it serves — is urgently needed to end the US behavioral health crisis.

Stimulant medications are the first-line treatment for ADHD, with non-stimulants often used if stimulants are ineffective. Here, by reinterpreting randomized controlled trials, addressing heterogeneity of treatment effects, and considering societal impact, we argue for equal consideration of stimulant and non-stimulants as first-line treatment options.

Disparities in cardiovascular health among Black and Latina women are exacerbated by chronic stressors and limited access to mental health care. Culturally adapted mindfulness-based interventions represent promising strategies to address these disparities, potentially improving cardiovascular health by integrating sociocultural contexts and unique stressors into mental health practices.

This Comment proposes a receptor-informed, neuroimaging-integrated framework for guiding personalized, mechanism-based psychedelic therapies.

Dementia affects more than 55 million people worldwide, and AI companions powered by large language models are emerging as a scalable option for prevention and care. This Comment considers the unique promise, concerns, and regulations surrounding AI companions for dementia.

In this Comment, Aruta explores how climate change and digital mental health intersect. The Comment maps four domains of convergence with global relevance and calls for an integrated agenda for research, policy and practice.

Digital cognitive twins could transform cognitive training into a personalized, clinically grounded and ethically governed modality for preventive use.

In this Comment, we describe the design, conduct and impact of a collaborative co-produced national study of suicide bereavement, including people with lived or living experience in the research. We highlight crucial gaps and challenges that need to be addressed.

Schools offer unparalleled reach for youth suicide prevention, particularly in low- and middle-income countries, where access to mental health care is limited. However, poor integration into education systems, short-term funding and weak links between health and education limit the impact of many programs. We call for systemic implementation approaches that embed prevention within school priorities, increase cross-sector collaboration, build on existing initiatives such as anti-bullying programs, and align policy and data to deliver sustainable, scalable strategies that reduce suicide risk among young people.

A large and consistent body of evidence indicates physical punishment is harmful, but more research is needed to prevent it effectively at scale.

Insulin resistance is emerging as an early metabolic risk marker in youth with mood disorders. In this Comment, we examine the interplay of insulin resistance, inflammation and circadian disruption that worsens both metabolic symptoms and mood symptoms, highlighting the potential for early integrated interventions.

To realize the potential of emerging psychedelic therapies, clinical and systemic obstacles must be surmounted.

In this Comment, we define the nascent field of metabolic psychiatry and highlight key questions regarding the overlap between metabolism and mental health. We also make recommendations to integrate considerations of diversity and inclusion, lived experience and open science to accelerate discovery and clinical translation in this field.