European Neuropsychopharmacology

Anxiety and maladaptive fear remain difficult to treat, and despite initial promising findings, evidence regarding the anxiolytic and translational potential of oxytocin (OT) remains inconsistent. In a preregistered, randomized, double-blind, placebo-controlled, parallel-group pharmaco-fMRI study in 67 healthy men, we tested whether intranasal OT reduces post-exposure subjective fear during prolonged naturalistic viewing a horror movie comprising independently defined low-, medium-, and high-fear segments. OT reduced subjective fear following naturalistic threat exposure after accounting for pre-exposure baseline ratings. Neuroimaging analyses revealed that OT attenuated recruitment of the dorsolateral prefrontal cortex particularly during higher fear, and enhanced coupling of this region with the bilateral amygdala. At the large-scale network level, OT increased communication between frontoparietal/default-mode control networks and subcortical/limbic networks during high fear indicating more integrative fear regulation. A whole-brain fear neuromarker (CAFE) further confirmed intensity-dependent OT effects. Together, these findings indicate that OT modulates post-exposure fear experience and fear-related neural dynamics in ecologically valid contexts.

Although non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) has demonstrated a therapeutic-relevant potential by enhancing mood recovery and fear extinction, its influence on neural dynamics during naturalistic, sustained fear processing remains unclear. In this study, we employed a randomized, sham-controlled, parallel-group design involving 63 participants (taVNS: n = 33; sham: n = 30) who provided continuous subjective fear ratings (1170 timepoints) while watching a 10-minute fear-inducing video, with simultaneous fNIRS recordings. We employed: (1) a convolutional neural network (CNN) to decode fear ratings from frontal activations, (2) validation of stimulus-evoked activity comparing fNIRS with fMRI signal, (3) dynamic conditional correlation analysis to assess taVNS-induced connectivity changes, and (4) moderation analysis to examine anxiety state effects. Behaviorally, taVNS significantly attenuated fear responses during four threat phases by content analysis: T1 (ghost appearance), T2 (escape sequence), T3 (sudden threat emergence) and T4 (suicide scene). Neurally, taVNS suppressed medial prefrontal cortex (mPFC) activation during escape (T2) and disrupted the typical fear coupling between fear experience and brain activity. Furthermore, taVNS enhanced intra-mPFC functional connectivity, suggesting a potential neural basis for modulating subjective threat appraisal. Additionally, state anxiety significantly moderated brain-behavior relationships. These findings demonstrate that taVNS attenuates fear responses through modulation of mPFC engagement and strengthening frontal network integration. Our results highlight taVNS as a promising neuromodulatory intervention for fear-related disorders (e.g., anxiety disorder), particularly as an early adjunct to exposure-based therapies, warranting further clinical validation.

Major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are prevalent, chronic, and disabling mental health conditions which are difficult to treat. Ketamine has demonstrated effect for improving depression and PTSD symptoms independently but reports often overlook focused comorbid improvement of these symptoms within individuals. To address this, we assessed blood-based biomarker and psychological changes following low-dose oral ketamine treatment for adults with MDD alone (n=14) and comorbid MDD+PTSD (n=21). Before treatment, the MDD clinical group presented with more severe depression, lower serotonin levels and higher kynurenine levels than the MDD+PTSD group. Post-treatment there were no detectable differences in the biological response between clinical groups, with combined analysis revealing common decreases in circulating brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF-A). Additionally, post-treatment, both clinical groups showed improvements in anxiety, stress, social functioning, suicidal ideation, and general well-being measures, as well as individual improvements in depression scores and PTSD symptoms in the MDD- and PTSD-containing groups, respectively. Collectively, this study presents additional evidence that low-dose oral ketamine treatment can be effective for MDD and MDD+PTSD, individually and comorbidly, and that both MDD and PTSD clinical groups responded in the same biological manner.

Social connection is fundamental to human wellbeing. Serotonergic psychedelics such as lysergic acid diethylamide (LSD) acutely heighten subjective connectedness, yet their effects on real-time social connection remain poorly understood. Using EEG hyperscanning in a randomized, double-blind, placebo-controlled crossover study, we recorded neural activity simultaneously from both members of healthy romantic couples (N=25) who received LSD (50 g) or placebo together, across resting and interactive states. LSD increased subjective connectedness, including feelings of love, closeness, trust, and being "in sync," while reducing loneliness, compared to placebo. This affiliative shift dissociated from the drugs pharmacokinetic time-course, remaining elevated as subjective intensity and plasma concentration declined. In parallel, LSD increased inter-brain synchrony during shared rest, carried specifically by theta-band amplitude-envelope coupling. Importantly, this effect survived two complementary controls. First, it exceeded coupling between unrelated individuals and second the effects depended on contemporaneous neural alignment rather than shared drug-induced dynamics. Exploratory analyses showed that romantic partners with greater resting synchrony reported greater feelings of connectedness. These findings provide the first evidence that a psychedelic enhances brain-to-brain coupling between people, linking a pharmacologically induced state of felt connection to a measurable signature shared across interacting brains.

Background: Substance use is common among individuals with depression. Transcranial magnetic stimulation (TMS) is an effective treatment for depression, but current clinical guidelines have discouraged TMS treatment for individuals with depression and co-occurring substance use given concerns for limited efficacy. However, limited data exists on whether substance use affects response to TMS. Methods: Using electronic health record data from patients who received a standard course of TMS for major depressive disorder at an academic medical center, we investigated associations between substance use frequency and response to TMS, defined as change in Patient Health Questionnaire-9 (PHQ-9) scores. Substance use frequency was extracted for alcohol, cannabis, nicotine, stimulants, benzodiazepines, opioids, inhalants, psychedelics, and other drugs. We performed ANCOVA and multiple regression analyses to predict change in PHQ-9 score based on substance use frequency, controlling for pre-TMS PHQ-9 score, age, sex, and number of TMS sessions received. Results: We extracted data from 219 TMS courses. Alcohol was the substance used most commonly (34.2%), followed by prescription benzodiazepines (28.3%), and prescription stimulants (21.0%). Across all substance categories, substance use was not associated with change in PHQ-9 score (all p > 0.05, Cohens d=0.00 to 0.30). In multiple regression models to compare individual levels of substance use frequency (e.g., daily use vs. no use), level of substance use was not associated with change in PHQ-9 score (all p > 0.05). The range of plausible effects of substance use frequency on PHQ-9 change was generally below the minimal clinically important difference for PHQ-9, suggesting substance use was unlikely to have a meaningful clinical effect on antidepressant response to TMS. Conclusions: Low to moderate substance use does not have a clinically significant effect on antidepressant response to TMS. Low-level substance use should not exclude individuals with depression from receiving TMS.

Background: Individuals receiving buprenorphine treatment for opioid use disorder (OUD) remain at high risk for treatment discontinuation and return to opioid use. Transcranial magnetic stimulation (TMS) has shown efficacy in reducing craving and substance use in other substance use disorders, but its application in OUD remains limited and the neural mechanism underlying its therapeutic effects is poorly understood. Determining the feasibility and generalizability of TMS in patients receiving buprenorphine - the most commonly prescribed medication for OUD - is therefore critical. This protocol aims to address these issues in a clinical trial of weekly TMS sessions for OUD. Methods: We will enroll up to 120 individuals with OUD taking buprenorphine in a randomized, single-blind, sham-controlled trial of left dorsolateral prefrontal cortex (DLPFC)-targeted intermittent theta burst stimulation (iTBS). Participants will receive active or sham iTBS weekly (2 sessions of 1800 pulses each applied once per week x 8 weeks, 16 sessions total) with pre- and post-iTBS assessments (10, 12, 20 weeks) of craving, opioid use, and treatment retention. A subset of individuals will undergo optional pre- and post-iTBS neuroimaging. The study will be conducted at an academic medical center and a private outpatient TMS clinic. Aims: Our primary aim is to determine whether 16 sessions of active iTBS applied to the left DLPFC results in reduced craving and opioid use, and higher treatment retention, relative to sham. In a secondary aim, we will also examine whether iTBS-related changes in craving are associated with changes in functional connectivity between the left DLPFC and both the dorsal striatum and anterior cingulate cortex. Discussion: By evaluating the feasibility and efficacy of a weekly TMS protocol that aligns with routine care and focuses on patients maintained on buprenorphine, this study addresses key limitations of prior TMS research in OUD. Furthermore, the inclusion of neuroimaging will help characterize the neural mechanisms underlying TMS-related changes in craving. Trial registration: This clinical trial is registered at ClinicalTrials.Gov; ID NCT07457489; date of registration: 03/02/2026.

Major depressive disorder (MDD) is strongly associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, systemic inflammation, and gut microbiota dysbiosis. Although selective serotonin reuptake inhibitors such as escitalopram are standard treatments, their efficacy is often constrained by partial response and gastrointestinal adverse effects. In this 12-week, randomized, double-blind, placebo-controlled trial, we evaluated the clinical efficacy and microecological mechanisms of adjunctive Lactiplantibacillus plantarum PS128 (PS128; 6*1010CFU/day) in MDD patients on stable escitalopram therapy. Adjunctive PS128 significantly enhanced clinical response compared to placebo, yielding substantial reductions in HAMD-17 and MADRS, alongside a higher remission rate. 16S rRNA sequencing and PICRUSt2 profiling revealed that PS128 enriched key short-chain fatty acid producers (Faecalibacterium, Coprococcus), counteracting the Klebsiella expansion seen in placebo. Functionally, PS128 up-regulated neuroprotective cofactor, B vitamins, biosynthesis and down-regulated the neurotoxic kynurenine pathway. Network analysis demonstrated that PS128 maintained a resilient, integrated microbial co-occurrence topology, whereas the placebo network showed structural segregation. This stabilized ecosystem attenuated peripheral inflammatory signaling and normalized salivary cortisol levels. Overall, adjunctive PS128 augments escitalopram efficacy by enhancing gut network stability, supporting cellular energetics, and modulating neuroendocrine activity, offering a promising multimodal strategy for MDD.

Suicidal behavior results from complex behavioral and biological changes. Previous cross-sectional studies indicate that proinflammatory immunobiological factors are often increased in close temporal proximity to a suicide attempt. Suicidal individuals may also exhibit a biological trait vulnerability to stress and inflammation, due to persistent epigenetic modifications. We enrolled 130 individuals with major depressive disorder (MDD), 83 with suicidal behavior at intake, and followed them for 12 months with up to eight clinical assessments. Quantification of plasma inflammatory markers and metabolites was performed by high-sensitivity electrochemiluminescence and Ultra High-Performance-Liquid-Mass Spectrometry (UPLC-MS), respectively. Epigenetic changes were identified using Illumina EPIC arrays. We identified 15 genes with altered DNA-methylation associated with suicidal behavior and attempts at baseline. Childhood trauma predicted lifetime suicide attempts and was associated with altered methylation of seven genes. Increased neutrophils and lower plasma serotonin at baseline predicted future suicide attempts over the following year (neutrophil estimate = 0.42, P = 0.016; serotonin OR = 0.58, 95% CI: 0.39-1.13). Utilizing biomarkers from baseline and epigenetic data from the genes with highest predictive values (STBD1 ,PRDM8, and TRIM15), we achieved an area under the curve (AUC) of 0.84 for suicide attempts over the year. Suicidal behavior in MDD was associated with specific epigenetic signatures. Several of the identified genes, such as MAD1L1, have been implicated in psychiatric disease, suicidal behavior and the immune response. These findings support the usefulness of epigenetic and immunometabolic blood markers for identifying suicidal individuals in clinical settings, potentially enhancing preventative efforts.

Importance There is increasing interest in the potential of psilocybin to treat mental health and neurodevelopmental conditions. At high doses, the therapeutic benefit of psilocybin is linked to greater functional connectivity or integration between large-scale brain networks which underpin mood, emotion and cognition. However, it is unknown how the brain responds to psilocybin in autism - a condition characterised by both altered functional connectivity and differential response to drugs. Thus, a first step before clinical trials of psilocybin involving autistic people, is to evaluate the response of the autistic brain to psilocybin, initially at low dose. Objective Low doses of psilocybin were used to test the hypothesis that the functional connectivity of large-scale resting-state brain networks respond differently in autistic and non-autistic adults. Design The PSILAUT study had a pseudo-randomised, cross-over, double-blind, case-control design. There was no evaluation of clinical efficacy. PSILAUT was not a Clinical Trial according to UK regulations. Data collection was conducted from January 2023 to August 2024. Setting Single-centre, study conducted at the Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, United Kingdom. Participants Adult (> 18 years) participants with and without an autism spectrum disorder (ASD) diagnosis were recruited and matched for age, sex and IQ. Autistic participants were included if they had an existing diagnosis (DSM-IV, DSM-5 or ICD-10 criteria). Exposures A single oral dose of 2 or 5 mg psilocybin or (inactive) placebo administered on separate visits at least one week apart. Main Outcomes and Measures Resting-state fMRI was acquired to investigate the change in functional connectivity within and between brain networks, as measures of network integrity and integration, respectively. Results A total of 67 participants were recruited (18-58 years at first visit; 30 non-autistic participants, mean [SD] age, 30.0 [8.3] years, 15 males [50%] and 37 autistic participants, mean [SD] age, 28.6 [9.2] years, 19 males [51%]). We report for the first time that the autistic brain responds differently to low doses of psilocybin, despite no group differences in network connectivity in the baseline placebo condition. 5 mg psilocybin elicited the greatest shifts in functional connectivity in both groups, but in different directions. In non-autistic participants only, on average, after 5 mg psilocybin within-network connectivity of the frontoparietal ({beta} = -0.053, T = -2.73, FDR-corrected P value = 0.027, Cohen d = -0.71) and limbic networks ({beta} = -0.087, T = -2.59, FDR-corrected P value = 0.021, Cohen d = -0.61) decreased. In contrast, in autistic participants, 5 mg psilocybin increased between-network connectivity (i.e. integration) of higher-order and attentional networks, but decreased connectivity between the same networks in non-autistic participants (default mode and frontoparietal networks, dose x group interaction: {beta} = 0.053, T = 2.91, FDR-corrected P value = 0.042; dorsal and ventral attention networks, dose x group interaction: {beta} = 0.059, T = 2.31, FDR-corrected P value = 0.015). Across the whole sample, the extent to which psilocybin elicited an increase in connectivity between higher-order ({beta} = 0.33, T = 2.16, FDR-corrected P value = 0.036) and attentional ({beta} = 0.36, T = 2.43, FDR-corrected P value = 0.036) networks was positively correlated with core autistic traits quantified using the Autism Quotient. Conclusions and Relevance Functional brain networks that support mood, emotion and cognition are more responsive to low dose psilocybin in autistic adults compared to non-autistic adults. Given that increased network integration is associated with clinical utility, future applications of psilocybin in autistic people should include the evaluation of low doses.

BackgroundPsychedelics have been proposed to enhance empathy and social connectedness, but it remains unclear whether these effects reflect global increases in empathic ability, whether they persist beyond the acute drug state, and whether they contribute to later psychological outcomes. MethodsIn a randomized, double-blind, placebo-controlled, parallel-group study, healthy participants received psilocybin (0.17 mg/kg) or placebo. Three dissociable components of empathy were assessed using the Multifaceted Empathy Test at baseline, during the acute drug state, and 7 days later: cognitive empathy (accuracy of emotion identification), emotional arousal (affective activation in response to anothers emotional state) and empathic concern (other-oriented compassion toward the depicted person. Persisting positive psychological effects were assessed at follow-up. Circulating oxytocin was measured, and spectral dynamic causal modeling was applied to resting-state fMRI data acquired during the acute drug state to examine effective connectivity within an empathy-relevant network. ResultsCompared with placebo, psilocybin acutely reduced cognitive empathy selectively for positive stimuli, while increasing emotional arousal for positive stimuli and empathic concern across valences. These empathy-related effects did not persist 7 days later. However, acute increases in empathic concern mediated later positive psychological changes, including improved attitudes about life and self, mood, and relationships. Psilocybin also increased circulating oxytocin compared to baseline, but oxytocin changes were not associated with empathy changes. Effective-connectivity analyses showed that empathic responding under psilocybin was associated with altered directional coupling among superior temporal and parahippocampal regions. ConclusionsPsilocybin does not simply enhance empathy, rather it impairs the identification of positive emotional states while heightening affective engagement and concern. Although these effects do not persist, acute empathic concern may contribute to later positive psychological change.

Background: Placebo responding involves the reduction of symptoms in response to contextual features of an intervention (e.g., verbal suggestions), yet it is characterized by pronounced heterogeneity. Although verbal suggestions are widely recognised as a hallmark method for inducing placebo responses, an open question is whether variability in placebo responding can be partly attributed to individual differences in trait responsiveness to verbal suggestions (REVS). We conducted a pre-registered meta-analysis (PROSPERO registration number CRD420250654692) to quantitatively synthesize available research on the association between trait REVS and placebo responding. Methods: PsycInfo, PubMed, MEDLINE, and Embase were searched up to June 2026 for original clinical or experimental studies involving both the assessment of REVS and symptom measures (self-report, behavioural, and/or physiological) in response to an inactive intervention (placebo). Results: Of 1,512 search results, 24 articles presenting 66 correlations between REVS and placebo responding were analysed (N = 1,137). A multi-level meta-analysis revealed a significant, albeit weak, positive correlation between REVS and placebo responses, r = 0.18 [95% CI: 0.13, 0.24], such that individuals with higher REVS reported greater symptom relief in response to the placebo. Meta-regression analyses did not identify any significant moderators of the correlation between REVS and placebo responding and sensitivity analyses based on Bayesian subgroup estimates indicated that the aggregate correlation was stable across methodological quality indicators and study features. Conclusion: These findings suggest that individual differences in REVS may partly explain variability in symptom reduction in response to placebos, with implications for the sources of variance in placebo effects in experimental and applied contexts.

BackgroundPsilocybin, a classic psychedelic, produces acute alterations in brain function, and has shown sustained therapeutic effects in psychiatric disorders. However, most studies focus on acute brain imaging readouts (e.g., fMRI) and rarely assess longer-term molecular changes. MicroRNAs (miRNAs) are small non-coding RNAs that regulate gene expression, are enriched in the brain, and can be released into blood, potentially indexing brain-relevant molecular processes. We hypothesised that a single psilocybin dose would show acute changes in miRNAs with predicted relevance to neuroplasticity related signalling and immune/inflammatory regulation in healthy adults. MethodsIn a randomised, double-blind, placebo-controlled study (N=62; 31 psilocybin, 31 placebo), volunteers received psilocybin (0.17 mg/kg) or placebo. Blood was collected at baseline, 360 minutes, and 7 days after dosing. Plasma miRNAs were quantified by small RNA sequencing. Elastic net regression was used for feature selection, followed by differential expression analysis and validation with linear mixed models. Pathway enrichment used Reactome and Gene Ontology. ResultsTwo circulating miRNAs (let-7g-5p and miR-150-5p) met criteria for differentially expressed at 360 minutes following psilocybin administration, with no significant differences detected at 7 days or in the placebo condition under the statistical thresholds used. Over representation analysis suggested enrichment of molecular processes involved in neuroplasticity (e.g., TrkA, MAPK), inflammation (e.g., IL-6, TGF-{beta}), and transcriptional regulation (e.g., RNA polymerase II, SMAD2/3/4). ConclusionsA single oral dose of psilocybin was associated with transient alterations in circulating miRNA expression, consistent with an acute shift in circulating gene-regulatory miRNA signals, without sustained miRNA changes at 7 days. These findings provide initial evidence that circulating miRNA changes after psilocybin may reflect acute molecular process responses and support further investigation of circulating miRNAs as potential biomarkers of psychedelic-induced molecular responses.

Background: Major depressive disorder (MDD) is a severe mental illness associated with severe clinical consequences and substantial societal burden. It's characterized by immune-inflammatory dysregulation and immune sensitization. Objective: To determine whether in vitro ketamine attenuates phytohemagglutinin (PHA)/lipopolysaccharide (LPS)-induced immune sensitization in patients with MDD and healthy controls (HCs). Methods: Whole blood from 18 patients with MDD and 18 HCs was stimulated with PHA/LPS and exposed to ketamine (0.3 M, 0.6 M, and 6 M) for 72 hours. Cytokines, chemokines, growth factors, and composite immune profiles, including M1/M2 macrophages, T helper (Th)1/2/17, the immune-inflammatory response system (IRS), and compensatory immunoregulatory system (CIRS), were synthesized and determined. Results: Under PHA and LPS stimulation in vitro, the MDD group exhibited markedly elevated immune profiles, including M1, M2, Th1, Th2, Th17, IRS, CIRS, chemokines, and growth factors, consistent with immune sensitization. Significant group-by-treatment interactions were observed for Th1-Th2, M2, growth factors, IL-12(p70), M1, and chemokines. Ketamine produced minimal changes in HCs but broader suppression in MDD, particularly at the highest concentration, without normalizing the sensitized immune phenotype. Among the immune markers with no notable group-by-treatment interactions, ketamine exerted diagnosis-independent effects, decreasing MIP-1{beta}, IL-1&{beta}, Th1, TNF-{beta} IRS, IFN-{gamma}, and IL-2 compared to the control condition. Conclusions: Ketamine exhibited two distinct immunoregulatory patterns: selective, disease-dependent attenuation of sensitized immune pathways and broader, diagnosis-independent suppression of the stimulated immune response, predominantly at higher concentrations. However, these effects were insufficient to normalize the immune-sensitized phenotype of MDD.

Background: Autism spectrum disorder is a prevalent neurodevelopmental condition featuring marked social difficulties. Oxytocin supplementation shows promising therapeutic efficacy in alleviating autism-like traits in rodent models, but clinical effects in humans remain inconsistent. The rodent-derived social salience network (SSN) comprises several oxytocin-modulated brain regions implicated in social behavior, but its conservation has not been established in humans. Here we assess, for the first time, functional connectivity (FC) within a homologous human SSN in autistic men to examine its relationship with behavioral traits and modulation by oxytocin. Methods: The human SSN atlas was collated from open-access cortical and subcortical parcellations, and used to retrospectively analyze a resting-state fMRI dataset of adult men with autism from a previously published, randomized, placebo-controlled oxytocin trial. SSN-wide and sub-network ROI-to-ROI FC correlations with social trait expression and salivary oxytocin concentrations were performed at baseline and post-administration. Treatment specific outcomes on FC were calculated using ANCOVA. Results: We observed SSN sub-network FC correlations with social and repetitive behavioral scores and identified strong oxytocin sensitivity of nucleus accumbens-somatosensory and paraventricular nucleus-somatosensory circuits at baseline. Following nasal spray administration, a strengthening of amygdala-somatosensory circuit was detected as the largest oxytocin-induced FC shift. Notably, baseline connectivity within this circuit strongly predicted treatment response, with individuals having lower baseline FC showing greater post-treatment FC. Conclusions: These findings provide first evidence for clinical relevance of the SSN in humans with autism and highlight circuits that may represent promising biomarkers for predicting oxytocin responsiveness.

Objective: Disruption of the excitation/inhibition balance may contribute to the pathophysiology of bipolar disorder, with post-mortem studies reporting abnormalities in GABA-receptors, interneurons and inhibitory signaling in prefrontal areas. Transcranial magnetic stimulation with electroencephalography (TMS-EEG) enables in vivo assessment of cortical excitability/inhibition. This study examined short-latency intracortical inhibition (SICI) after left- and right-dorsolateral prefrontal cortex (DLPFC) stimulation in bipolar depression (BDep, n=10) and healthy controls (HC, n=22). Methods: SICI (paired-pulse TMS) and excitability (single-pulse TMS) were quantified using local- and global-mean-field-power. Associations with lithium use and between-group differences in TMS-evoked potential amplitudes were also explored. Results: For left-DLPFC stimulation, BDep showed weaker SICI than HC (local: 3.7%{+/-}12.5 vs 9.0%{+/-}20.3, p=0.05; global: 1.5%{+/-}11.7 vs 8.8%{+/-}20.6, p=0.10), driven by larger ppTMS responses (weaker inhibition). For right-DLPFC stimulation, BDep showed stronger SICI than HC (local: 17.3%{+/-}16.1 vs 0.75%{+/-}27.1, p=0.36; global: 16.2%{+/-}14.6 vs -1.0%{+/-}21.8, p=0.03), driven by a larger spTMS response (enlarged excitability). Stronger right-hemispheric global-SICI was most pronounced in BDep patients not using lithium (17.9%{+/-}7.0) vs lithium users (3.9%{+/-}11.9) and HC (pFDR=0.03). Conclusions: BDep is characterized by reduced cortical inhibition after left DLPFC stimulation and enlarged cortical excitability after right DLPFC stimulation; the latter partly normalized by lithium. Significance: To our knowledge, this is the first study to apply TMS-EEG to the bilateral DLPFC in BDep, revealing distinct patterns of hemispheric dysfunction. These findings warrant replication in larger samples, to further elucidate the underlying pathophysiology and inform the mechanisms of action of neuromodulation treatments, such as rTMS.

Background Childhood adversity is linked to psychopathology risk and dysregulated stress reactivity; however, unified underlying neural mechanisms are unclear. A central visceral network, including the bed nucleus of the stria terminalis (BNST), amygdala and subgenual anterior cingulate cortex (sgACC), is implicated in affective processes and proximally controls stress reactivity. We examined relationships among childhood adversity, stressor-evoked neural activity/connectivity and affective and cardiovascular outcomes. Methods Participants were adults (n=97, mean age=27.32, SD=4.02, 57 females) uniformly distributed across physical abuse severity. Childhood adversity was assessed by threat (abuse or traumatic events) and socioeconomic deprivation (SED). Participants performed an fMRI stress task with cardiovascular recordings. Linear/curvilinear regressions were performed with threat and deprivation together as predictors of stressor-evoked activity/connectivity. Neural variables showing significant adversity associations were examined as predictors of affective symptoms/diagnoses or cardiovascular responses. Results Threat and SED displayed opposing curvilinear relationships with stressor-evoked amygdala and sgACC activity, respectively: at low and high adversity, amygdala reactivity was greater, whereas sgACC reactivity was blunted. Greater SED was associated with weaker BNST-sgACC connectivity. Blunted amygdala reactivity and lower sgACC reactivity were associated with greater post-traumatic stress symptoms. Affective diagnoses peaked at near-zero BNST-sgACC connectivity. Greater amygdala reactivity was associated with blunted diastolic blood pressure reactivity and recovery. Conclusions The curvilinear relationships suggest adversity-related vulnerability thresholds. Blunted amygdala, lower sgACC reactivity and weaker BNST-sgACC connectivity may confer affective risk, whereas heightened amygdala reactivity may confer cardiovascular risk. Our findings support a central visceral network pathway by which childhood adversity may contribute to affective and cardiovascular health.

Long-term opioid therapy is limited by analgesic tolerance and opioid-induced hyperalgesia, but the roles of genetic background, sex, and drug exposure remain unclear. We used 20 inbred strains from the Hybrid Rat Diversity Panel to examine thermal sensitivity, oxycodone analgesia, tolerance, and hyperalgesia-like changes following voluntary intravenous oxycodone or saline self-administration. Rats underwent tail-immersion testing before self-administration (Pre-SA) and after self-administration (Post-SA). Oxycodone analgesia was assessed using the percent maximum possible effect time course and the corresponding area under the curve. Pre-SA thermal sensitivity differed across strains and between sexes, and Pre-SA oxycodone analgesia also differed across strains. Oxycodone self-administration produced a sex-dependent increase in thermal sensitivity that was most evident in males. During Post-SA testing, oxycodone self-administering rats showed reduced analgesic responsiveness compared with saline controls, and the magnitude of this difference varied across strains. Within-strain Pre-SA-to-Post-SA comparisons identified tolerance-like reductions in several strains. Across strains and sexes, oxycodone self-administering rats showed a greater Pre-SA-to-Post-SA reduction in analgesic responsiveness than saline controls, consistent with analgesic tolerance. Total oxycodone intake was not associated with tolerance at either the strain-mean or individual-animal level. Heritability estimates were higher for thermal sensitivity and analgesia (H2 {approx} 0.28-0.40) than for changes in thermal sensitivity and tolerance (H2 {approx} 0.18-0.27). These findings demonstrate strain variation in thermal sensitivity and oxycodone analgesia, sex-dependent hyperalgesia-like effects, and reduced analgesic responsiveness following voluntary oxycodone intake.

Background: The October 7, 2023 attack in southern Israel was one of the deadliest terror attacks in modern history, with 1,182 fatalities, more than 4,000 wounded individuals, and 251 hostages. The Nova music festival, an all-night outdoor rave near the Gaza border, suffered the highest number of civilian casualties, with more than 370 festival attendees killed. Survivors were exposed to prolonged life-threatening trauma with similar characteristics and within a narrow time window. Many survivors also reported being under the acute influence of psychoactive substances during the attack and the following hours. This tragic combination of civilian mass trauma and naturalistic pharmacological exposure created a rare opportunity to study trauma processing prospectively. Objective: This paper describes the rationale, design, and methodology of the Nova Protocol, a multimodal longitudinal observational study of survivors of the October 7, 2023 Nova festival attack and a sociocultural comparison group. Methods: The protocol spans from the first weeks to approximately 24 months post-trauma and includes three major assessment time points. It integrates repeated online clinical assessments, prolonged wearable-sensor monitoring, ecological assessments, saliva-based endocrine and inflammatory markers, structural and functional MRI, cardiac interoception paradigms, online and in-scanner reinforcement-learning tasks, and semi-structured qualitative interviews. Primary outcomes are PTSD symptom severity (PCL-5) and general psychological distress (K6), supplemented by a rich battery of secondary measures. Conclusion: The Nova Protocol provides an unusually rich longitudinal framework for characterizing psychological, behavioral, physiological, inflammatory, neural, interoceptive, and subjective mechanisms that shape clinical trajectories after civilian mass trauma. Because psychoactive substance exposure was naturalistic and self-selected, findings will be interpreted as mechanistic and prognostic associations rather than causal effects. The protocol is expected to inform early risk detection and scalable post-disaster monitoring and intervention strategies, as well as unique insights into how psychoactive substances impact trauma processing.

Post-traumatic stress disorder (PTSD) is a highly prevalent, debilitating psychiatric condition. Existing treatments are ineffective for many patients. 3,4- methylenedioxymethamphetamine (MDMA)-assisted psychotherapy has demonstrated substantial clinical efficacy but relies on prolonged, resource-intensive therapeutic protocols that limit scalability and accessibility. Here, we investigated whether combining MDMA with exposure-based intervention could enhance therapeutic efficiency in a preclinical model of PTSD-like behavior. Using a learned helplessness paradigm in mice, we identified trauma-susceptible individuals based on persistent escape failures following inescapable stress. Traumatised mice subsequently received brief treatment regimens consisting of MDMA or saline vehicle administered with or without exposure to the traumatic cue. Behavioral outcomes were tracked longitudinally using active avoidance performance as the primary endpoint, complemented by assays of anxiety- like, depressive-like, cognitive, and social behaviors. MDMA treatment markedly reduced trauma-associated behavioral deficits. MDMA combined with exposure produced rapid and sustained recovery compared to control conditions. Statistical analyses revealed significant treatment- and time-dependent effects on avoidance behavior, indicating accelerated resilience acquisition in MDMA-treated groups. Additional behavioral assays demonstrated dose-dependent effects of MDMA on anxiety- and depression-related measures. Together, these findings provide proof-of-principle that pharmacological modulation with MDMA can enhance exposure-driven behavioral recovery, supporting a strategy to integrate MDMA into more efficient and accessible PTSD treatment frameworks. This work establishes a preclinical foundation for clinical studies aimed at optimizing MDMA-assisted interventions to improve scalability and patient access.

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with perinatal and genetic risk factors, including prenatal maternal smoking, pre-pregnancy BMI, gestational age, birth weight, and common genetic variants. These risk factors, as well as ADHD symptoms themselves, have previously been linked to cord blood DNA methylation (DNAm). We tested the hypothesis that cord blood DNAm mediates the effects of these risk factors on ADHD symptoms. Methods: Participants were drawn from two large European population-based cohorts: the Generation R Study and Avon Longitudinal Study of Parents and Children (n=3087). Cord blood DNAm was assessed using Illumina 450k and EPIC v1 arrays. ADHD symptoms were repeatedly measured with parent-based questionnaires between the ages 6 and 10 years. A high-dimensional mediational model based on DNAm principal components mediation analysis (PCMA) estimated the global mediation effect of all tested DNAm sites. Mediation via single principal components and individual DNAm sites was also evaluated using structural equation modeling and Divide-Aggregate Composite-null Test (DACT). Results: DNAm globally mediated the relationships of maternal smoking, low birth weight, and an ADHD polygenic score (PGS) with ADHD symptoms. Specifically, DNAm explained 62% of the total effect for maternal smoking, 56% for birth weight, and 35% for the ADHD-PGS. No association with individual principal components or single DNAm sites survived multiple testing correction. Evidence for mediation was absent for pre-pregnancy BMI and inconsistent for gestational age. Conclusions: In this first epigenome-wide mediation study of ADHD, we demonstrate a role of DNAm at birth in mediating the association of maternal smoking, birth weight and ADHD-related genetic variants with ADHD symptoms. However, lack of individual site-specific findings and the observational design limit causal biological interpretations. We therefore encourage further research of epigenetic pathways for these three risk factors.