Since 2024 the CHUM’s Laboratory for Psychedelic Research, led by Dr. Nicolas Garel, conducts cutting-edge clinical research at the intersection of psychoactive substances and mental health care. Bringing together professionals and trainees from diverse disciplines, the laboratory is committed to the highest standards of scientific rigor and ethical integrity in clinical research.

1 Greenway KT, Garel N, Jerome L, Feduccia AA. Integrating psychotherapy and psychopharmacology: psychedelic-assisted psychotherapy and other combined treatments. Expert Rev Clin Pharmacol. 2020;13(6):655-670. doi:10.1080/17512433.2020.1772054

Although combinations of psychotherapy and pharmacological treatments, including psychedelic-assisted approaches, show strong clinical promise, their shared therapeutic mechanisms remain unclear. This analysis suggests that the contextual model of common psychotherapy factors provides a unifying framework, with antidepressants and especially psychedelics potentially enhancing therapeutic outcomes by increasing neurochemical plasticity and sensitivity to context.

 

2 Rosenblat JD, Husain MI, Lee Y, et al. The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: Serotonergic Psychedelic Treatments for Major Depressive Disorder. Can J Psychiatry Rev Can Psychiatr. 2023;68(1):5-21. doi:10.1177/07067437221111371

The Canadian Network for Mood and Anxiety Treatments conducted a systematic review of clinical trials on serotonergic psychedelics for major depressive disorder. Evidence from small studies suggests preliminary antidepressant effects of psilocybin and ayahuasca, but findings are limited by small samples and methodological issues. Overall, the evidence remains low-level, and psilocybin is currently considered an experimental treatment recommended primarily within clinical trials in Canada.

 

3 Garel N, McAnulty C, Greenway KT, et al. Efficacy of ketamine intervention to decrease alcohol use, cravings, and withdrawal symptoms in adults with problematic alcohol use or alcohol use disorder: A systematic review and comprehensive analysis of mechanism of actions. Drug Alcohol Depend. 2022;239:109606. doi:10.1016/j.drugalcdep.2022.109606

This systematic review evaluated the evidence for ketamine as a treatment for alcohol use disorder and alcohol withdrawal, identifying eight studies across outpatient and intensive care settings. Findings were mixed regarding its effects on alcohol use, cravings, and withdrawal symptoms. Although results appear promising, the current evidence is insufficient to draw firm conclusions, highlighting the need for larger, well-designed trials.

 

4 Garel N, Drury J, Thibault Lévesque J, et al. The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression. Front Psychiatry. 2023;14. doi:10.3389/fpsyt.2023.1268832 

This article introduces the Montreal model, a biopsychosocial approach to subanesthetic ketamine for treatment-resistant depression developed over six years in public healthcare settings. The model integrates biomedical and psychedelic frameworks, pairing six ketamine infusions with structured psychiatric care and preparatory and integrative psychotherapy. Conceptualizing ketamine as creating “windows of opportunity” for symptom relief and psychological growth, the approach aims to offer a standardized yet flexible model, though further research is needed to evaluate its effectiveness and mechanisms.

 

5 Garel N, Tate S, Nash K, Lembke A. Trends in hallucinogen-associated emergency department visits and hospitalizations in California, USA, from 2016 to 2022. Addiction. 2024;119(5):960-964. doi:10.1111/add.16432 

This ecological study analyzed California health-care data (2016–2022) to compare trends in hallucinogen-, alcohol-, and cannabis-associated emergency visits and hospitalizations. Hallucinogen-related ED visits and hospitalizations increased by over 50% during this period, a significantly steeper rise than those associated with alcohol or cannabis. Despite this large relative increase, the absolute number of hallucinogen-related cases remained comparatively small.

 

6 de la Salle S, Kettner H, Thibault Lévesque J, et al. Longitudinal experiences of Canadians receiving compassionate access to psilocybin-assisted psychotherapy. Sci Rep. 2024;14(1):16524. doi:10.1038/s41598-024-66817-0

This prospective longitudinal study examined Canadian cancer patients granted legal access to psilocybin-assisted psychotherapy through Section 56 exemptions. Among eight participants, significant improvements were observed in anxiety, depression, pain, quality of life, and spiritual well-being two weeks post-treatment, with most describing the experience as highly meaningful. Findings suggest real-world benefits comparable to clinical trials, though small sample size and reports of adverse effects highlight the need for ongoing monitoring and formal evaluation.

 

7 Garel N, Thibault Lévesque J, Sandra DA, et al. Imprinting: expanding the extra-pharmacological model of psychedelic drug action to incorporate delayed influences of sets and settings. Front Hum Neurosci. 2023;17:1200393. doi:10.3389/fnhum.2023.1200393

This study examined how past environmental exposures shape ketamine experiences in patients with treatment-resistant depression, introducing the concept of “imprinting” to describe these time-lagged effects. Reviewing clinical sessions and interviews, the authors found that prior media exposure significantly altered the phenomenology and therapeutic impact of ketamine, sometimes overriding intention-setting practices. They propose expanding the traditional set and setting model to include imprinting as a key contextual factor in psychedelic treatment.

 

8 Greenway KT, Garel N, Goyette N, Turecki G, Richard-Devantoy S. Adjunctive music improves the tolerability of intravenous ketamine for bipolar depression. Int Clin Psychopharmacol. 2021;36(4):218-220. doi:10.1097/YIC.0000000000000363 

This case report describes two patients with bipolar I depression who found that adding music during ketamine infusions reduced the distress associated with dissociative side effects, even if it did not reduce the intensity of dissociation itself. Music improved treatment tolerability and helped both patients complete six infusions, ultimately leading to remission. The authors suggest that structured music use, informed by psychedelic research, may enhance ketamine treatment and deserves further study.

 

9 Greenway KT, Garel N, Dinh-Williams LAL, et al. Music as an Intervention to Improve the Hemodynamic Response of Ketamine in Depression: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(2):e2354719. doi:10.1001/jamanetworkopen.2023.54719

The MUSIK randomized clinical trial tested whether curated music during subanesthetic IV ketamine infusions could reduce treatment-induced increases in blood pressure in patients with treatment-resistant depression. Thirty-two participants were randomized to receive music or usual care across six infusions, and changes in systolic blood pressure were compared between groups. The study aimed to determine whether music could mitigate ketamine’s hemodynamic side effects as a simple, adjunctive intervention.

 

10 Garel N, Greenway KT, Dinh-Williams LAL, et al. Intravenous ketamine for benzodiazepine deprescription and withdrawal management in treatment-resistant depression: a preliminary report. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2023;48(12):1769-1777. doi:10.1038/s41386-023-01689-y

This ambi-directional cohort study examined whether subanesthetic ketamine infusions for treatment-resistant depression could support discontinuation of long-term benzodiazepine/z-drug use. Among 22 patients, 91% successfully stopped BZDRs during the 4-week ketamine course, with relatively few experiencing significant withdrawal-related worsening of mood, anxiety, sleep, or suicidality. At one-year follow-up, 64% remained abstinent, suggesting ketamine may help facilitate safe deprescription in this high-risk population.

 

11 Garel N, Greenway KT, Tabbane K, Joober R. Serotonin syndrome: SSRIs are not the only culprit. J Psychiatry Neurosci JPN. 2021;46(3):E369-E370. doi:10.1503/jpn.210001

This case report describes a 30-year-old man with treatment-resistant depression who developed serotonin syndrome after combining escitalopram, mirtazapine, tramadol, and L-tryptophan. He presented with agitation, hyperthermia, hypertension, and neuromuscular abnormalities, and improved rapidly after discontinuation of serotonergic agents and supportive care. The report highlights the risks of serotonergic polypharmacy, the importance of early recognition, and the need for careful prescribing and patient education to prevent recurrence.

 

12 Garel N, Nazon M, Naghi K, et al. Ketamine for depression: a potential role in requests for Medical Aid in Dying? Int Clin Psychopharmacol. 2023;38(5):352-355. doi:10.1097/YIC.0000000000000462

This article reports the case of a Canadian patient with severe, prolonged treatment-resistant depression who was actively requesting Medical Assistance in Dying (MAiD) but achieved remission following a course of intravenous ketamine infusions. The case raises important ethical questions about how “irremediability” is defined in psychiatric MAiD requests. The authors argue that a trial of ketamine may warrant consideration before determining eligibility for MAiD in similar cases.

 

13 Greenway KT, Garel N, Dinh-Williams LAL, et al. The Music for Subanesthetic Infusions of Ketamine randomised clinical trial: ketamine as a psychedelic treatment for highly refractory depression. Br J Psychiatry J Ment Sci. Published online June 18, 2025:1-9. doi:10.1192/bjp.2025.102

This secondary analysis of a randomized clinical trial examined the Montreal Model of ketamine-psychotherapy for severe treatment-resistant depression, with or without music. Across six infusions, both groups showed large and sustained reductions in depression, anxiety, and suicidality, with no significant differences between music and non-music conditions. Mystical-like and emotionally intense experiences emerged as key mechanisms underlying ketamine’s antidepressant effects, suggesting a psychedelic model may help explain its therapeutic impact.

 

14 Payette O, Lespérance P, Desbeaumes Jodoin V, et al. Intravenous ketamine for treatment-resistant depression patients who have failed to respond to transcranial magnetic stimulation: A case series. J Affect Disord. 2023;333:18-20. doi:10.1016/j.jad.2023.04.019

This case series examined intravenous racemic ketamine in 21 patients with treatment-resistant depression who had not responded to a standard course of TMS. After six infusions over two weeks, patients showed a significant reduction in depressive symptoms, with 19% responding and 9.5% achieving remission. Although limited by its open-label design, the study suggests ketamine may offer a therapeutic option even after TMS failure.

 

15 Garel N, Garel P. Diagnosis of Autism Spectrum Disorder in Adolescents with Complex Clinical Presentations: A Montreal Case Series. Adolesc Psychiatry. 2019;9(1):33-43. doi:10.2174/2210676609666181204125951

This retrospective case series reviewed eight adolescents who received a late diagnosis of high-functioning autism spectrum disorder (ASD) after years of misdiagnoses, including depression, anxiety, and behavioral disorders. Their intellectual abilities had masked longstanding social and developmental irregularities, delaying recognition of ASD despite persistent childhood signs. The authors emphasize that clinicians should consider ASD in youths with complex, treatment-resistant psychiatric symptoms and atypical developmental histories, particularly when social difficulties are subtle but enduring.

 

16 Garel N, Joober R. Treatment of first-episode psychosis in patients with autism-spectrum disorder and intellectual deficiency. J Psychiatry Neurosci JPN. 2019;44(6):E31-E32. doi:10.1503/jpn.190081

The article describes the treatment of first-episode psychosis in an 18-year-old woman with autism-spectrum disorder and intellectual deficiency. Topics include the response of the patient to antipsychotic medication, two intramuscular injections of loxapine received by the patient after trying to assault a nurse, and reduction in the patient's psychotic symptomatology after five days of treatment.

 

17 Diep D, de la Salle S, Thibault Lévesque J, Lifshitz M, Garel N, Greenway KT. The ketamine chameleon: history, pharmacology, and the contested value of experience. Expert Rev Clin Pharmacol. 2025;18(3):109-129. doi:10.1080/17512433.2025.2459377 

This review traces the historical evolution of how ketamine’s subjective effects have been interpreted—moving from dissociative and psychotomimetic models to dream-like and psychedelic frameworks. The authors argue that factors such as dose, language, expectations, and treatment context significantly shape both the experience and its therapeutic impact. They conclude that ketamine is best understood as context-dependent, calling for an interdisciplinary approach that integrates environment, preparation, and explanatory models to optimize outcomes.

 

18 Elkrief L, Sharafi H, Bakouni H, et al. Efficacy and Safety of Modafinil for Treatment of Amphetamine-Type Stimulant Use Disorder: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials: Efficacité et innocuité du modafinil pour le traitement des troubles liés à l’usage de stimulants de type amphétamine : revue systématique et méta-analyse d’essais randomisés contrôlés par placebo. Can J Psychiatry Rev Can Psychiatr. 2024;69(11):793-805. doi:10.1177/07067437241262967

This systematic review and meta-analysis of five randomized controlled trials (N = 451) evaluated modafinil for amphetamine-type stimulant use disorder (ATSUD). The findings showed no significant effects on stimulant use, craving, treatment retention, or discontinuation due to adverse events compared to placebo. Higher doses were associated with more serious adverse events, and overall, the evidence does not currently support modafinil as an effective treatment for ATSUD.

 

19 Garel N, Rigas C, Ben M’rad M, et al. Mindfulness-based intervention for benzodiazepine deprescription in hemodialysis patients with anxiety and depressive symptoms. J Psychiatry Neurosci JPN. 2023;48(3):E149-E150. doi:10.1503/jpn.220216

This case report describes a 35-year-old hemodialysis patient who successfully discontinued long-term clonazepam use after completing an 8-week mindfulness-based stress reduction (MBSR) program. Using breathing and attention-based techniques, she managed withdrawal symptoms and remained benzodiazepine-free for over 18 months. The case suggests mindfulness may support benzodiazepine deprescribing in medically complex patients.

 

20 Garel N, Joober R. Are mental disorders orphan diseases? J Psychiatry Neurosci JPN. 2020;45(2):75-78. doi:10.1503/jpn.200026 

This article suggests that psychiatric disorders may consist of many biologically distinct, rare conditions grouped under shared symptom-based diagnoses. Drawing on advances in genetics and neuroscience, the authors argue that current categories may mask individual differences in underlying mechanisms. They propose that this perspective could encourage more personalized approaches to research and treatment.

 

21 Elkrief K, Lavin P, Greenway KT, et al. Heart transplant outcomes in patients with substance use disorder history: a nationwide cohort study using high-dimensional propensity score matching. Eur Heart J Qual Care Clin Outcomes. 2026;12(1):124-133. doi:10.1093/ehjqcco/qcaf117 

This retrospective cohort study examined heart transplant outcomes in patients with and without substance use disorders (SUDs) using a large U.S. national database and propensity score matching. After adjusting for sociodemographic and medical confounders, there were no significant differences in mortality, hospitalization, or organ rejection at 1 or 5 years between groups. The findings challenge assumptions that SUD history alone predicts poorer post-transplant outcomes.

 

22 Garel N, Dols A, Yu J, Cresce CD, Rej S, Sajatovic M. Effect of Cariprazine on Outcomes in Older-aged and Younger-aged Patients with Bipolar I Disorder: A Post-hoc Analysis. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2025;33(4):372-386. doi:10.1016/j.jagp.2024.12.006

This pooled post-hoc analysis evaluated cariprazine in older- and younger-age adults with bipolar I disorder experiencing depressive or manic/mixed episodes. Cariprazine significantly improved depressive and manic symptoms compared to placebo in both age groups, with largely similar treatment effects. The findings suggest cariprazine is effective across age groups in bipolar I disorder.

 

23 Longpré-Poirier C, Miron JP, Garel N, et al. Elevated allostatic load is associated with poorer response to repetitive transcranial magnetic stimulation in treatment-resistant depression. Psychiatry Res. 2024;340:116122. doi:10.1016/j.psychres.2024.116122

This cohort study examined whether allostatic load (AL), measured through pre-treatment biomarkers, predicts response to rTMS in treatment-resistant depression. Higher AL was associated with poorer overall treatment response status, though not with the magnitude of symptom reduction on the MADRS. The findings suggest that biomarker profiles based on allostatic load may help guide treatment decisions in TRD.

 

24 Richard-Devantoy S, Berlim MT, Garel N, Inja A, Turecki G. The impact of antidepressant treatment on the network structure of neurocognition and core emotional depressive symptoms among depressed individuals with a history of suicide attempt: An 8-week clinical study. J Affect Disord. 2024;361:425-433. doi:10.1016/j.jad.2024.05.111

This study used network analysis to examine relationships between history of suicide attempt (HSA), core depressive symptoms, and neurocognitive functioning in patients with major depressive disorder. At baseline, HSA was associated with lower phonemic verbal fluency, but this link was no longer present after 8 weeks of antidepressant treatment. The findings suggest that treatment may modify the relationship between suicidal history and specific cognitive domains.

 

25 Garel N, Brodsky KL, Ostacher MJ. Advancing research: a commentary on the untapped potential of acceptance and commitment therapy in alcohol use disorder treatment. Alcohol Alcohol. 2024;59(4):agae042. doi:10.1093/alcalc/agae042

This article highlights alcohol use disorder as a major global health concern and explores the potential of Acceptance and Commitment Therapy (ACT) as a treatment approach. Although ACT has shown effectiveness for various mental health conditions, controlled trials specifically targeting alcohol use disorder remain limited. The authors emphasize the need for further research to evaluate ACT’s efficacy in this population.

 

26 Guay É, Brouillette MJ, Drury J, Garel N, Greenway K. Rapid Improvement of Post-Partum Depression With Subanesthetic Racemic Ketamine. J Clin Psychopharmacol. 2024;44(2):196-198. doi:10.1097/JCP.0000000000001780

This case report describes a woman with peripartum depression who experienced only limited improvement with bupropion but showed rapid and sustained mood enhancement after two subanesthetic ketamine treatments combined with psychotherapy. Notably, she reported a marked improvement in bonding with her infant shortly after the first infusion. The authors suggest ketamine may represent a promising, fast-acting option for peripartum depression and call for further clinical research.

 

27 Garel N, Greenway K, Joober R. The antipsychotic potential of cannabidiol: clinical implications for patients with psychosis and comorbid cannabis use disorder. J Psychiatry Neurosci JPN. 2021;46(1):E164-E165. doi:10.1503/jpn.200114

This case report describes a young man with first-episode psychosis and cannabis use disorder who relapsed after resuming high-THC cannabis use. Through psychoeducation and a harm-reduction approach, he switched to cannabis with a higher CBD:THC ratio, reporting reduced paranoia and anxiety. The article highlights the potential protective role of CBD and supports integrating cannabinoid-focused psychoeducation into first-episode psychosis programs.

 

28 Longpré-Poirier C, Garel N, Samson-Daoust E, et al. The influence of metabolic dysfunction on depressive symptom trajectories: A one-year follow-up study. J Affect Disord. 2026;392:120203. doi:10.1016/j.jad.2025.120203

This longitudinal study found that higher metabolic syndrome (MetS) scores were associated with slower improvement in depressive symptoms over one year in patients with depressive disorders. Health-related behaviors such as smoking, alcohol and drug use, and sleep did not independently predict depression trajectories nor mediate the effect through MetS. The findings suggest that metabolic dysfunction may represent a biological vulnerability influencing depression outcomes and treatment response.

 

29 Desbeaumes Jodoin V, Bousseau E, Trottier-Duclos F, et al. Stepwise interventional psychiatry approach for major depression: A case series. J Psychiatr Res. 2025;191:177-179. doi:10.1016/j.jpsychires.2025.09.060

This case series explored a stepwise treatment strategy for treatment-resistant depression using tDCS, followed by rTMS and intravenous ketamine for those who did not respond. The findings suggest that sequential neuromodulation approaches may help capture different responder profiles and improve overall outcomes. The study supports further research into personalized treatment sequencing for TRD.

 

30 Garel N, Plourde L, Greenway KT, Dorval M. The promise and challenges of psychedelic-assisted therapy: lessons from Canada’s Special Access Program. Nat Ment Health. 2025;3(7):756-759. doi:10.1038/s44220-025-00446-y

This article analyzes access to psilocybin-assisted psychotherapy through Canada’s Special Access Program and notes declining approval rates despite ongoing demand. The authors highlight barriers such as regulatory complexity, lack of standardized training and care guidelines, infrastructure limitations, and stigma. They call for clearer standards and systemic reforms to support the safe integration of psychedelic therapies into clinical practice.

 

31 Garel N, Goonetilleke P, Kuriksha A, Tate S. Online Drug Markets and Implications for Addiction Medicine: A Narrative Literature Review. J Addict Med. 2025;19(4):365-370. doi:10.1097/ADM.0000000000001490

This narrative review explores the rise of online drug markets, particularly darknet platforms, and their implications for addiction medicine. It outlines how these markets operate, who uses them, and how they are reshaping substance access. The authors emphasize the need for adapted prevention strategies, innovative interventions, and thoughtful use of digital tools in addiction treatment.

 

32 Farzin H, Koren B, Ferrier H, Sanders JJ, Garel N. Home-based psilocybin-assisted therapy for a patient with advanced cancer: A case report. Palliat Support Care. 2025;23:e189. doi:10.1017/S1478951525100941

This case report describes a man with metastatic lung cancer and severe existential distress who received home-based psilocybin-assisted therapy after limited response to standard treatments. The intervention was well tolerated and led to sustained reductions in anxiety, depression, and suffering. The findings suggest psilocybin-assisted therapy may be a feasible option in palliative care settings.

 

33 Elkrief L, Kerr P, Garel N, et al. Exploring the Role of Symptom Networks in Predicting Treatment Response in Depression: A Plan for Network Analysis. Brain Stimul Basic Transl Clin Res Neuromodulation. 2025;18(1):572-573. doi:10.1016/j.brs.2024.12.1039 

This study will use psychological network analysis to examine whether baseline symptom centrality predicts response to rTMS in treatment-resistant depression. By comparing responders and non-responders, it aims to identify key symptoms that could inform more personalized treatment approaches.

 

34 Garel N, Greenway KT, Lavin P, et al. Increased Risks of Major Cardiac Adverse Events in Stimulant Use Disorder as Compared With Other Substance Use Disorders: A Propensity-score Matching Cohort Study. J Addict Med. 2025;19(5):599-604. doi:10.1097/ADM.0000000000001461

This retrospective cohort study found that individuals with stimulant use disorders had a higher risk of major adverse cardiac events compared to those with other substance use disorders, even after adjusting for confounders. The findings highlight elevated cardiovascular risk, including increased mortality, among people with stimulant use disorders.

 

35 Garel N. Nicolas Garel: Combining psychoactive molecules and psychotherapy for patients suffering from mood and substance use disorders: a new therapeutic paradigm. Psychedelics. 2024;1(1):3-5. doi:10.61373/pp024k.0016

Dr. Nicolas Garel is an Assistant Professor in Psychiatry at the University of Montreal and a junior investigator at the CHUM Research Center. His research focuses on integrating psychoactive compounds, including ketamine, with psychotherapy to treat comorbid mood and substance use disorders. In this “Innovators & Ideas” feature, he shares perspectives from his clinical and research work.

 

36 Garel N, Dols A, Yu J, Cresce CD, Rej S, Sajatovic M. Effect of Cariprazine on Outcomes in Older-aged and Younger-aged Patients with Bipolar I Disorder: A Post-hoc Analysis. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2025;33(4):372-386. doi:10.1016/j.jagp.2024.12.006

This pooled post-hoc analysis evaluated cariprazine in older- and younger-age adults with bipolar I disorder during depressive and manic/mixed episodes. Cariprazine significantly improved depressive and manic symptoms compared to placebo in both age groups, with largely similar treatment effects. The findings suggest cariprazine is effective across age groups in bipolar I disorder.

 

37 Garel N, Greenway KT, Dinh-Williams LA, et al. 68. Ketamine as a Potential Intervention for Benzodiazepine Discontinuation in Treatment Resistant Depression. Biol Psychiatry. 2023;93(9):S121. doi:10.1016/j.biopsych.2023.02.308

This study examined whether ketamine could support benzodiazepine discontinuation in patients with treatment-resistant depression. Given the difficulty of tapering benzodiazepines due to withdrawal symptoms and the lack of evidence-based strategies for depressed patients, the study explored ketamine’s potential as a therapeutic aid in facilitating safe deprescription.

 

38 Garel N. Ketamine as a potential intervention for alcohol withdrawal and benzodiazepine deprescribing in patient suffering from major depressive disorders. Accessed February 13, 2026. https://escholarship.mcgill.ca/concern/theses/sn00b430c

This thesis explored ketamine’s role in alcohol and benzodiazepine/Z-drug discontinuation, particularly in treatment-resistant depression. A systematic review suggested ketamine may reduce alcohol withdrawal symptoms, and a cohort study found high rates of successful BZDR discontinuation after ketamine infusions. The findings support further research into ketamine as a potential aid for deprescription in complex patients.

 

39 Garel N, Bloom D, Joober R. Treating anxious syndromes with pregabalin in patients with psychosis. J Psychiatry Neurosci JPN. 2020;45(5):370. doi:10.1503/jpn.200033

This case report describes a woman with schizoaffective disorder and severe anxiety whose worsening psychotic symptoms and suicidal ideation improved after treatment with pregabalin for comorbid generalized anxiety disorder. Antidepressants and benzodiazepines were contraindicated, and pregabalin led to significant reductions in anxiety, psychosis, and suicidality. The case highlights pregabalin as a potential adjunctive option for anxiety in patients with psychotic disorders.