ECNP 2025

ECNP 2025 Day 1 

The opening day of the 2025 European College of Neuropsychopharmacology (ECNP) Congress established a reflective yet forward-looking tone; across sessions, clinicians and researchers grappled with one of psychiatry’s most enduring questions: how to deliver mechanistically precise treatments while restoring the wholeness of patients’ lives. 

From cardiometabolic vulnerability in schizophrenia to the measurement of patient-reported outcomes and novel frameworks for holistic care, Day 1 highlighted psychiatry’s evolving identity as a truly translational discipline. 

1. A Heart-to-Heart on the Hidden Challenges of Schizophrenia (Chaired by Sofia Pappa, Speakers: Toby Pillinger, Angel Luis Montejo Gonzalez) 

One of the first sessions of the conference, “A heart-to-heart chat on the hidden challenges in schizophrenia,” cast a spotlight on the high cardiometabolic burden among patients with schizophrenia - an effect driven by a combination of disease-related physiology, lifestyle factors, and medication side-effects. The speakers highlighted that, despite the availability of metabolic monitoring guidelines, real-world adherence remains strikingly low. Emerging data also reinforced that cardiometabolic dysfunction begins early, often during the prodromal or first-episode stages. This finding challenges the notion that cardiovascular risk is a late consequence of chronic illness or antipsychotic exposure. 

Equally important, presenters addressed the sexual-health dimension, an area that continues to receive limited clinical attention despite its profound impact on quality of life and treatment adherence. Studies have shown that sexual dysfunction affects more than half of individuals treated with second-generation antipsychotics, yet structured assessment is rare. 

For the pharmaceutical sector, this convergence invites a new class of therapeutic goals that extend beyond psychosis control to integrate efficacy with tolerability, and promote metabolic, endocrine, and sexual wellbeing. 

2. Patient-Reported Outcomes in Depression and Brain-Health Disorders: from Measurement to Clinical Impact (Chaired by Stephen M. Stahl, Speakers: Lucie Bartova, Marcin Siwek) 

*Session financially supported by Angelini Pharma 

If schizophrenia exemplifies the cost of neglecting physical health, depression illustrates the perils of undervaluing subjective experience. The session “Patient-reported outcomes (PROs) in depression and brain-health diseases: from measurement to clinical impact” explored how modern psychiatry can quantify how patients feel and function, and what they value and expect from treatment. 

Traditional outcome measures (symptom scales such as HAM-D or MADRS) have driven decades of antidepressant research but capture only part of the patient journey. Speakers argued that recovery must be measured in terms of functioning, motivation, cognition, and social connectedness. The potential of new digital and ecological-momentary assessment tools in capturing mood variability, cognitive performance, and fatigue in real time was also discussed; by integrating these metrics into clinical trials, investigators could better align regulatory endpoints with patient priorities. Importantly, regulatory agencies, including the EMA and FDA, are increasingly receptive to patient-centred endpoints in pivotal trials. As speakers highlighted it, demonstrating improvements in functioning and self-perceived wellbeing - not just symptom reduction - can redefine what treatment success means. 

3. A New Peak in Psychiatry: The Pyramidal Approach to Holistic Treatment (Chaired by Kamilla Miskowiak, Speakers: Christoph U. Correll, Kamilla Miskowiak, Roger McIntyre) 

*Session financially supported by Gedeon Richter & AbbVie 

Among Day 1’s conceptual highlights was the unveiling of the ‘pyramidal approach’ to holistic treatment, a new model for organizing psychiatric care. Framed as “a new peak in psychiatry,” the approach conceptualizes treatment as a multi-layered pyramid, integrating psychopathology, somatic symptoms, functioning, and patient satisfaction and quality of life. 

The speakers argued that psychiatry has historically operated in silos, while the pyramidal approach aims to unify these formerly disparate aspects of psychiatric care through shared biomarkers, integrated care pathways, and multidimensional outcome tracking.  

4. Towards Full Recovery in Major Depressive and Treatment-Resistant Depression: from Optimization to Patient Perspectives (Chaired by Livia De Picker, Speakers: Narcis Cardoner Álvarez, Andrew Cutler, Henricus G. Ruhé) 

*Session financially supported by Janssen Pharmaceutica NV, a Johnson & Johnson Company 

This session revisited sobering statistics showing that a large proportion of patients with major depressive disorder (MDD) or treatment-resistant depression (TRD) fail to achieve full functional recovery, even if symptom remission is achieved. 

Speakers highlighted a number of strategies that could help clinicians maximise their patients’ chances of achieving functional recovery. For instance, early treatment optimization, including early dose optimization, faster transitions between treatments, and rational augmentation strategies, can meaningfully improve outcomes, as shown by real-world evidence presented during this session.  

Treatment personalization was also discussed, including advances in biomarker-guided treatment selection; genetic polymorphisms influencing pharmacokinetics, neuroimaging predictors of antidepressant response, and inflammatory markers are all being integrated into predictive algorithms, and machine-learning models trained on large clinical datasets are now approaching practical utility for informing treatment choice.  

Lastly, speakers discussed integrating the patients’ perspective in their treatment decisions; panels featuring patient advocates emphasized outcomes like energy restoration, cognitive clarity, and re-engagement with life roles as key indicators of recovery, and Incorporating patient-defined recovery metrics into both research and clinical practice was deemed essential to bridging the gap between statistical and meaningful recovery.  

5. Breaking Hot Topic Symposium (Chaired by Hilleke Hulshoff Pol, Speakers: Aleksi Hamina, Veerle Bergink, Katarzyna A. Dudek, Pauline Favre, Laurel Morris, Erika Comasco) 

One of the talks delivered as part of the ‘Breaking Hot Topic’ symposium confronted an uncomfortable truth: a large proportion of patients with major depression would be ineligible for most randomized controlled trials of anti-depressant treatments, revealing a gap between research samples and real-world patients. Presenters shared data showing that up to 60–70 % of routine clinical patients, including those with comorbid anxiety, substance use, suicidal ideation, or chronic medical conditions, would fail to meet typical RCT inclusion criteria. These exclusions, while designed to ensure methodological purity, create a trial population unrepresentative of everyday psychiatric practice.  

The speakers called for a paradigm shift toward inclusive, pragmatic, and patient-centred trial designs that reflect the heterogeneity of major depressive disorder. Potential strategies discussed included, adaptive protocols and real-world evidence platforms integrating electronic health records, digital symptom tracking, and broader psychosocial variables to capture outcomes that matter most to patients. For the pharmaceutical industry, this dialogue signals a critical inflection point: success will increasingly depend not only on demonstrating efficacy in idealised conditions but on proving effectiveness, safety, and functional benefit in the complex populations that dominate real-world care settings.    

ECNP 2025 Day 2 

The second day of the 2025 European College of Neuropsychopharmacology (ECNP) Congress continued to underscore the rapid transformation of neuropsychiatric research. From breakthroughs in psychedelic medicine and rapid-acting antidepressants to evolving psychiatric diagnostics and social prescribing models, the conference painted a picture of psychiatry at the edge of a paradigm shift - one increasingly defined by mechanistic insight, translational ambition, and patient-centred outcomes. 

1. Time Matters: the Potential of Rapid-Acting Antidepressants in Treatment-Resistant Depression (Chaired by Michael E. Thase, Speakers: Michael E. Thase, Lisa Harding, Jan Ramaekers, Wiesław J. Cubala) 

*Session financially supported by GH Research 

The ‘Time Matters’ session revisited a key challenge in treatment-resistant depression (TRD): how to deliver rapid, meaningful, and sustained symptom relief. The field has evolved significantly since the introduction of psilocybin, ketamine and esketamine, all of which have demonstrated that antidepressant effects need not take weeks to emerge. 

Speakers reviewed progress on next-generation compounds targeting glutamatergic, GABAergic, and neuroplasticity-related pathways, including classic and non-classic psychedelics, and agents aimed at enhancing synaptic plasticity. The discussion emphasized the importance of temporal dynamics - not merely in terms of efficacy onset, but in understanding how rapid-acting interventions reshape neural circuits over days and weeks. As one presenter noted, future antidepressant pipelines will likely be judged as much by the speed and durability of effect as by the classical benchmarks of efficacy and tolerability.  

2. Highlights in Psychedelics (Speaker: Francesco Bavato) 

Few domains in neuropsychiatry have captured attention and controversy quite like psychedelic medicine. This session offered a mature and data-driven perspective, with results from recent randomized controlled trials that collectively advance understanding while also tempering some of the initial enthusiasm. 

One of the highlighted studies came from Robinson et al’s (2025) report of a Phase 2b randomized trial investigating MM120 (lysergide D-tartrate) in generalized anxiety disorder (GAD). The investigators identified a significant and clinically meaningful reduction in anxiety at four weeks, suggest that a single administration of MM120 could induce anxiolytic effects. Importantly, adverse events were consistent with the expected psychedelic profile, with visual perceptual changes and transient nausea being most common. This trial’s findings inform dose selection for Phase 3 development, marking an important milestone for MindMed’s MM120 program and for the broader class of psychedelics targeting anxiety. Nevertheless, Dr Bavato highlighted certain limitations, including a high likelihood of functional unblinding, the absence of a ‘treatment-as-usual’ comparator, and variable psychotherapy exposure among participants. 

In another pivotal study, Rieser et al. (2025) examined psilocybin-assisted psychotherapy for relapse prevention in patients with alcohol use disorder (AUD) following withdrawal treatment. While both the psilocybin and placebo groups exhibited reduced cravings and improved self-control, the magnitude of change did not differ significantly, and psilocybin did not significantly outperform placebo in terms of abstinence duration or alcohol consumption at follow-up. Despite its negative outcome, the trial contributes crucial nuance to the psychedelic discourse; the study highlights the importance of exploring dose optimization, multi-session regimens, and individualized psychotherapeutic frameworks.  

The microdosing phenomenon was also discussed, focusing on Mueller et al.’s (2025) data from a Phase 2a double-blind trial of low-dose LSD in adults with ADHD. The results showed that while LSD was safe and well-tolerated, but no more effective than placebo in reducing ADHD symptoms. Both the placebo and LSD groups demonstrated symptom reduction, suggesting significant placebo and expectancy effects, possibly amplified by functional unblinding. These findings challenge anecdotal claims about microdosing’s cognitive or attentional benefits in ADHD, reinforcing the need for rigorous methodology and dose calibration in future trials.  

The last study highlighted in this session was a meta-analysis comparing control arm outcomes across trials of psilocybin, SSRIs, and esketamine for depression (Hieronymus et al., 2025). The findings were striking: control group improvements were markedly smaller in psilocybin trials compared with SSRI and esketamine controls. This suggests that the treatment effects of psilocybin may be overestimated compared to those of SSRIs and esketamine, potentially reflecting differences in expectancy and blinding integrity. For industry observers, this is a pivotal insight, implying that the next generation of psychedelic trials must adopt more sophisticated control conditions and expectancy management strategies to yield robust efficacy estimates.  

3. DSM Update Session – Future Directions and Biomarkers (Chaired by Martien Kas, Speaker: Nitin Gogtay) 

One of the most forward-looking talks of Day 2 was the DSM Update Session, featuring members of the APA’s strategic committee, including Martien Kas and Nitin Gogtay. With planning underway for the next revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), this session represented a rare convergence of clinical, cultural, and neuroscientific perspectives on psychiatric nosology. 

Nitin Gogtay, the Chief of Research and Medical Director of the American Psychiatric Association led this session; he acknowledged that the DSM’s historically atheoretical stance, which focuses on descriptive symptom clusters rather than underlying mechanisms, has limited the field’s capacity to integrate biomarkers and biological insights. He explained that the next edition aims to improve upon DSM-5-TR by: 

• Incorporating dimensional models of symptom severity 

• Integrating biomarker-informed categories where evidence supports diagnostic validity 

• Accounting for social determinants and cultural context in diagnosis 

• Expanding emphasis on quality of life and functional outcomes as core diagnostic considerations 

The conversation emphasized that a neuroscience-informed DSM is not simply a technical update but a philosophical shift toward precision psychiatry. However, ethical and practical challenges loom large: how to handle predictive biomarkers, manage incidental findings, and ensure equitable access to biologically informed diagnostics? For the pharma industry, these developments could transform target selection, trial inclusion criteria, and regulatory endpoints, aligning drug development with our evolving knowledge of psychiatric nosology.  

4. Social Prescribing: Psychiatry’s Expanding Therapeutic Toolkit (Moderated by Nicholas C. Stefanis, Speaker: Daisy Fancourt)

Complementing the biological focus of prior sessions, this talk highlighted the importance of social prescribing, the practice of linking patients to non-clinical interventions such as community activities, exercise, or arts-based programs to enhance mental health and wellbeing. 

As health systems across Europe adopt social prescribing at scale, psychiatrists are being urged to engage with this model proactively rather than view it as peripheral. Presenters highlighted the growing evidence base linking social connectedness, lifestyle engagement, and reduced psychiatric morbidity, particularly in depression and anxiety. 

For clinical psychiatrists, social prescribing represents a tangible tool for improving functioning and quality of life, aligning with the DSM committee’s renewed emphasis on holistic outcomes. For industry stakeholders, it signals that the future of psychiatric care will be multimodal, integrating pharmacologic, psychotherapeutic, and social interventions in personalized care frameworks.    

ECNP 2025 Day 3 

The penultimate day of the ECNP Congress was forward-looking and pragmatic in equal measure. After two days of bold conceptual shifts and emerging data, Day 3 focused on translational implementation and how new treatments, technologies, and clinical frameworks can be responsibly integrated into psychiatric care.  

1. Novel Therapies Symposium (Chaired by Andreas Reif and Mark Weiser, Speakers: Michael Browning, Maxine Dibué, Thomas Desmidt, Abhishek Pratap, Gahan Pandina, Wiesław J. Cubala) 

*Session discusses studies sponsored by LivaNova, Boehringer Ingelheim, Johnson & Johnson, and GH Research  

Day 3’s Novel Therapies Symposium surveyed recent clinical advances across depression and schizophrenia.  

The first session of the symposium focused on the placebo-controlled phase 2b PAX-D trial, which evaluated treatment augmentation with the dopamine agonist pramipexole in adults with treatment-resistant depression (TRD). Researchers found that pramipexole produced a statistically significant and clinically meaningful reduction in MADRS scores versus placebo at 12 weeks. However, researchers also highlighted that treatment termination due to adverse effects was more frequent in the pramipexole group. 

The following talk highlighted new long-term data for Implanted Vagus Nerve Stimulation (VNS) therapy for chronic and treatment-resistant depression. The speakers discussed the RECOVER and RESTORE-LIFE programs; in the U.S. RECOVER trial patients receiving VNS alongside treatment-as-usual achieved higher rates of remission and quality-of-life improvement than those receiving usual care alone, and the European RESTORE-LIFE post-market study mirrored these findings in real-world clinical practice, reporting approximately 50% response rates at one year, improved daily functioning, and low discontinuation. Together, these studies indicate that VNS delivers meaningful, enduring relief for a subset of patients with severe, refractory depression, underscoring its potential role as a neuroadaptive therapy complementing pharmacologic and psychotherapeutic approaches. 

The next session focused on recent work that has revitalized interest in nitrous oxide (N₂O) as a potential rapid-acting antidepressant. In a clinical study combining neuroimaging and physiological measurements, a single one-hour inhalation of nitrous oxide produced sustained mood improvement lasting up to two weeks in patients with antidepressant-resistant major depression. These findings highlight nitrous oxide as rapid-onset antidepressant, which Dr Desmidt and his team are currently investigating for older adults, as they often show hypersensitivity in response to conventional antidepressants and could benefit from nitrous oxide’s rapid onset of action and benign safety profile. 

The fourth session of the symposium included data from the BI-sponsored CONVOKE study, which marks one of the first large-scale clinical evaluations of a digital therapeutic designed to target the negative symptoms of schizophrenia, which remain poorly addressed by current medications. Participants used an app-based platform that combined cognitive and behavioural exercises with clinician monitoring tools, and over 16 weeks, the digital therapeutic produced significant improvements in negative symptoms and functional capacity compared with treatment-as-usual, with high adherence and positive user feedback. For researchers and industry alike, CONVOKE demonstrated that digital interventions are emerging as legitimate, evidence-based treatment modalities, capable of complementing pharmacotherapy in complex psychiatric disorders. 

The J&J-sponsored talk that followed discussed Seltorexant, a first-in-class selective orexin-2 receptor antagonist, that has emerged as a promising approach for patients with major depressive disorder with symptoms of insomnia. Earlier phase 2 data demonstrated that nightly seltorexant produced mild, but statistically significant improvements in both depression severity and sleep quality, establishing the rationale for a large phase 3 trial comparing it with quetiapine XR as adjunctive therapy. According to the top-line results presented, seltorexant achieved comparable antidepressant efficacy with a superior tolerability profile, although it did not reach statistical superiority over quetiapine on the primary endpoint.  

The final session of the symposium highlighted the findings of a recent Phase 2b GH001 trial in patients with treatment-resistant depression. GH001, a proprietary, inhaled formulation of mebufotenin, is designed to induce a rapid, self-limiting psychedelic experience lasting only minutes. GH001 demonstrated a significantly higher reduction in MADRS scores compared to placebo at only 2 hours post-administration, with these effects persisting for at least 8 days. While the majority of participants experienced at least one mild or moderate transient adverse event, GH001 was safe and well tolerated, with no instances of discontinuation due to side effects. However, minimal changes were reported in depression scores for the placebo group, potentially hinting at functional unblinding affecting the final results. Nevertheless, these data position GH001 as an interesting rapid-acting antidepressant treatment that could deliver clinically meaningful benefit within hours.   

2. Discontinuation of Antidepressants: Who, When, and How? (Chaired by Henricus G. Ruhé, Speakers: Trevor Sharp, Jonathan Henssler, Jakob Van Gaalen, Katharine Wallis)

With millions of individuals worldwide taking long-term antidepressants, often for years beyond the acute treatment phase, the question of when and how to stop has become both a clinical and public health concern. Speakers reviewed data examining the neurobiological underpinnings of antidepressant discontinuation syndrome, which affects a significant proportion of patients when attempting to discontinue their medications, and suggested that gradual, hyperbolic tapering (reducing doses exponentially rather than linearly) may mitigate withdrawal more effectively.  

The “who” question proved as complex as the “how.” Predictors of successful discontinuation include long-term remission, strong psychosocial support, and absence of residual anxiety or anhedonia. Conversely, patients with comorbid conditions or multiple prior episodes remain at higher risk for relapse. Speakers highlighted ongoing work toward biomarkers of relapse vulnerability, which could eventually inform personalized discontinuation planning. 

A consistent message was that psychotherapy and behavioural interventions should be considered as companions to pharmacological discontinuation. Cognitive-behavioural therapy (CBT) and mindfulness-based relapse prevention (MBRP) appear to buffer against both physiological withdrawal and psychological dependence. Clinicians were urged to adopt a shared-decision model, balancing medical prudence with patient autonomy. The tone was pragmatic rather than alarmist: discontinuation is feasible but must be planned as carefully as initiation. 

For the pharmaceutical industry, the discourse on discontinuation introduces both challenges and opportunities. On one hand, awareness of withdrawal syndromes may temper enthusiasm for long-term prescribing. On the other, it incentivizes development of shorter acting, more easily ‘taperable’ formulations and adjunctive agents to support neurochemical normalization during withdrawal. From a regulatory and reimbursement perspective, structured discontinuation programs could soon become quality indicators in mental-health services, aligning with global trends toward deprescribing frameworks in chronic care.  

ECNP 2025 Day 4 

The final day of this year’s ECNP explored how neuroscience, technology, and patient-centred insights are converging to reshape mental health care. From molecular studies of psychedelics to longitudinal analyses in bipolar disorder and advances in digital psychiatry, ECNP’s closing day captured a field uniting biology, computation, and lived experience. 

1. Targeting Neural Circuits in Psychiatry: New Frontiers in Circuit Neuroscience (Chaired by Odile van den Heuvel, Speakers: Martien Kas, Ingo Willuhn, Martijn Figee) 

The ‘Targeting Neural Circuits in Psychiatry’ session focused on ECNP’s Precision Psychiatry Roadmap Initiative. This Initiative laid out a Precision Psychiatry Roadmap (PPR), a plan to move beyond purely symptom-based DSM/ICD labels by integrating biology and behavior (omics, imaging, physiology, digital phenotyping) with clinical measures. The speakers proposed an iterative, flexible framework in which quantitative biological and behavioural measures progressively complement today’s diagnoses, enabling biologically defined subgroups, better patient stratification, and ultimately mechanism-based treatments. This effort is being coordinated under the ECNP umbrella following its 2024 New Frontiers meeting and is explicitly designed to bring together academia, industry, regulators, funders, clinicians, and patient groups. 

The roadmap has three key pillars: (1) global alignment on principles, governance, and communication across stakeholders; (2) consensus-building on predictive validity, i.e., harmonized methods to judge when biomarkers, digital measures, and circuit-level readouts are robust enough to guide care or trials; and (3) operationalization, which involves turning validated measures into an evolving biology-informed framework that can reshape trial design, inclusion criteria, endpoints, and labelling. The speakers emphasized equity and the exposome (environmental and social determinants) as core inputs, not afterthoughts. The end-state isn’t to replace the DSM, but to layer biology and behavior onto it, improving diagnosis, reducing Phase-2/3 attrition, and speeding mechanism-matched treatments to the ‘right patient at the right time’.   

2. Psychedelics and Plasticity: From Synapses to Cognition (Chaired by Friederike Holze, Speakers: Linda Simmler, Emma Robinson, Frederick S. Barrett, Patrick Fisher) 

*Session discusses studies sponsored by Boehringer Ingelheim and Compass Pathways 

The session ‘Psychedelics and Plasticity’ comprised of different talks, all aiming to highlight novel research on psychedelics and connect molecular neuroscience with clinical outcomes. Throughout this session, speakers traced the path from rapid synaptic remodelling to lasting psychological change, arguing that psychedelics’ enduring effects may stem from transient windows of neuroplasticity that reorganize cortical networks involved in mood and self-processing.  

A dedicated discussion revisited the fundamental question of why psychedelics can produce long-lasting effects after a single dose. The convergence of molecular, circuit, and psychological evidence indicate that acute psychedelic states may open a transient ‘critical period’ of plasticity, during which learning and emotional reconsolidation are amplified. Researchers presented data showing that a single dose of psilocybin increased dendritic-spine density in mice’s prefrontal cortex, paralleling persistent behavioural improvements in stress and anhedonia paradigms. Animal data also show that administration of psychedelics induces head-twitch responses in rodents - a behavioural correlate of 5-HT2A receptor activation - paralleling the intensity of human hallucinogenic effects. Researchers are now leveraging these translational markers to quantify plasticity-linked receptor. 

Among the day’s clinical data highlights was a presentation of Müller et al. (2025) randomized, double-blind study comparing low- and high-dose LSD-assisted psychotherapy in major depressive disorder. Over 19 weeks of treatment and follow-up, clinician- and self-rated depression scales showed greater symptom reduction in the high-dose group, with improvements that persisted for several months, but statistical significance was not achieved following baseline adjustment. Still, the direction and magnitude of improvement were consistent with results from contemporary trials of other psychedelics, and the intervention was generally well tolerated, with only mild and transient drug-related side-effects. However, speakers also noted that maintaining effective blinding remains a key challenge in psychedelic trials, as participants and therapists often guessed group allocation correctly. 

Lastly, Professor Frederick Barrett explored how psychedelic drugs such as LSD and psilocybin affect creativity, cognitive control, and emotional well-being, and why these effects can be both beneficial and impairing. He argued that psychedelics temporarily shift the brain’s balance between cognitive stability (focused, goal-directed thought) and cognitive flexibility (open, associative thinking), temporarily biasing the brain toward a more flexible, exploratory mode of cognition. In moderate doses, this shift may enhance divergent thinking, creativity, and openness, but at higher doses it can impair attention, working memory, and response inhibition. These effects depend not only on the dose and timing (acute vs. post-acute) but also on individual baseline brain chemistry. 

Professor Barett and his colleagues have also proposed a mechanistic bridge between psychedelics’ short-term cognitive effects and their long-term mood benefits and suggest that psychedelics may open a window of heightened plasticity during which people can ‘relearn’ more adaptive cognitive strategies. In depression, for example, excessive cognitive stability can trap individuals in ruminative thought patterns; by promoting flexibility and positive affect while enhancing neural plasticity, psychedelics might help rebalance this system, leading to lasting improvements in mood and psychological resilience.   

3. Insights from Longitudinal Studies in Bipolar Disorder (Chaired by Katharina Förster, Speakers: Luisa Klahn, Danella Hafeman, Hanne Lie Kjaerstad, Tomas Hajek) 

Moving from acute interventions to chronic treatment trajectories, the bipolar disorder session examined long-term course modifiers, biomarkers, and digital tracking in affective instability. New evidence from multinational cohorts suggests that early subthreshold mood fluctuations and circadian rhythm disruptions can predict subsequent manic episodes and recurrence. Inflammatory and metabolic markers also appear to mediate these outcomes. Clinicians were urged to adopt staging models of bipolar disorder and identify prodromal, acute, and residual phases with tailored therapeutic intensity. For pharma, such staging opens avenues for phase-specific interventions, from neuroprotective or anti-inflammatory agents early on to cognitive enhancers and neuromodulators later in the disease course.  

4. Unravelling Suicide’s Multidimensional Puzzle: From Genetic Insights to Clinical Interventions (Chaired by Giuseppe Fanelli and Anjali Sankar, Speakers: Giuseppe Fanelli, Xenia Gonda, Marcus Sokolowski, Raffaella Calati) 

One of the day’s most sobering yet essential discussions addressed suicide risk through a multidimensional framework. Genomic data reveal polygenic overlaps between suicidality, impulsivity, and mood dysregulation, suggesting that suicidal behavior is a distinct, biologically influenced phenotype, not merely a symptom of depression. Functional imaging studies identify aberrant circuit activity associated with impaired valuation and cognitive control in people with suicidal ideation and a history of attempted suicide. 

Speakers emphasized that integrating biological markers with digital behavioural data, such as sleep irregularity, social withdrawal, linguistic markers in text or voice, could enable earlier detection. Clinically, interventions are moving toward real-time monitoring and just-in-time adaptive support, combining pharmacotherapy, psychotherapy, and digital outreach; overall, the goal for the clinical management of suicidality and suicide prevention is to move from risk assessment to risk interception.  

5. Predicting Emerging Episodes in Affective Disorders: Is Mobile Monitoring the ‘Holy Grail’? (Chaired by Ulrich Ebner-Priemer and Silke Matura, Speakers: Ulrich Ebner-Priemer, Faith Matcham, Marieke Schreuder, Evelien Snippe) 

Continuing the discussion on how digital health tools can enhance the clinical management of psychiatric disorders, this session focused on whether continuous mobile monitoring could become psychiatry’s ‘holy grail’ and enable pre-emptive intervention before full-blown relapse. Integrating wearable data (e.g., heart-rate variability, sleep architecture), passive smartphone sensing, and self-report apps, multi-parameter models are beginning to delineate individualized digital phenotypes. Pilot programs now link these predictions to just-in-time therapeutic prompts or clinician alerts, effectively creating a digital ‘early-warning system’. However, speakers cautioned that predictive accuracy must be balanced with clinical interpretability and patient autonomy; over-surveillance risks eroding patient-clinician trust, while under-monitoring risks missing opportunities for prevention.    

6. Highlights in Digital Health and Artificial Intelligence (Speaker: Thomas Wolfers)  

The digital-health session demonstrated that psychiatry’s digital transformation is no longer theoretical, through a series of presentations on how different technologies are currently being used to improve the management of mental health conditions worldwide. 

Large-scale mobile-monitoring studies now aggregate multimodal data, including sleep, activity, voice, and social-interaction metrics, which can be used to create models that anticipate and predict mood episodes across affective disorders. For instance, preliminary findings show that algorithmic models can predict the onset of manic episodes in bipolar disorder and relapse in depressive disorders with a high degree of specificity and sensitivity. 

AI-driven platforms can also be used to reduce barriers to care and provide continuous symptom tracking. When combined with pharmacological therapy, these systems can improve adherence and allow clinicians to adjust treatment dynamically. Regulators in Europe are currently developing new frameworks for combinations of digital therapeutics with pharmaceutical interventions, which could redefine future reimbursement models and clinical-trial designs in the near future. 

The discussion also tackled the ethical dimensions of digital psychiatry, including patient consent, algorithmic bias, and data privacy, and the speakers emphasized the need for human-in-the-loop oversight to ensure AI systems enhance, not replace, clinician judgment.   

Overall, ECNP 2025 underscored that psychiatry is entering an era of convergence where neuroscience, clinical pragmatism, and societal relevance must coexist. Psychedelics continue to intrigue but must prove durable and replicable effects under rigorous conditions, and rapid-acting antidepressants demonstrate that temporal precision can redefine therapeutic categories. Meanwhile, initiatives like the DSM update, the Precision Psychiatry Roadmap, social prescribing, and digital tools remind us that the next decade in neuropsychiatry will reward integration across disciplines, data types, and dimensions of human experience.