Background: Antidepressants are essential in managing depression, including treatment-resistant cases. Public perceptions of these medications, shaped by social media platforms like X (formerly Twitter), can influence treatment adherence and outcomes. This study explores public attitudes toward antidepressants through sentiment and topic modeling analysis of tweets in English and Spanish from 2007 to 2022. Methods: Tweets mentioning antidepressants approved for depression were collected. The analysis focused on selective serotonin reuptake inhibitors (SSRIs) and glutamatergic drugs. Sentiment analysis and topic modeling were conducted to identify trends, concerns, and emotions in discussions across both languages. Results: A total of 1,448,674 tweets were analyzed (1,013,128 in English and 435,546 in Spanish). SSRIs were the most mentioned antidepressants (27.9% in English, 58.91% in Spanish). Pricing and availability were key concerns in English tweets, while Spanish tweets highlighted availability, efficacy, and sexual side effects. Glutamatergic drugs, especially esketamine, gained attention (15.61% in English, 25.23% in Spanish), evoking emotions such as fear, sadness, and anger. Temporal analysis showed significant increases in discussions, with peaks in 2012 and 2021 for SSRIs in Spanish, and exponential growth from 2018 to 2021 for glutamatergic drugs. Emotional tones varied across languages, reflecting cultural differences. Conclusions: Social media platforms like X provide valuable insights into public perceptions of antidepressants, highlighting cultural variations in attitudes. Understanding these perceptions can help clinicians address concerns and misconceptions, fostering informed treatment decisions. The limitations of social media data call for careful interpretation, emphasizing the need for continued research to improve pharmacovigilance and public health strategies.

Background: Public discourse on social media plays an increasingly influential role in shaping health-related perceptions and behaviours. Individuals share experiences, concerns, and opinions beyond clinical settings around different issues. X (formerly Twitter) provides a unique lens through which to examine how different treatments are perceived, used, and debated across diverse communities over time. Objective: The study aims to (a) identify the types of ADHD medications mentioned in posts, depending on language and user type; (b) evaluate the popularity of content related to these medications, considering language and user type; (c) analyse temporal changes in the frequency of mentions between 2006 and 2022; and (d) examine the distribution of tweets across different content categories. By addressing these objectives, this study provides insights into public perceptions of ADHD medications, which may help healthcare professionals better understand online discussions and improve their communication with patients, facilitating more informed treatment decisions. Methods: An observational study was conducted analysing 254,952 tweets in Spanish and English about ADHD medications from January 2006 to December 2022. Content analysis combined inductive and deductive approaches to develop a categorisation codebook. BERTWEET and BETO models were used for machine learning classification of English and Spanish tweets, respectively. Descriptive statistical analysis was performed. Results: Overall, stimulant medications were posted more frequently and received higher engagement than non-stimulant medications. Methylphenidate, dextroamphetamine, and atomoxetine were the most commonly mentioned medications, especially by patients, who emerged as the most active users among the English tweets. Regarding medical content, tweets in English contained more than twice the number of mentions of inappropriate use compared to those in Spanish. There was a high content of online medication requests and offers in both languages. Conclusions: In this study, conducted on X, discussions on ADHD medications highlighted concerns about misuse, adherence, and trivialisation, with clear differences between English and Spanish tweets regarding focus and type of user participation. These findings suggest that monitoring social media can provide early signals about emerging trends, helping clinicians address misconceptions during consultations and informing public health strategies aimed at the safer and more responsible use of ADHD medications.

Background: Although lithium is considered the gold standard for the maintenance treatment of bipolar disorder (BD), its prescription has declined in recent decades. At the same time, second-generation antipsychotics (SGAs), such as quetiapine, and other mood stabilisers such as valproic acid, have been increasingly used. Social media platforms such as X (formerly Twitter) provide real-time insights into public and professional perceptions of these treatments, which may influence their use and adherence. Aims: To analyse how lithium, quetiapine, and valproic acid have been represented on X, by focusing on user type, engagement levels, and thematic content of tweets. Method: We conducted a mixed-methods, observational study of tweets published in English and Spanish between 2008 and 2022. Tweets containing the generic or commercial names of lithium, valproic acid, and quetiapine were retrieved and analysed using a validated codebook and semi-supervised machine-learning models. Tweets were categorised by user type and clinical and non-clinical content themes. Results: Among the 236,797 analysed tweets, quetiapine was the most frequently mentioned drug (69.4%), followed by valproic acid (19.1%) and lithium (11.5%). Lithium tweets showed the highest engagement (54.0 likes and 18.0 retweets per tweet). Patients mainly focused on quetiapine (47.0%), while healthcare professionals more often discussed lithium (58.1%). Tweets containing clinical content were more common in English (78.0%) than in Spanish (54.7%), especially regarding side effects (53.1% vs 8.2%). Tweets on effectiveness were more frequently discussed in English (48.8%), especially for quetiapine (54.7%), but were less common in Spanish (9.8%). Discussion about drug shortages was more prevalent in Spanish tweets (31.6% vs 0.5%), particularly for valproic acid (55.8%). Conclusions: Despite lithium being the least mentioned drug, it generated the highest level of engagement, particularly among healthcare professionals. In contrast, quetiapine was widely mentioned by patients, which reflects a more socially widespread and, at times, problematic use. These findings highlight the value of listening to conversations on social media to better understand perceptions, concerns, and attitudes that may influence adherence and prescribing trends in mental health.

Background: Mental health disorders have been rising globally, and social media platforms provide a unique opportunity to examine public perceptions of psychotherapy. However, little is known about how different therapeutic modalities are discussed across linguistic and cultural contexts. Objective: To analyse how psychotherapies are discussed on X (formerly Twitter) over a 15-year period, comparing thematic content and emotional tone between English and Spanish-speaking communities' tweets. Methods: We collected 102,946 public tweets from 2008 to 2022, including 76,878 in English (74.7%) and 26,068 in Spanish (25.3%), related to four therapies: Acceptance and Commitment Therapy (ACT), Cognitive Behavioural Therapy (CBT), Psychoanalytic/Psychodynamic Therapy (PAT), and Narrative Therapy (NT). Topic modelling was performed using BERTopic. Emotion classification was conducted using DistilRoBERTa and Robertuito pre-trained transformer-based language models based on Ekman's six basic emotions. Results: CBT was the most frequently mentioned therapy (51,250 tweets, 49.8%), followed by ACT (18,196 tweets, 17.7%). In English tweets, the main theme was professional therapy promotion (CBT: 29,383 tweets), and fear was the most prevalent emotion. In Spanish tweets, personal experiences were more common, particularly in ACT (2,528 tweets), while anger dominated tweets about PAT (2,825 tweets), linked to a lack of understanding. Joy emerged as the dominant emotion in Spanish tweets about ACT and NT. The volume of tweets increased notably from 2020 onwards, especially in English, coinciding with the COVID-19 pandemic. Conclusions: Clear linguistic differences shape the public discourse around psychotherapy. English tweets emphasise clinical utility and are marked by fear, whereas Spanish tweets focus on individual experiences, with emotions ranging from joy to frustration. These findings underscore the importance of culturally adapted mental health communication strategies on social media.

Background: Neurodevelopmental disorders, especially attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), have seen a marked rise in public attention, yet research on public opinion remains limited. Social media analysis offers real-time, unfiltered insights into public perceptions, enabling empirical examination of public attitudes and opinions. Objective: This study aimed to assess the evolution of public opinion on ADHD and ASD between 2009 and 2023 by analyzing posts from X (formerly known as Twitter; X Corp), comparing perceptions across English and Spanish languages and against other mental health conditions. Methods: Posts mentioning keywords related to ADHD and ASD and control conditions (eg, depression, anxiety, insomnia, bipolar disorder, schizophrenia, suicide, and substance use disorders) were collected from X between 2009 and 2023. The dataset included posts in both English and Spanish. Machine learning algorithms were then applied to classify post content into predefined categories, including volume of posts, engagement, personal experiences, trivialization, perceived causes, and perceived treatability. Parametric and nonparametric tests were used to assess for differences by language. Descriptive statistics were presented using tables and graphical representations. Results: A total of 852,990 posts were analyzed, including 511,510 (59.97%) in English and 341,480 (40.03%) in Spanish. Overall, post volume on mental health conditions increased across the study period. In English, posts about ADHD (97,084/511,510, 18.98%) and ASD (74,619/511,510, 14.59%) were among the most frequent, while of the 341,480 Spanish posts, there were 49,475 (14.49%) ASD posts, significantly outnumbering ADHD posts (n=18,223, 5.34%; chi-square test P<.001). Engagement analysis indicated a notable increase in likes and reposts per post over time, particularly after 2019, with ADHD-related posts in English experiencing peak engagement during the COVID-19 pandemic. However, ASD posts had comparatively lower engagement across languages. Posts sharing personal experiences were more polarized in Spanish, with higher proportions of negative and positive experiences compared with English posts. Trivialization of mental illnesses was less common in Spanish posts than in English posts, particularly for ADHD (17,053/18,223, 93.59%; chi-square test P<.001) and ASD (41,933/49,475, 84.73%; chi-square test P<.001). User-perceived causes included multifactorial factors, biological or genetic factors, substance use, psychological susceptibility, acute psychosocial stressors, and COVID-19. Perceived treatability varied by language but consistently included high perceived incurability, limited improvement despite professional help, and low perceived self-manageability except for anxiety. Conclusions: Analysis of social media discourse showed that ADHD attracted higher post volumes, particularly during the COVID-19 pandemic, often described with multifactorial causes including substance use and genetics. ASD consistently received lower engagement. Both language groups showed low trivialization, awareness of the chronicity of the illness, and limited support for the self-management of mental health conditions. These findings underscore social media’s value for capturing direct public perceptions to guide future educational and intervention efforts.

To comprehensively synthesize the meta-analytic evidence regarding bipolar spectrum disorder (BSD) in children and adolescents. PRISMA-compliant umbrella review (PROSPERO:CRD420250651065) across multiple databases to identify meta-analyses involving children and adolescents with BSD. Literature search, screening, data extraction, and quality assessment (via AMSTAR-2) were performed independently. Findings were synthesized and grouped according to key clinical, cognitive, biological and treatment domains. Fifty-two meta-analyses were included (k=754, N=59,967, age=13.0 years, 44.8% female participants). Most reported symptoms were increased energy (79%, 95% confidence interval (CI)=61-93%), irritability (77%, 95%CI=64-88%), and mood lability (76%, 95%CI=55-92%). Psychiatric comorbidities were common, with attention-deficit/hyperactivity disorder being most frequent (53%, 95%CI=36-70%). Treatment delay was longer in children and adolescents than in adults with BSD (SMD=0.39, 95%CI=0.15-0.64). 26.2% (95%CI=24.4-28.0) of children and adolescents with BSD attempted suicide at least once, with higher risk vs. children and adolescents with depression (OR=1.59; 95%CI=1.24-2.05) and adult-BSD (OR=1.68, 95%CI=1.29-2.18). Compared to healthy controls (HCs), children and adolescents with BSD showed neurocognitive impairments. Abnormalities in neuroimaging markers were significant in children and adolescents with BSD vs. HCs, children and adolescents with depression and adult-BSD. Second-generation antipsychotics (SMD=0.68, 95%CI=0.51-0.86) and mood stabilizers (SMD=0.61, 95%CI=0.40-0.82) were superior for mania vs. placebo. Cognitive behavioral therapy (CBT) was associated with improvements in manic and depressive symptoms. BSD in children and adolescents is linked to illness severity, cognitive deficits, and neuroimaging abnormalities, requiring integrated pharmacological and psychosocial interventions (e.g. CBT). SGAs effectively treat mania, but options for depression remain limited. More prognostic and long-term studies are needed.