The most common question that people ask when they start TMS is how long it will take to get well with TMS. A recent article published in the American Journal of Psychiatry looked at the results from a six week study designed to compare theta burst and regular TMS in order to assess patterns of response over time. The authors …
Default Mode Network and Depression Treatment – Ketamine and TMS
Interaction between the default mode network and parts of the pre-frontal cortex may explain some depression phenomena and also links to why TMS and ketamine work
Lithium and Genes
Several studies have suggested that lithium response has a genetic component. Whether someone with bipolar will respond to treatment with lithium seems to be strongly associated with the presence or absence of a family history of response to the medication. A recent article in the Lancet reports the results of a genome-wide association study of lithium response in 2563 patients collected …
Ketamine for Depression Update
Probably the most exciting development in psychopharmacology in years is the discovery of the dramatic effects of ketamine on depression. However, a recent report from the American Psychiatric Association (APA) Task Force on Novel Biomarkers and Treatments highlights not only the reason for the excitement about ketamine but also the significant areas of uncertainty that make it not yet ready to …
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 …
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 …
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 …
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 …
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 …
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