An article that will soon appear in the American Journal of Psychiatry suggests that it may be possible to predict who will respond to different antidepressants using a genetic test. The study looked at whether by testing for specific genetic variants of a protein involved in transporting drugs and other potentially toxic substances into and out of cells and across the blood …
MAOI Diet Update
MAOI diet information on the Internet can be very confusing for someone just starting one of these antidepressant medications. Monoamine oxidase inhibitors (MAOIs) are medications that inhibit the action of the enzyme monoamine oxidase. breaks down the three chemicals in the brain which may be deficient in people with depression: norepinephrine, serotonin, and dopamine. Almost all antidepressants in use today work, …
Stimulants and Geriatric Depression
Stimulants and Geriatric Depression May be Underused. A well designed study showed that adding methylphenidate (Ritalin and others) to citalopram (Celexa) improve the likelihood of complete remission from depression in older patients. In general older depressed patients are more likely to have some cognitive impairment and are less likely to respond to antidepressants. A number of reports suggests that adding stimulants to antidepressants can …
Methylfolate and Depression
Depression and Methylfolate The role of methylfolate in the treatment of patients with depression has once again been highlighted by an article published in the American Journal of Psychiatry in 2016. After successfully treating treatment resistant depression in a patient deficient in cerebrospinal fluid (CSF) tetrahydrobiopterin (necessary for biosynthesis of several neurotransmitters) with sapropterin (a synthetic form of tetrahydrobiopterin’s active isomer), …
NMDA Receptor and Depression
A new drug that stimulates the glycine site of NMDA receptors had rapid antidepressant effects in the just released results of a phase II clinical trial. The drug substantially reduced depression symptoms, with no severe side effects. The NMDA receptor has 2 sites that are involved in its activation. One site is stimulated by glutamate or aspartate. Another site is stimulated by glycine. For …
ECT for Bipolar Depression
ECT for bipolar depression may be much more effective than psychiatric medications. That is the conclusion of the recently published, well designed study of 73 in patients with bipolar depression who had failed adequate trials with mood stabilizers. In the initial 2 months after the patients were randomized to either ECT or algorithm based pharmacotherapy (psychiatric medications carefully managed and …
Bipolar Depression
The recent presentation that I gave at UCSF on this topic allowed me to review all of the controlled clinical trials related to the treatment of bipolar depression. In a follow-up post I plan on talking about some of the exciting new developments that suggest that we will soon, and to some extent do already, have some very promising approaches …
Anhedonia and Ketamine
Anhedonia, meaning the loss of the normal experience of pleasure in life, can be one of the most troubling symptoms of depression. And also one for which we have relatively few treatments. We know that a small group of dopamine neurons in the ventral tegmentum (limbic system) which project to the prefrontal cortex, among other locations in the brain, are …
TMS Media – The Doctors
TMS Media – “The Doctors” December 3 I am excited to share with you that on December 3rd “The Doctors” featured a segment on TMS. Todd Hutton, MD, Medical Director, Southern California TMS Center, was invited to appear with a patient who is doing great 18 months post TMS treatment. I hope you can watch and that this contributes to further awareness …
Anhedonia Treatment with Ketamine
The treatment of anhedonia and bipolar depression can be very difficult. An article published in Translational Psychiatry in October of 2014 highlights the role of glutametergic transmission in anhedonia and points to the potentially unique efficacy of ketamine in treating this stubborn problem. Anhedonia, the lack (an-) of pleasure (-hedonia), is one of the 2 main symptoms of a major …