Interaction between the default mode network and parts of the pre-frontal cortex may explain some depression phenomena and also links to why TMS and ketamine work
Ketamine for Depression – 2017
I just got back from an inspiring conference in Berkeley on Ketamine for Depression. I am eager to implement some changes in how we work with people we refer or provide ketamine infusion for that may make the treatment more effective. The conference was organized by Alison McInnes, MD, MS, who is in charge of the Kaiser, San Francisco Ketamine Treatment Program, …
Efficacy or Effectiveness
What is the difference between efficacy and effectiveness? We tend to use these terms interchangeably in our posts on this site, but the two are different and the difference can be important. Efficacy refers to the power of a treatment to achieve a given outcome assuming that the patient is perfectly compliant and completes the treatment. Effectiveness addresses the more …
Antidepressant Selection Based on Symptom Clusters
Can we do a better job of antidepressant selection based on symptom clusters, analyzed using machine learning techniques? Perhaps so. And if so we will avoid a great deal of unnecessary suffering as people try one medication after another until the find the right medication or combination of medications to treat their depression. That is the premise behind an ambitious …
TMS Effectiveness Updated
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, …
Depression Biology and Treatment
New research on depression biology and treatment highlights the rapid increase in knowledge in this area in the last decade. In this post we will summarize some of these research findings briefly. This brief tour will take us to a newly discovered protein that may be a vital link between stress and depression. A genome wide search for changes associated …
Long Term Depression Psychotherapy
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. …
Antidepressant Response Linked to Norepinephrine Transporter Genotype
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. …
Where is the Outrage About Suicide?
A wonderful editorial in JAMA Psychiatry highlights the overwhelming evidence that stigma is continuing to drive underfunding for treatment and prevention of suicide deaths. Suicide and “accidental” overdose deaths are an epidemic in this country. Since 1999, the rate of suicide deaths increased by 28.2%, and this probably underestimates the increase because there is evidence that coroners are categorizing more and …
Depression, Anhedonia, Glutamate, and Inflammation
That depression may be linked to alterations in glutamate circuits is suggested by the observation that ketamine (which is an NMDA glutamate receptor antagonist) may rapidly reverse depression in some patients. Depression has also been found to be associated in some people with various markers for inflammation (c reactive protein, tumor necrosis factor, interleukin 1 beta, and interleukin 6). As …