Long Term Depression Psychotherapy

Peter Forster Best Practices, Major Depression, Treatments of Depression

Effective psychotherapy for depression that has lasted for years is needed because chronic depression (lasting two years or longer) develops in up to a third of people with an episode of major depression. Chronic depression is associated with more suicidality, more impairment in functioning, and more hospitalizations. Chronic depression psychotherapy is often less effective than therapy for other forms of depression. …

Atypical Antipsychotics with Mood Stabilizers

Peter Forster Best Practices, Bipolar Treatment

Many people with bipolar receive atypical antipsychotics with mood stabilizers. As in many areas of medicine, we have relatively little data about longer-term outcomes when people receive this combination. If an atypical antipsychotic is added to a mood stabilizer to control a manic episode, how long should that combination be prescribed? A recent study conducted by the Canadian Mood and …

Antidepressant Response Linked to Norepinephrine Transporter Genotype

Peter Forster Best Practices, Major Depression, Testing, Treatments of Depression

A large study of patients treated with venlafaxine found that antidepressant response was linked to the norepinephrine transporter (NET) genotype. The study looked at response in a sample of 350 individuals over the age of 60 with severe depression (MADRS greater than or equal to 15) who were treated with venlafaxine up to a dose of 300 mg a day. …

Insomnia Relief

Peter Forster Best Practices, Insomnia, Insomnia Treatment

How to find insomnia relief is a question that many people we work with struggle with. A recent editorial in JAMA Psychiatry and the accompanying research article suggests that the online program that we’ve been recommending to our patients for years (SHUTi) is the treatment of choice for insomnia. We have been extremely pleased with the results from this program which can …

CBT for Insomnia Reduces Depression

Peter Forster Best Practices, Insomnia, Insomnia Treatment

An online sleep program using CBT for insomnia (Cognitive Behavioral Therapy for Insomnia – CBTi) has been shown to reduce depression in a study published in the April 2016 edition of Lancet Psychiatry. CBT for Insomnia CBTi is the most effective program for treating chronic insomnia and chronic insomnia is a major risk factor for developing depression. Unfortunately, CBTi is …

Neurocognitive Testing Online

Peter Forster Best Practices, Testing

Neurocognitive Testing Online Now Available Problems with memory, inattention, distractibility and cognitive function are common symptoms of mood and anxiety disorders. They may also be side effects of the medications used to treat those conditions. Or they may be a sign of some other condition that needs to be evaluated. How can these evaluated? A key part of a comprehensive assessment …

Measurement Based Care Improves Outcomes

Peter Forster About GPS, Best Practices

Patients at Gateway Psychiatric are sometimes perplexed by the amount of time and energy we devote to tracking how they are doing. It can seem annoying to answer questions repeatedly or to fill out forms. An article in the journal Psychiatric Services summarizes the data that shows that this process (known as “measurement based care” or MBC) is associated with significantly …

Genetic Tests for Depression Reviewed

Peter Forster Best Practices, Major Depression, Psychobiology, Testing

Are genetic tests for depression treatment worthwhile? Or is this an expensive technology that is not ready for routine use? Peter Roy-Byrne, writing in NEJM Journal Watch seems to say no. Although some clinicians may argue that such testing “can’t hurt and might help,” current psychopharmacological practice is complex, usually including combinations of multiple medications, and patients can have multiple …

Mania and Depression Sequence

Peter Forster Best Practices, Bipolar Treatment

One of the key features of bipolar disorder that, in our experience, is most useful in predicting treatment response is the usual sequence of manic (or hypomanic) and depressive episodes. For years we have used the mnemonics MDI and DMI as ways of categorizing patients’ course. But we could not find the reference to that idea. We are indebted to …

Mindfulness for Depression – Research Update

Peter Forster Best Practices, Major Depression, Treatments of Depression

Mindfulness has received a lot of attention recently as an approach to improving mental health in a number of conditions. But is it really effective as part of a strategy for treating serious depression? And, if so, how can we best incorporate it into treatment, given the great difficulty that many people with depression have doing even a small amount …