Why SSRIs May Increase Anxiety Short Term

Peter Forster Psychobiology, Treatments of Depression

SSRIs are among the most commonly prescribed medications for chronic anxiety, but not infrequently these medications may be associated with a short term increase in symptoms that precedes the long term benefit. In an elegant series of studies published online in late August 2016 in the premier scientific journal, Nature, researchers from the NIH and the University of North Carolina at …

Genesight – Genetic Testing to Predict Medication Response

Peter Forster GPS Update, Psychobiology, Testing

We have been using the Genecept Assay from Genomind for several years to help guide treatment selection in patients with either unusually high rates of side effects from medications or those who have failed multiple trials of medications. Although the test can be expensive, costing anywhere from a couple of hundred dollars to five hundred dollars or more, it is our experience …

Antidepressants Alter Gene Expression

Peter Forster Major Depression, Psychobiology, Treatments of Depression

An interesting study looked at similarities and differences in the effects of two medications that have anti-depressant effects and yet are extremely different in terms of how they work: ketamine and imipramine (a tricyclic antidepressant). This industry supported study looked at the effects of these two agents on a reward circuit (involving the prefrontal cortex (PFC), nucleus accumbens, hippocampus, and amygdala – …

A Better Ketamine

Peter Forster Major Depression, Psychobiology, Treatments of Depression

A better ketamine may be coming. That is the conclusion of NEJM Journal Watch Psychiatry reviewer Barbara Geller. A common pathway to identifying new drugs, is looking at metabolites of a medication to see if there is one metabolite that works better than the active drug (desvenlafaxine – one of the metabolites of venlafaxine – may or may not be …

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 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 of multiple medications, and …

Genetics of bipolar disorder – update

Peter Forster Psychobiology

Unraveling the genetics of bipolar disorder has been a much more complicated task than anyone thought. Although the best estimates suggest that genetic factors account for the very high percentage of the risk of developing bipolar, with an estimated an estimated 0.7 to 0.8 heritability (Sullivan), it has been remarkably difficult to find genes with significant individual effects that are replicated …

Depression and Inflammation

Peter Forster Basic Science, Major Depression, Psychobiology

Is depression one of a series of illnesses caused by inflammation? There has been a lot of interest in the last year in the idea that inflammation (activation of the body’s immune system) might be a cause as well as a consequence of depression. One theory suggests that depression might be an inflammatory disorder, rather than a disorder of altered neurotransmitter levels. Certainly …

Norepinephrine dopamine and depression

Peter Forster Basic Science, Major Depression, Psychobiology, Treatments of Depression

In an elegant set of studies published in February 2016 in Nature Neuroscience the team of Bruno Giros, a researcher at the Douglas Mental Health University Institute and Professor of Psychiatry at McGill University, reports the first-ever connection between noradrenergic neurons and vulnerability to depression. The study involved research using probably the most well developed animal model for depression – chronic or …

Lithium and Genes

Peter Forster Bipolar Treatment, Psychobiology, Testing

Several studies have suggested that lithium response has a genetic component. Whether someone with bipolar will respond to treatment with lithium seems to be strongly associated with the presence or absence of a family history of response to the medication. A recent article in the Lancet reports the results of a genome-wide association study of lithium response in 2563 patients collected …

Rapastinel for Depression

Peter Forster Major Depression, Psychobiology, Treatments of Depression

The U.S. Food and Drug Administration (FDA) has granted Breakthrough Therapy designation to rapastinel, which follows the medication receiving a 2014 Fast Track Designation from the FDA. Rapastinel, an investigational medication for adjunctive treatment of major depressive disorder, is an intravenous drug that is a novel NMDA receptor agonist. It is being developed by Allergan. The Breakthrough Therapy designation is a new …