CBASP Advanced Training and Certification for Gateway Therapists – Update

Peter Forster About GPS, Best Practices, Major Depression, Treatments of Depression Leave a Comment

Gateway Psychiatric was established with the belief that in order to give our patients the best care possible, it is necessary to invest heavily in training for the clinical staff. We particularly focus on evidence based practices that have been shown to address significant problems facing our patients. Since chronic depression is one of the most common problems seen in …

Antidepressant Diet

Antidepressant Diet Cookbook

Peter Forster Major Depression, Physical Conditions and Health, Self Care, Treatments of Depression Leave a Comment

Two recent studies suggest that the Mediterranean diet may be an antidepressant diet as well as the diet that reduces heart disease, inflammation, and the risk of dementia. In the SMILES trial 65 patients with depression were randomized to a Mediterranean diet based intervention (a diet support group) or a social support group. The group excluded people who were treatment …

Maintenance TMS

Maintenance TMS

Peter Forster Major Depression, Treatments of Depression Leave a Comment

A patient with treatment resistant depression and an excellent initial response to TMS asked me about the value of maintenance TMS. The question is a reasonable one given what we know generally about the treatment of chronic and/or treatment resistant depression. Almost all of the effective treatments (psychotherapy, medications, ECT, etcetera) have acute and maintenance treatment components. And for all …

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 …

Antidepressant Selection Based on Symptom Clusters

Peter Forster Best Practices, Major Depression, Testing

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 …

Depression and Inflammation: Treatment Options

Peter Forster Major Depression, Physical Conditions and Health, Treatments of Depression

A host of conditions have been associated with mild to moderate levels of inflammation in the body. Depression is one of these. Elsewhere in this blog we have discussed the relationship between depression and inflammation, evidence that treatment with an antidepressant (escitalopram) reduces inflammation in depression, and talked about how exercise prevents depression. We have also noted that elevated levels of inflammation (simple …

Pramipexole in Unipolar and Bipolar Depression

Peter Forster Bipolar Treatment, Treatments of Depression

For many years we’ve been impressed with the response in some patients with bipolar depression to relatively high doses of pramipexole. Pramipexole is an agent that enhances dopamine neurotransmission and has been approved for the treatment of Parkinson’s disease. There are relatively few medications that significantly affect dopamine, one of the three monoamine neurotransmitters associated with depression and pramipexole is …

TMS Cost Effectiveness

Peter Forster Costs of Treatment, Treatments of Depression

“Is TMS Cost-Effective?” His provocative title of an article just published in psychiatric times which summarizes an Australian pharmaco-economic study. In case you don’t want to read through the rest of this article, here is the summary: “Australian researchers compared the cost-effectiveness of rTMS with pharmacotherapy in treatment-resistant patients with MDD (ie, those who have failed at least 2 courses …

Antidepressants Update

Peter Forster Major Depression, Treatments of Depression, Website Update

I just wanted to make a quick note that I recently posted a major update of the information on this site about antidepressants. This follows the recent introduction of a few interesting new antidepressant medications. I hope to expand that by adding a page talking about atypical antipsychotics and perhaps other classes of medications routinely used in this practice. Since …