Neuropsychiatric Disease and Treatment
January 1, 2020
Daphne Voineskos, Zafiris J. Daskalakis, Daniel M. Blumberger
430 citations
Treatment-resistant depression (TRD) is a form of major depressive disorder that does not respond to standard first-line treatments. Although no consensus definition exists, all models require an inadequate response to at least two trials of antidepressant medication. This review compiles meta-analyses, trials, and reviews on TRD challenges and management. It discusses confounds in definitions and staging, difficulties in assessment, and pharmacological augmentation strategies (lithium, triiodothyronine, second-generation antipsychotics, switching antidepressant class). Somatic therapies (electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, deep brain stimulation), psychotherapeutic approaches, and novel treatments (ketamine, psilocybin, anti-inflammatories) are reviewed. The evidence indicates that further large-scale work is needed to understand appropriate treatment pathways and prescribe effective options.
Neuropsychiatric Disease and Treatment
August 1, 2021
A. Wilkowska, A. Włodarczyk, M. Gałuszko-węgielnik et al.
33 citations
In an open-label observational study, 13 patients with treatment-resistant bipolar depression received eight intravenous infusions of 0.5 mg/kg ketamine over four weeks. After the seventh infusion, 61.5% responded and 46.2% achieved remission. Responders also showed a significant antisuicidal effect. Ketamine caused a transient rise in blood pressure and increased dissociative symptoms, but no manic switch or serious adverse events occurred. The findings suggest ketamine is a safe and feasible add-on treatment for this population.
Neuropsychiatric Disease and Treatment
May 1, 2015
22 citations
A four-week loving-kindness meditation program, practiced three times a week for about 30 minutes each session, improved positive emotions, interpersonal interactions, and complex understanding of others among college freshmen. The meditation group showed strong effects, with effect sizes above 0.8 for both interpersonal interaction and complex understanding of others, compared to a control group that received no meditation training. The findings suggest that loving-kindness meditation can effectively enhance social and emotional functioning in college students.
Neuropsychiatric Disease and Treatment
December 1, 2022
Peng Liu, Shanshan Zhang, Yun Liang et al.
16 citations
Adding esketamine to an antidepressant improves outcomes for people with treatment-resistant depression more than placebo plus antidepressant. Across seven randomized controlled trials involving 701 patients receiving esketamine plus antidepressant and 551 receiving placebo plus antidepressant, the combination led to greater reductions in depression severity scores (Montgomery-Asberg Depression Rating Scale and self-rating depression scale), higher response and remission rates at the end of the double-blind induction period, and better quality of life and health status ratings. Minor adverse reactions occurred with esketamine.
Neuropsychiatric Disease and Treatment
March 1, 2018
Eva Češková, Petr Šilhán
Current treatment for severe mental disorders remains suboptimal. Improvement comes from both new procedures and optimizing existing ones, including therapeutic drug monitoring. New pharmacological options include more sophisticated monoaminergic drugs, rediscovered older drugs, and agents targeting novel mechanisms. For depression, treatment resistance is a major challenge; switching to multimodal antidepressants or augmenting with atypical antipsychotics like aripiprazole and brexpiprazole shows promise, as do nutraceuticals, ketamine, and opioids. Antipsychotics remain central for schizophrenia; new partial dopamine agonists brexpiprazole and cariprazine join aripiprazole, and long-acting injectable formulations of aripiprazole lauroxil and 3-month paliperidone palmitate are now available. Emerging options include cannabidiol, glutamate modulators, and nicotine receptor agonists.