Recently there has been a lot of interest in using psilocybin as a treatment for depression, anxiety and alcohol use disorder. We certainly need more safe and effective treatments. It may be worth considering where we are in the evaluation of these agents. Right now there is a growing literature supporting the potential value of these agents, but there is …
Psychedelic Medicine Association Member
Gateway Psychiatric just joined the Psychedelic Medicine Association. This membership is a continuation of our longstanding interest in alternative treatments for depression. I have been working with Bay Psychiatric Associates and Roberto Estrada for nearly five years providing ketamine infusion and now nasal esketamine to patients with treatment resistant depression. This followed attending the 2017 Ketamine Conference which was held …
SSRI Doses and Effectiveness – High Dose vs Low Dose, Is There a Difference?
One of the questions that has bedevilled clinicians ever since the introduction of the first SSRI (Prozac, fluoxetine) is whether there is any relationship between SSRI doses and effectiveness. In other words, do higher doses result in greater effectiveness. I can recall about 20 years ago reading the first clinical trial looking at this question. It was an article published …
SSRI and Other Antidepressants and Pregnancy – 2020
We have several other posts on this topic which trace the evolution of our thinking about the risks of using antidepressants during pregnancy. Generally, the data continues to support our view that the risks of depression during pregnancy, both in terms of effects on the mother and effects on the child, usually outweigh the risks of antidepressant use. Another large …
Psychotherapy is Important for Depression Prevention
Psychotherapies — particularly cognitive-behavioral approaches used as adjunctive treatments — can play a critical role in helping people with a history of depression avoid relapse. For many people, major depression is a chronic illness. Even when they are no longer depressed, people who have had several episodes of depression have to be concerned about a significant risk of a recurrence …
Psilocybin-Assisted Supportive Psychotherapy in the Treatment of Major Depression
We have been eagerly awaiting the results of controlled studies of psilocybin treatment of depression (used along with psychotherapy). A large multi-center study is still recruiting participants. Meanwhile a great deal of interest in this topic has been stirred up by Michael Pollan and his book How to Change Your Mind. But clinicians have had very little solid science upon …
Limbic and Prefrontal Connectivity and Treatment Selection for Depression
Boadie Dunlop, M.D., M.S., and Helen Mayberg, M.D., both of Emory University School of Medicine, and colleagues assessed resting-state functional connectivity between the subcallosal cingulate cortex (SCC) and three other brain regions—the dorsal midbrain, the ventrolateral prefrontal cortex and anterior insula, and the ventromedial prefrontal cortex—in 122 patients with depression. The patients were then randomized to 12 weeks of cognitive-behavioral …
Impaired Decision Making in Depression – Treatment Implications
Why do depressed people make choices that are unlikely to be rewarded. And why aren’t they willing to make choices that are likely to be rewarded. In fact, why are depressed people less likely than people who are not depressed to choose to take an antidepressant, or begin psychotherapy, or follow the advice of a therapist? A meta-analysis of many …
New Biomarker for Treatment Response in Depression – GPR56/ADGRG1
What happens in the body when antidepressants work. An international group of researchers, led by Professor Gustavo Turecki of McGill University and the Douglas Mental Health University Institute, examined changes in the activity of genes (measured using mRNA) in the blood in over 400 patients who were being treated with antidepressants. They identified one gene that was significantly more active …
Mobile Monitoring Systems for Depression Care
Passive tracking of vocal and behavioral indicators of symptoms via a smartphone app can be an effective way to treat depression in a time-sensitive and accurate fashion. A recent randomized clinical trial compared the use of an app to track indicators with “usual care” for depression, and, although the sample size is small, the results are very promising. For the …