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
TMS Effectiveness Updated
TMS effectiveness for depression is clear. But now there are more machines for providing TMS and more protocols. Is deep TMS better than regular TMS? Or is deep TMS just a marketing phrase? A major review article in JAMA Psychiatry updated our understanding of alternatives to the initial protocol for TMS. JAMA Psychiatry is the most prestigious journal in psychiatry, …
Long Term Depression Psychotherapy
Effective psychotherapy for depression that has lasted for years is needed because chronic depression (lasting two years or longer) develops in up to a third of people with an episode of major depression. Chronic depression is associated with more suicidality, more impairment in functioning, and more hospitalizations. Chronic depression psychotherapy is often less effective than therapy for other forms of depression. …
Why SSRIs May Increase Anxiety Short Term
SSRIs are among the most commonly prescribed medications for chronic anxiety, but not infrequently these medications may be associated with a short term increase in symptoms that precedes the long term benefit. In an elegant series of studies published online in late August 2016 in the premier scientific journal, Nature, researchers from the NIH and the University of North Carolina at …
Genesight – Genetic Testing to Predict Medication Response
We have been using the Genecept Assay from Genomind for several years to help guide treatment selection in patients with either unusually high rates of side effects from medications or those who have failed multiple trials of medications. Although the test can be expensive, costing anywhere from a couple of hundred dollars to five hundred dollars or more, it is our experience …
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 – …
TMS Guidelines
In the April edition of Brain Stimulation, the Clinical TMS Society published expert consensus guidelines on the use of TMS. This definitive review of the literature identifies both what is known as well as significant areas of uncertainty about the use of TMS in the treatment of depression. The process of developing the guideline is described in the introduction to the …
A Better Ketamine
A better ketamine may be coming. That is the conclusion of NEJM Journal Watch Psychiatry reviewer Barbara Geller. A common pathway to identifying new drugs, is looking at metabolites of a medication to see if there is one metabolite that works better than the active drug (desvenlafaxine – one of the metabolites of venlafaxine – may or may not be …
Mindfulness for Depression – Research Update
Mindfulness has received a lot of attention recently as an approach to improving mental health in a number of conditions. But is it really effective as part of a strategy for treating serious depression? And, if so, how can we best incorporate it into treatment, given the great difficulty that many people with depression have doing even a small amount …
“I am looking for a doctor who can treat me with Ketamine infusions for treatment resistant depression.”
I was inspired to write this blog post by the third patient in three days to contact me about Ketamine infusions. She wanted to know if I could provide her with Ketamine infusions for her treatment resistant depression. Ketamine infusions are one of the treatments for depression that we provide access to for our patients. Among the other treatments are …