Melatonin and Sleep

Peter Forster Basic Science, Insomnia, Insomnia Treatment, Psychobiology

What is the relationship between melatonin and sleep? And why are the results that people have from taking melatonin supplements to help induce sleep so variable? A recent article has suggested that the two melatonin receptors, melatonin one (M1) and melatonin two (M2) that have been shown to existing humans may have different effects on sleep. A quick review may …

Antidepressants May Blunt Feelings of Romance

Peter Forster Treatments of Depression

Antidepressants may blunt feelings of romance when taken long-term according to a recent study, but the way this effect shows up may be quite different in men and women. Researchers presented a study at the European College of Neuropsychopharmacology (ECNP) Congress which used a newly developed Sex-Attachment-Love Test (SALT) questionnaire. They looked at almost 200 adults with mild or moderate depression …

Institute for Psychiatric Services

Peter Forster General, GPS Update

The Institute for Psychiatric Services, the American Psychiatric Association’s smaller and more collegial educational program, is coming to San Francisco next week. The meeting will be in San Francisco’s Moscone Center from Thursday through Sunday and promises to be a not to miss educational and social program for clinicians with an interest in treating major depression, bipolar, and other serious mental illnesses. …

TMS Effectiveness

Peter Forster Major Depression, Treatments of Depression

TMS effectiveness is something I have spent a fair amount of time researching. Last year I gave two Grand Rounds presentations on this topic at the University of California, San Francisco and at the California Pacific Medical Center. But despite the compelling evidence that, if you have failed two (or maybe three) antidepressant trials for the treatment of your depression, your …

Prior Authorization Form – New Law in California

Peter Forster Costs of Treatment, Policy

Prior authorization forms for medications, and the entire prior authorization process, can be a nightmare. In my experience, with at least one company, the rule seemed to be, if you filled out a form you were told that you needed to call to obtain the OK, and if you called you were told to fill out a form. It was …

Bipolar or Unipolar Depression?

Peter Forster Diagnosis

Bipolar or unipolar depression: How to distinguish between these two conditions, which can have very different treatment response remains a difficult question without really satisfying answers. As noted in the picture to the right, misdiagnosis is common and can have serious consequences. An article in European Psychiatry adds to the literature pointing to certain features that increase the odds that someone …

Genetic Testing for Depression Drugs

Peter Forster Costs of Treatment, Major Depression, Testing, Treatments of Depression

Genetic testing for depression drugs is a new approach to selecting medications that may have value, especially in patients with treatment resistant depression. We have been using the Genecept Assay for patients with treatment resistant depression and have found that the results improve our ability to choose effective treatments. Patients who have failed multiple adequate trials of medications are much less likely to …

Therapy or Medication for Depression

Peter Forster Major Depression, Treatments of Depression

Therapy or medication for depression? Which is more effective? When might you want to consider both treatments? These are among the most frequent questions that we are asked. A recent study published in JAMA Psychiatry provides the best information available about how to make this decision. The study involved 452 patients who received antidepressant medication treatment for depression with or …

TMS Mechanism of Action – Changes in Brain Connectivity?

Peter Forster Basic Science, Treatments of Depression

TMS’s mechanism of action has been unclear. Transcranial magnetic stimulation affects activity locally in the region of the brain that is stimulated, but does that explain how it works? Since it affects local activity in every patient, why does it not work for everyone? A new article in Biological Psychiatry suggests that it may be changes in brain connectivity that …

Exercise and Stress – How Exercise Prevents Depression

Peter Forster Major Depression, Physical Conditions and Health, Treatments of Depression

Exercise seems to reduce stress. But how does this work? And what about exercise effects on depression? An article in the New York Times summarizes a recent publication in the journal Cell which may explain how exercise prevents depression. A wealth of research shows that regular exercise reduces the risk of depression. A very large study in Britain, for example, suggested that …