Depression and Anxiety
April 17, 2013
Anthony P. King, Thane M. Erickson, Nicholas D. Giardino et al.
258 citations
Group mindfulness-based cognitive therapy (MBCT) adapted for combat posttraumatic stress disorder (PTSD) is feasible, acceptable, and associated with clinically meaningful reductions in PTSD symptom severity, particularly avoidance and numbing symptoms, and trauma-related cognitions such as self-blame. In an outpatient VA clinic, veterans with chronic PTSD who completed an 8-week MBCT group showed significant improvement on clinician-rated PTSD symptoms, whereas those in brief treatment-as-usual did not. Homework compliance was good, and drop-out rates were modest. The findings suggest MBCT as a brief adjunctive therapy for combat PTSD, but randomized controlled trials are needed to confirm efficacy.
Depression and Anxiety
April 6, 2016
Chadi G. Abdallah, Thomas G. Adams, Benjamin Kelmendi et al.
204 citations
Major depressive disorder is a common psychiatric condition that often responds poorly to traditional antidepressants, which can take weeks to work. Over the past two decades, the NMDA receptor antagonist ketamine has attracted attention because a single low dose produces rapid antidepressant effects in people with treatment-resistant depression. Evidence from animal and human studies suggests that ketamine triggers a surge of glutamate, initiating a cascade that promotes synaptogenesis and reverses stress-related damage, especially in the prefrontal cortex. This review covers the neurobiology of stress-related depression, the safety and efficacy of ketamine, its mechanism of action, and predictors of treatment response, along with research limitations and future directions.
Depression and Anxiety
August 1, 2016
S. Sassano-Higgins, D. Baron, Grace Juarez et al.
200 citations
Ketamine, discovered in the 1960s and released in 1970, is used clinically for analgesia and sedation, and more recently for pain, asthma, and depression. It causes dissociation and emergence delirium, leading to recreational abuse. While death from direct pharmacological effects is rare, disinhibition and altered perceptions increase risk of environmental harm and nonconsensual sexual intercourse. Chronic use may impair memory and cause persistent dissociative, depressive, and delusional thinking, as well as lower urinary tract symptoms, cystitis, and gastric and hepatic pathology including abnormal liver function tests and bile duct dilations. S-ketamine shows hepatotoxicity in vitro. Abstinence is the mainstay treatment; specialized urine testing may be needed for detection.
Depression and Anxiety
December 30, 2018
Naji C. Salloum, Maurizio Fava, Marlene P. Freeman et al.
49 citations
In a double-blind trial, 99 people with treatment-resistant depression received either a single intravenous dose of ketamine (0.1, 0.2, 0.5, or 1.0 mg/kg) or midazolam (0.045 mg/kg). Among them, 45 had high baseline anxiety and 54 did not. No significant difference in depression improvement was found between the ketamine and midazolam groups for either anxious or nonanxious participants at 1 or 3 days after infusion. The results suggest that ketamine may work similarly for both anxious and nonanxious treatment-resistant depression, unlike some traditional antidepressants.
Depression and Anxiety
July 5, 2020
N. Weston, Damian Gibbs, Catherine Bird et al.
38 citations
A systematic review of literature from 1940 to 2000 examined the combined use of psychological therapies and psychedelic drugs for treating ICD-10 anxiety disorders. Twenty studies were included in the final analysis. Three studies reported improvements in anxiety on standardized measures, with two finding a dose-related effect. Among 145 cases of psychoneurotic anxiety reaction, 94 (65%) showed improvement ranging from moderate to full recovery. The majority of studies indicated that combining psychedelic drug administration with psychological therapy was most beneficial; no study suggested that the drug alone was sufficient.
Depression and Anxiety
April 15, 2016
Samuel T. Wilkinson, Gerard Sanacora
38 citations
Ketamine appears to rapidly but transiently reduce suicidal ideation, according to a review of open-label and randomized controlled trials. Some studies showed mixed results at different time points or with different assessments. The existing evidence is very preliminary due to small sample sizes, exclusion of patients with significant suicidal ideation at baseline, and potential functional unblinding when saline is used as a placebo. Ketamine is a promising therapeutic option for patients at imminent risk of suicide, but further controlled trials are needed before meaningful clinical recommendations can be made.
Depression and Anxiety
March 7, 2007
Heather Durdle, Leslie H. Lundahl, Chris‐ellyn Johanson et al.
34 citations
Among 226 MDMA users, 11.5% met lifetime criteria for Major Depressive Disorder. No association was found between the number of MDMA uses and major depression. However, those with lifetime major depression had higher rates of lifetime cannabis use disorder (adjusted odds ratio 2.40). Logistic regression indicated that lifetime cannabis use disorder, but not MDMA use, was significantly associated with lifetime Major Depressive Disorder. For females, a lifetime cannabis use disorder was strongly associated with major depression (adjusted odds ratio 4.99), while for males, neither drug use variable was associated with major depression.
Depression and Anxiety
August 19, 2023
Anna J. Harvey, Stevan Nikolin, Nicholas Chand et al.
4 citations
A single dose of ketamine, compared to an active control (midazolam), did not produce significant changes in most measures of emotional or cognitive processing in people with treatment-resistant depression one day after treatment. However, participants who received ketamine showed a significant improvement on a test of negative processing bias, though this improvement was not significantly linked to changes in depressive symptoms. The study was small and exploratory, and larger trials are needed to confirm the finding.
Depression and Anxiety
July 22, 2021
E. Daly, I. Turkoz, G. Salvadore et al.
Patients with treatment-resistant depression who also have anxiety tend to respond less well to antidepressants. This analysis of existing trial data examined whether adding esketamine to an antidepressant improves outcomes for such patients. Among those with comorbid anxiety, the combination of esketamine and an antidepressant led to greater improvement in depressive symptoms compared to an antidepressant alone. The benefit was also seen in patients without anxiety, though the difference was less pronounced. The results suggest that esketamine augmentation may be particularly helpful for treatment-resistant depression patients who also struggle with anxiety.