Frontiers in psychiatry
January 1, 2025
Valerio Ricci, Maria Celeste Ciavarella, Carlotta Marrangone et al.
7 citations
Substance-induced psychoses (SIPs) triggered by novel psychoactive substances differ from endogenous psychoses like schizophrenia in three key ways: dissociation, mental automatism, and temporality. Dissociation in SIPs causes fragmentation of consciousness and identity detachment, distinct from the spaltung seen in schizophrenia. Mental automatism, as described by De Clerambault, appears early in SIPs with cognitive disruptions preceding delusions. Temporally, SIPs trap individuals in an eternal present, disconnected from past and future, unlike the fragmented temporality in schizophrenia. The paper argues that a phenomenological approach aids clinical differentiation and targeted interventions.
Journal of affective disorders
December 15, 2024
Giacomo d'Andrea, Andrea Miuli, Mauro Pettorruso et al.
6 citations
In patients with treatment-resistant depression, combining vortioxetine with esketamine nasal spray reduces depressive symptoms as effectively as the standard combination of an SSRI or SNRI with esketamine. The vortioxetine combination also showed a larger reduction in emotional blunting after three months and had fewer treatment-emergent side effects. These findings come from a post-hoc analysis of twenty patients, ten in each group. The authors suggest the vortioxetine-plus-esketamine regimen may be a valuable alternative, but they call for larger randomized controlled trials to confirm the results.
Clinical Neuropsychopharmacology and Addiction
September 25, 2025
Stefania Chiappini, Clara Cavallotto, Andrea Miuli et al.
2 citations
About 30–50% of patients with major depression do not respond to two or more antidepressant trials, a condition called treatment-resistant depression (TRD). A narrative review of 60 studies found that glutamatergic agents such as intravenous ketamine and intranasal esketamine consistently produce rapid and clinically meaningful reductions in depressive symptoms. Augmentation with atypical antipsychotics also helps partial responders. Psychedelic-assisted therapies show sustained antidepressant benefits and affect biomarkers like BDNF and inflammatory markers. The findings suggest a shift toward personalized, mechanism-driven treatments for TRD, with ketamine and esketamine offering rapid relief for acute high-risk cases and psychedelics remaining experimental but promising as adjunctive options.
Psychiatry Research
August 18, 2025
Ilenia Rosa, L. Padula, Francesco Semeraro et al.
2 citations
Treatment-resistant depression (TRD) challenges standard approaches, prompting a shift toward non-monoaminergic interventions like neuromodulation and glutamatergic agents. This narrative review examines the endocannabinoid system (ECS) as a potential common pathway for these treatments. Evidence indicates that repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) increase endocannabinoids anandamide and 2-arachidonoylglycerol, correlating with clinical improvement. Ketamine and esketamine modulate CB1 receptors, while psilocybin restores 2-AG and enhances CB1 expression in mood-related brain regions. These findings suggest ECS modulation may unify diverse antidepressant mechanisms in TRD, offering a promising target for novel therapies.
Journal of Substance Use and Addiction Treatment
July 1, 2026
Alessio Mosca, Stefania Chiappini, Andrea Miuli et al.
Management of ketamine misuse relies on supportive care, psychotherapy, and off-label medications, but robust evidence is lacking. A systematic review of 73 studies found that approaches include symptomatic medical care, psychotherapeutic interventions such as motivational interviewing and cognitive-behavioral therapy, and pharmacological treatments including benzodiazepines, SSRIs, naltrexone, lamotrigine, and gabapentinoids, with varying effectiveness. Multidisciplinary strategies addressing both psychiatric and somatic complications, such as 'K-bladder' and 'K-cramps', are essential. High relapse rates and limited follow-up weaken the evidence, and there is an urgent need for controlled studies and standardized treatment protocols.