World Psychiatry
September 15, 2023
Roger S. McIntyre, Mohammad Alsuwaidan, Bernhard T. Baune et al.
712 citations
At least 30% of people with depression meet the common definition of treatment-resistant depression (TRD): inadequate response to two or more antidepressants despite adequate trials and adherence. Many cases are actually pseudo-resistant due to insufficient treatment or non-adherence. No consensus definition with proven predictive utility for clinical decisions exists, leading to varied prevalence estimates and inconsistent care. Intravenous ketamine and intranasal esketamine are effective for TRD. Some second-generation antipsychotics (e.g., aripiprazole, quetiapine XR) help as adjuncts in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation and electroconvulsive therapy are established effective interventions. Evidence for extending trials, switching, or combining antidepressants is mixed, and manual-based psychotherapies are not effective alone but help when added to antidepressants.
Brain Connectivity
December 5, 2016
Lauren Mak, Luciano Minuzzi, Glenda Macqueen et al.
354 citations
The default mode network (DMN) is a set of brain regions active during rest and self-referential thought. This review of studies up to August 2016 examined how DMN functional connectivity varies in healthy people by age, sex, cognitive function, and analysis method. DMN connectivity follows an inverse U-shape across the lifespan: strongest in adulthood, lowest in children and the elderly. Cognitive function positively correlates with DMN connectivity. Females show stronger intranetwork connectivity than males. Effects of analysis type were inconclusive. A voxel-wise meta-analysis for age confirmed an immature network in children versus adults and a stronger network in adults versus the elderly. Defining normal variation may help identify DMN changes in pathology.
The Canadian Journal of Psychiatry
August 17, 2022
Joshua D. Rosenblat, Muhammad Ishrat Husain, Yena Lee et al.
58 citations
Serotonergic psychedelics are being reconsidered as potential treatments for major depressive disorder. A Canadian task force systematically reviewed clinical trials from 1990 to 2021 and found that only psilocybin and ayahuasca have been tested in contemporary studies. Two pilot studies of single-dose ayahuasca for treatment-resistant depression showed preliminary positive effects (Level 3 evidence). Small randomized controlled trials of psilocybin combined with psychotherapy for major depressive disorder showed superiority to waitlist controls and comparable efficacy and safety to escitalopram with supportive psychotherapy, with additional trials showing efficacy in cancer-related depression (Level 3 evidence).
medRxiv
January 17, 2023
Ryan Yermus, Michael Verbora, Sidney H. Kennedy et al.
2 citations
preprint
Ketamine-Assisted Psychotherapy (KAP) produced large and sustained reductions in depression, anxiety, and PTSD symptoms for up to six months after treatment. In a retrospective trial of 1806 adults with treatment-resistant depression, anxiety, or PTSD, effect sizes at three months ranged from 0.75 to 0.86 and were maintained at six months (0.61 to 0.73). Between 39% and 41% of patients showed case reductions at three months, and 29% to 37% at six months. A minimal clinically important difference was reported by 50% to 75% at three months and 48% to 70% at six months. The treatment involved 4 to 6 guided ketamine sessions with psychotherapy.