Boadie Dunlop, M.D., M.S., and Helen Mayberg, M.D., both of Emory University School of Medicine, and colleagues assessed resting-state functional connectivity between the subcallosal cingulate cortex (SCC) and three other brain regions—the dorsal midbrain, the ventrolateral prefrontal cortex and anterior insula, and the ventromedial prefrontal cortex—in 122 patients with depression. The patients were then randomized to 12 weeks of cognitive-behavioral …
Predicting Lithium Response
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 …
Genetic Tests for Antidepressants – CNS Dose
About a year ago we reviewed the data on the use of genetic tests for antidepressants as well as other medications and identified three pharmacogenetic panels that seem to have research support: Genecept by Genomind, Genesight, and CNS Dose. Of these three we have been using Genecept and Genesight with some success but now we are happy to add to …
Efficacy or Effectiveness
What is the difference between efficacy and effectiveness? We tend to use these terms interchangeably in our posts on this site, but the two are different and the difference can be important. Efficacy refers to the power of a treatment to achieve a given outcome assuming that the patient is perfectly compliant and completes the treatment. Effectiveness addresses the more …
Antidepressant Selection Based on Symptom Clusters
Can we do a better job of antidepressant selection based on symptom clusters, analyzed using machine learning techniques? Perhaps so. And if so we will avoid a great deal of unnecessary suffering as people try one medication after another until the find the right medication or combination of medications to treat their depression. That is the premise behind an ambitious …
Depression and Inflammation: Treatment Options
A host of conditions have been associated with mild to moderate levels of inflammation in the body. Depression is one of these. Elsewhere in this blog we have discussed the relationship between depression and inflammation, evidence that treatment with an antidepressant (escitalopram) reduces inflammation in depression, and talked about how exercise prevents depression. We have also noted that elevated levels of inflammation (simple …
Mania and Depression Sequence
One of the key features of bipolar disorder that, in our experience, is most useful in predicting treatment response is the usual sequence of manic (or hypomanic) and depressive episodes. For years we have used the mnemonics MDI and DMI as ways of categorizing patients’ course. But we could not find the reference to that idea. We are indebted to …