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 …
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 …
Chronic Pain and Depression
Chronic pain and depression often co-occur in the relationship between the two experiences can be hard to separate. An important article just published in Biological Psychiatry (Barthas, et al) identifies 2 sets of circuits in the brain for processing pain: One is located in the anterior cingulate cortex and seems to be involved in the emotional experience of pain, the …
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 …
Bipolar Depression Update
On Thursday at noon Dr. Peter Forster, our clinical director, will be giving a presentation to the UCSF Department of Psychiatry Mood Disorder Grand Rounds on the topic of “Bipolar Depression: An Update.” He will be reviewing the recent literature on new treatment options and will summarize some of the talk findings in a future blog post.
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 …
Chronotherapy for Depression Treats Suicidality
Chronotherapy for depression may be a very fast and effective treatment for suicidality, according to a preliminary study just published in the Journal of Psychiatric Research. 10 inpatients received what was called “triple chronotherapy” and showed dramatic and rapid reductions in suicidal ideation and depression. Of course this is a very small sample and only one study. But it points …
TMS Effectiveness
TMS effectiveness is something I have spent a fair amount of time researching. Last year I gave two Grand Rounds presentations on this topic at the University of California, San Francisco and at the California Pacific Medical Center. But despite the compelling evidence that, if you have failed two (or maybe three) antidepressant trials for the treatment of your depression, your …
Bipolar or Unipolar Depression?
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 …