Treatment Resistant Depression – More Clues to Predicting Response – VAST-D

Peter Forster Major Depression, Treatments of Depression Leave a Comment

Clues that can help us provide more effective care for those with treatment resistant depression are urgently needed. Sidney Zisook and colleagues report an analysis of the data from a large study of veterans with chronic depression (VAST-D) and conclude that two clinical features can help predict likely response to medications changes for some patients who have failed at least …

Ketamine Short Term Treatment Strategies

Peter Forster Major Depression, Treatments of Depression, Uncategorized Leave a Comment

What are the best strategies for using ketamine to treat major depression in the short term? Although we know that ketamine (and, now, esketamine) can be helpful we really don’t know that much about what strategy works best. The most commonly used ketamine infusion protocol is adapted from studies using ketamine to treat chronic pain. An article in the March …

Deaths of Despair Anthony Bourdain Suicide

Deaths of Despair – Suicide & Self Injury Crisis in US

Peter Forster Major Depression, Policy Leave a Comment

The news of Anthony Bourdain and Kate Spade’s death by suicide as well as the CDC’s report on increasing suicide rates in the US reminds us of a larger public health crisis that was given the name “deaths of despair” by researchers Case and Deaton (see below). We have been collecting information on this topic in preparation for an effort …

Gerard Sancora Esketamine is Effective

Intranasal Esketamine is Effective for Depression

Peter Forster Major Depression, Treatments of Depression, Uncategorized Leave a Comment

Intranasal esketamine is effective for treating severe depression and suicidality when added to comprehensive standard of care treatment in patients who were felt to be at imminent risk of suicide. 68 patients seen in an emergency department were randomized to receive esketamine or placebo as well as comprehensive treatment including inpatient care and antidepressant medications. Patients receiving esketamine had a …

Antidepressant Diet

Antidepressant Diet Cookbook

Peter Forster Major Depression, Physical Conditions and Health, Self Care, Treatments of Depression Leave a Comment

Two recent studies suggest that the Mediterranean diet may be an antidepressant diet as well as the diet that reduces heart disease, inflammation, and the risk of dementia. In the SMILES trial 65 patients with depression were randomized to a Mediterranean diet based intervention (a diet support group) or a social support group. The group excluded people who were treatment …

Depression Resilience and Neural Connectivity

Peter Forster Basic Science, Major Depression, Psychobiology Leave a Comment

Much has been written about risk factors for depression but we know less about depression resilience factors. Why do some people at high risk develop depression, while others do not. A study conducted at Stanford by Adina S. Fischer, MD PhD, and colleagues, suggests that increased regulation of limbic areas (the parts of the brain that are most directly involved in …

TMS Predictors of Outcome

TMS Predictors of Outcome in Bipolar Depression and Unipolar Major Depression

Peter Forster Bipolar Treatment, Major Depression, Treatments of Depression Leave a Comment

What TMS predictors of outcome in bipolar depression and unipolar major depression can we use to identify those who are likely to respond to treatment? An article in 2017 in the journal Clinical Neurophysiology reports data from a very large series of patients with both types of depression who were treated with TMS. The study looked at records from 105 …

Maintenance TMS

Maintenance TMS

Peter Forster Major Depression, Treatments of Depression Leave a Comment

A patient with treatment resistant depression and an excellent initial response to TMS asked me about the value of maintenance TMS. The question is a reasonable one given what we know generally about the treatment of chronic and/or treatment resistant depression. Almost all of the effective treatments (psychotherapy, medications, ECT, etcetera) have acute and maintenance treatment components. And for all …

State and Trait Brain Function in Depression

State and Trait Brain Function in Depression

Peter Forster Basic Science, Major Depression, Psychobiology Leave a Comment

Understanding the neurobiology of depression involves more than just knowing about serotonin, we need to know how state and trait brain function in depression is different from brain functioning in those who have never had a major depression. State and trait are key concepts in understanding psychiatric conditions: state refers to those alterations in functioning that occur when someone is …

ketamine long term effects

Long Term Effects of Ketamine

Peter Forster Major Depression, Treatments of Depression Leave a Comment

One of my patients asked me what the long term effects of ketamine are. She was particularly interested in long-term adverse effects. The last time I did a review of the literature I noted that there seem to be very little information available. This is not surprising with the psychiatric literature since ketamine and its use for chronic depression are …