Lithium is usually considered the most effective treatment for bipolar disorder. However, at least 30% of lithium-treated patients do not have a clinically significant response; and only 30% have a long-lasting full response. Since close laboratory monitoring is required, and adverse effects are not uncommon, identifying predictors of lithium response is highly desirable. In this largest-ever study of lithium recipients …
How Long Does It Take to Get Well with TMS
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 …
Predicting Lithium Response with Brain Imaging
Predicting lithium response with brain imaging may be an option in the future if the preliminary results of a study published in 2017 are confirmed. Researchers from the University of Cincinnati used three tools to create a program that was remarkably successful at predicting which bipolar patients would respond to lithium. 20 first onset bipolar patients who received adequate trials …
Functional Brain Imaging in Depression
Is there a role for functional brain imaging in depression? Many people seeking treatment are interested in the notion that the brain imaging, particularly imaging that looks at neural activity, might be useful in guiding treatment. Up until the last couple of years the answer to this question has always been that the role is primarily restricted to research settings …
Atypical Antipsychotics with Mood Stabilizers
Many people with bipolar receive atypical antipsychotics with mood stabilizers. As in many areas of medicine, we have relatively little data about longer-term outcomes when people receive this combination. If an atypical antipsychotic is added to a mood stabilizer to control a manic episode, how long should that combination be prescribed? A recent study conducted by the Canadian Mood and …
Antidepressant Response Linked to Norepinephrine Transporter Genotype
A large study of patients treated with venlafaxine found that antidepressant response was linked to the norepinephrine transporter (NET) genotype. The study looked at response in a sample of 350 individuals over the age of 60 with severe depression (MADRS greater than or equal to 15) who were treated with venlafaxine up to a dose of 300 mg a day. …
Antidepressants Alter Gene Expression
An interesting study looked at similarities and differences in the effects of two medications that have anti-depressant effects and yet are extremely different in terms of how they work: ketamine and imipramine (a tricyclic antidepressant). This industry supported study looked at the effects of these two agents on a reward circuit (involving the prefrontal cortex (PFC), nucleus accumbens, hippocampus, and amygdala – …
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 …
Functional Brain Imaging and Antidepressant Response
One of the most exciting initiatives currently in the important area of the treatment of depression is the International Study to Predict Optimized Treatment in Depression (iSPOT-D). This large multi-center initiative is based on a private industry and academic partnership that is designed to both identify best practices in the treatment of depression and also commercialize them. The most recent publication from this …
ABCB1 Gene Predicts Antidepressant Response
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 …
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