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, …
Rapastinel for Depression
The U.S. Food and Drug Administration (FDA) has granted Breakthrough Therapy designation to rapastinel, which follows the medication receiving a 2014 Fast Track Designation from the FDA. Rapastinel, an investigational medication for adjunctive treatment of major depressive disorder, is an intravenous drug that is a novel NMDA receptor agonist. It is being developed by Allergan. The Breakthrough Therapy designation is a new …
SSRI Dose Response
It has long been unclear whether higher doses of SSRIs are associated with greater response. What has been clear is that higher doses are associated with significantly increased side effects. In fact previous research, whether individual studies or meta-analyses have failed to find a significant dose response with the result that many have felt that there is a flat dose response …
Vortioxetine for Cognitive Impairment in Depression
Takeda and Lundbeck announced that the Food and Drug Administration (FDA)’s Psychopharmacologic Drug Advisory Committee (PDAC) voted to support the efficacy of vortioxetine (Brintellix) for treating cognitive dysfunction in adults with major depressive disorder (MDD). The advisory committee also reviewed evidence to suggest that cognitive dysfunction in people with major depressive disorder was an appropriate target for treatment. Several recent …
Depression Screening Recommended
Although it seems like nothing more than common sense, we were very pleased to see that the United States Preventive Services Task Force (USPSTF), which is the major organization responsible for guidelines for public health interventions in the United States, added depression screening for adults, in particular for pregnant women and women who recently given birth, to its short list of …
Pregnancy and Mental Health
This past week, a colleague at UCSF, Dr. Anna Glezer, wrote to let me know about a new patient-centered informational website she is launching focused on issues related to pregnancy and mental health. It’s called Mind Body Pregnancy, and she started it because in her reproductive psychiatry practice she was finding many patients asking similar questions. She wanted to reach beyond just those she is able to see in clinic and …
Escitalopram Reduces Inflammation in Depression
Escitalopram reduces inflammation in depression and potentially reduces neurotoxicity according to an article just published in the Journal of Psychiatric Research. A pro-inflammatory tendence has previously been noted in patients with depression, and this seems to be associated strongly with increases in kynurenine (see below for more information on how exercise counteracts this tendency). Kynurenine is the first step in …
Lurasidone for Depression with Mixed Features
Lurasidone (Latuda) May Treat Depression with Mixed Features A recently published clinical trial suggests that lurasidone, which is an atypical antipsychotic with strong evidence for efficacy in treating bipolar depression, may be associated with response in patients who, according to DSM5, do not meet criteria for bipolar disorder, but do have evidence of mixed features. The study points to the importance …
SSRI Doses – Higher May Be Better
SSRI Doses – Optimal Doses May Be Higher than Usual Doses One of the questions that often comes up has to do with the patient who has a partial response to a serotonin antidepressant but who remains depressed. Should we increased the dose about the standard initial dose, should wait and see if there’s further improvement? Should we add a …
Bright Light for Non-Seasonal Depression
Bright light may work for non-seasonal depression. This is the conclusion of a study published in the prestigious psychiatric journal JAMA Psychiatry. Researchers at the University of Toronto and the University of British Columbia in Canada conducted a randomized, double-blind, placebo- and sham-controlled, 8-week trial in adults (aged 19-60 years) with major depression of at least moderate severity. 122 patients were …