Bipolar Therapy with Family

Psychotherapy for Bipolar

Peter Forster Best Practices, Bipolar Treatment, GPS Leave a Comment

People with bipolar disorder are much less likely to receive psychotherapy (26-50% of patients in one study got therapy) as opposed to psychiatric medications (46-90% were treated with medications) according to a study sponsored by the Depressive and Bipolar Support Association. This is not surprising since many mental health professionals were taught when we were in training that bipolar depression …

Limbic and Prefrontal Connectivity and Treatment Selection for Depression

Peter Forster Basic Science, Best Practices, Major Depression, Psychobiology, Treatments of 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 …

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 …

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 …

Efficacy or Effectiveness

Peter Forster Major Depression, Treatments of Depression

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 …

Measurement Based Care Controversies

Peter Forster Best Practices

Measurement based care often evokes controversies. A brilliant colleague, Carol Heckler, who is something of a local expert in psychopharmacology, interrupted a conversation I was having with another psychiatrist to say that she thought that standardized rating scales were useless. Echoing comments that I’ve heard from many of my patients, she said “how can you reduce human experience to a number?” This …

Long Acting Injectable Aripiprazole for Bipolar

Peter Forster Bipolar Treatment

Long acting injectable aripiprazole for bipolar one patients has been shown to significantly reduce the risk of a recurrence of a mood episode in a 52 week placebo controlled clinical trial. Poor adherence to treatment is a significant problem in patients with bipolar disorder, putting patients at increased risk of recurrence of mood episodes, hospitalization, and suicide. One other study …

SSRIs and Pregnancy Updates

Peter Forster Physical Conditions and Health, Treatments of Depression

Several recent articles provide additional information about the effects on the infant of exposure to SSRI antidepressants during pregnancy. A large study published in Pediatrics adds to information that suggests that exposure to SSRI antidepressants, particularly late in pregnancy, may be associated with birth complications. As with other studies, one major limitation in the design of the study is that it …

Measurement Based Care Improves Outcomes

Peter Forster About GPS, Best Practices

Patients at Gateway Psychiatric are sometimes perplexed by the amount of time and energy we devote to tracking how they are doing. It can seem annoying to answer questions repeatedly or to fill out forms. An article in the journal Psychiatric Services summarizes the data that shows that this process (known as “measurement based care” or MBC) is associated with significantly …

Functional Brain Imaging and Antidepressant Response

Peter Forster Basic Science, Testing, Treatments of Depression

One of the most exciting initiatives currently in the important area of  the treatment of depression is the International Study to Predict Optimized Treatment in Depression (iSPOT-D). This large multi-center initiative is based on a private industry and academic partnership that is designed to both identify best practices in the treatment of depression and also commercialize them. The most recent publication from this …