Stimulants and Geriatric Depression May be Underused. A well designed study showed that adding methylphenidate (Ritalin and others) to citalopram (Celexa) improve the likelihood of complete remission from depression in older patients. In general older depressed patients are more likely to have some cognitive impairment and are less likely to respond to antidepressants. A number of reports suggests that adding stimulants to antidepressants can …
Methylfolate and Depression
Depression and Methylfolate The role of methylfolate in the treatment of patients with depression has once again been highlighted by an article published in the American Journal of Psychiatry in 2016. After successfully treating treatment resistant depression in a patient deficient in cerebrospinal fluid (CSF) tetrahydrobiopterin (necessary for biosynthesis of several neurotransmitters) with sapropterin (a synthetic form of tetrahydrobiopterin’s active isomer), …
NMDA Receptor and Depression
A new drug that stimulates the glycine site of NMDA receptors had rapid antidepressant effects in the just released results of a phase II clinical trial. The drug substantially reduced depression symptoms, with no severe side effects. The NMDA receptor has 2 sites that are involved in its activation. One site is stimulated by glutamate or aspartate. Another site is stimulated by glycine. For …
Chronic Pain and Depression
Chronic pain and depression often co-occur in the relationship between the two experiences can be hard to separate. An important article just published in Biological Psychiatry (Barthas, et al) identifies 2 sets of circuits in the brain for processing pain: One is located in the anterior cingulate cortex and seems to be involved in the emotional experience of pain, the …
Beta Catenin and Depression
Beta catenin is a molecule that may play a key role in preventing depression in those exposed to stress, at least if mice and humans share the same biology. Beta catenin is involved in a number of quite different functions in the cell. To give you an idea, it may be involved in the development of cancer (it is a …
Chronotherapy for Depression Treats Suicidality
Chronotherapy for depression may be a very fast and effective treatment for suicidality, according to a preliminary study just published in the Journal of Psychiatric Research. 10 inpatients received what was called “triple chronotherapy” and showed dramatic and rapid reductions in suicidal ideation and depression. Of course this is a very small sample and only one study. But it points …
TMS Effectiveness
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 …
Genetic Testing for Depression Drugs
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?
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 …
Exercise and Stress – How Exercise Prevents 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 …