TMS Effectiveness Updated

Peter ForsterBest Practices, Major Depression, Treatments of Depression

TMS effectiveness for depression is clear. But now there are more machines for providing TMS and more protocols. Is deep TMS better than regular TMS?  Or is deep TMS just a marketing phrase? A major review article in JAMA Psychiatry updated our understanding of alternatives to the initial protocol for TMS. JAMA Psychiatry is the most prestigious journal in psychiatry, …

Measurement Based Care Controversies

Peter ForsterBest Practices

Measurement based care often evokes controversies. A brilliant colleague, Carol Heckler, who is something of a local expert in psychopharmacology, interrupted a conversation I was having with another psychiatrist to say that she thought that standardized rating scales were useless. Echoing comments that I’ve heard from many of my patients, she said “how can you reduce human experience to a number?” This …

Long Term Depression Psychotherapy

Peter ForsterBest 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 ForsterBest 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 ForsterBest 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 ForsterBest 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 Somryst

CBT for Insomnia Reduces Depression – Somryst

Peter ForsterBest 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 ForsterBest 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 ForsterAbout 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 Updated 2023

Peter ForsterBest Practices, Major Depression, Psychobiology, Testing

Do Genetic Tests Help? 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 that they aren’t worth it. Although some clinicians may argue that such testing “can’t hurt and might help,” current psychopharmacological practice is complex, usually including combinations …