Treatment Resistant Depression – More Clues to Predicting Response – VAST-D

Peter Forster Major Depression, Treatments of Depression Leave a Comment

Clues that can help us provide more effective care for those with treatment resistant depression are urgently needed. Sidney Zisook and colleagues report an analysis of the data from a large study of veterans with chronic depression (VAST-D) and conclude that two clinical features can help predict likely response to medications changes for some patients who have failed at least …

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 …

TMS Effectiveness Updated

Peter Forster Best Practices, Major Depression, Treatments of Depression

TMS effectiveness for depression is clear. But now there are more machines for providing TMS and more protocols. Is deep TMS better than regular TMS?  Or is deep TMS just a marketing phrase? A major review article in JAMA Psychiatry updated our understanding of alternatives to the initial protocol for TMS. JAMA Psychiatry is the most prestigious journal in psychiatry, …

Buprenorphine for Depression – A Combination Approach

Peter Forster Major Depression, Treatments of Depression

While we were in the midst of a seeming epidemic of concern about opiate prescribing and possible overuse of opiates by physicians, it is ironic that we are also seeing a small stream of articles being published about the potential effectiveness of opiate agonists in treating patients with treatment resistant depression. I’ve been interested in this topic since Enoch Callaway, …

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 …

Aripiprazole for Late Life Depression

Peter Forster Major Depression, Treatments of Depression

A study suggests that aripiprazole augmentation may be an effective strategy for treating major depression in older adults. The article has generated a lot of interest because of evidence suggesting that late life major depression may be different from major depression in early adulthood. Cognitive impairment, including memory troubles and trouble with planning and decision making (executive function), seems to …