Bipolar or unipolar depression: How to distinguish between these two conditions, which can have very different treatment response remains a difficult question without really satisfying answers. As noted in the picture to the right, misdiagnosis is common and can have serious consequences. An article in European Psychiatry adds to the literature pointing to certain features that increase the odds that someone …
Genetic Testing for Depression Drugs
Genetic testing for depression drugs is a new approach to selecting medications that may have value, especially in patients with treatment resistant depression. We have been using the Genecept Assay for patients with treatment resistant depression and have found that the results improve our ability to choose effective treatments. Patients who have failed multiple adequate trials of medications are much less likely to …
Therapy or Medication for Depression?
Therapy or medication for depression? Which is more effective? When might you want to consider both treatments? These are among the most frequent questions that we are asked. A recent study published in JAMA Psychiatry provides the best information available about how to make this decision. The study involved 452 patients who received antidepressant medication treatment for depression with or …
TMS Mechanism of Action – Changes in Brain Connectivity?
TMS’s mechanism of action has been unclear. Transcranial magnetic stimulation affects activity locally in the region of the brain that is stimulated, but does that explain how it works? Since it affects local activity in every patient, why does it not work for everyone? A new article in Biological Psychiatry suggests that it may be changes in brain connectivity that …
Exercise and Stress – How Exercise Prevents Depression
Exercise seems to reduce stress. But how does this work? And what about exercise effects on depression? An article in the New York Times summarizes a recent publication in the journal Cell which may explain how exercise prevents depression. A wealth of research shows that regular exercise reduces the risk of depression. A very large study in Britain, for example, suggested that …
Ketamine for Depression – Mechanism of Action
Ketamine for Depression: How does it work? We ran across a useful review of the basic science literature in an interview of David Nichols on the Psych Congress Network. http://www.psychcongress.com/video/ketamine-quick-guide-receptors-19116 Although ketamine blocks the NMDA subtype of glutamate receptors (blocks an excitatory neurotransmitter) the net effect seems to be an increase in excitatory neurotransmission. This image from Nature may help …
TMS Outcomes – Long Term Study
TMS outcomes have seemed favorable for patients with treatment resistant major depression, but what are the long term effects of TMS (transcranial magnetic stimulation)? TMS is a non-invasive technique for stimulating brain activity in parts of the brain that seem to be turned off in depression – the dorsolateral prefrontal cortex. TMS uses magnets to stimulate the brain and the …
Blood Test for Depression
How many times has a new patient in the clinic asked, “isn’t there a blood test for depression?” Always in the past we had to say that there were no reliable tests that could identify depression. There was some evidence that functional brain imaging could do so but the technique was expensive and experimental. In an article published in the …
Predicting Bipolar Disorder
Predicting bipolar disorder might allow early intervention that could change the course of the condition, or prevent at risk adults or adolescents from developing severe mood swings. But is predicting bipolar disorder a reasonable goal? What is the science behind this effort? The August 2014 issue of Bipolar Disorders (the official journal of the International Society for Bipolar Disorders) has …
TMS Improves Memory
TMS improves memory. According to a study published in the Aug. 29 issue of the journal Science, “electrically stimulating a portion of the brain that coordinates the way the mind works can enhance memory and improve learning.” The researchers used Transcranial Magnetic Stimulation (TMS) to indirectly stimulate activity in the hippocampus, a key part of the brain involved in the storage …