The nucleus accumbens (NAc) (or ventral striatum) is a central part of the reward system. The reward system has been the focus of much interest and research because of its role in the development and maintenance of addiction and depression. The reward system evolved to motivate survival behaviors and behaviors linked to reproduction and health. Evidence from research in a great number of animal species suggests that social intelligence …
Active Treatment
Why are we so insistent that people in “active treatment” at Gateway Psychiatric, have to always have a future appointment, and must discuss with us the issue of visit frequency? Why don’t we let them come in when they feel the need? Today we were meeting with someone who was asking all of those questions and who also, in many …
Genetic Testing Guides Treatment for Bipolar or Depression
We have been using a relatively new assay from a company called Genomind (the Genecept test) in some of our patients with bipolar and/or depression. The test involves a saliva sample which is analyzed for ten gene variants that may be useful in guiding treatment. So far we find that in about half of the patients with treatment resistant depression …
Treatment of Fatigue in Patients with Depression or Bipolar
Treatment of depression in patients with depression or bipolar is often complicated. If medications are prescribed, will they make mood symptoms worse, or have other significant adverse effects? And yet fatigue is common in people with a history of depression (it occurs in up to 10% of the general population and is much more common in women, who have a …
Data Security at Gateway Psychiatric Services
We have been following the stories of data lost or stolen this past year with increasing concern about the safety of the internet. As a result we spent much of the summer hard at work upgrading the level of security at Gateway. This is important work, although not terribly rewarding. Some of these changes – We no longer rely on just user …
RDOCS and DSM 5: Diagnosis and Psychiatry
Tom Insel, the Director of the National Institute for Mental Health, to celebrate the release of DSM5 in May of 2013, famously announced that the manual was already irrelevant to psychiatric research. This quote from Psychology Today captures the moment fairly well. Just two weeks before DSM-5 is due to appear, the National Institute of Mental Health, the world’s largest funding agency …
Low Frequency Magnetic Stimulation is Rapid Antidepressant
There is a lot of interest in an article that just appeared in Biological Psychiatry about a new magnetic stimulation technique that may be associated with rapid antidepressant effects in both unipolar and bipolar depression. Researchers at McLean Hospital were studying Low Frequency Magnetic Stimulation as a way of imaging the brains of bipolar patients and discovered that many of …
New Drug with New Mechanism for Insomnia – Suvorexant
Belsomra (suvorexant) was approved earlier this week by the FDA for use as needed to treat difficulty in falling and staying asleep. The drug blocks receptors for orexin – also known as hypocretin – the master hypothalamic regulator of the sleep-wake cycle. There are, in fact, two forms of orexin, A and B; hence it is a dual orexin …
Depression Costs US 200 Billion Dollars Per Year
A meta-analysis of more than 60 clinical studies covering almost 60,000 adult patients estimates that the total cost in the United States of the treatment of patients with depression is in the range of $188 billion to $200 billion. Roughly a third of all costs ($64 billion) are related to people with treatment-resistant depression, who represent only a fraction of all cases. The article, “A Review of the Clinical, Economic, …
Biomarker for Suicidality
A just published study by Jerry Guintivano, et al, in the July issue of the American Journal of Psychiatry reports having identified a gene that seemed to predict suicide. The study used one population to identify the risk association and then confirmed it prospectively in a second population. Zachary Kaminsky, Ph.D., an assistant professor of psychiatry and behavioral sciences at …