Mindfulness involves focusing attention on present-moment experience with curiosity, openness, and acceptance. This review describes three mindfulness interventions effective for psychiatric symptoms and pain: Zen meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). Zen is a Buddhist tradition, while MBSR and MBCT are secular, manualized clinical methods. Studies indicate that MBSR and MBCT have broad-spectrum antidepressant and antianxiety effects and reduce general psychological distress. MBCT is strongly recommended as an adjunctive treatment for unipolar depression. Both MBSR and MBCT show efficacy for anxiety symptoms. MBSR benefits general psychological health and stress management in medical, psychiatric, and healthy individuals. MBSR and Zen meditation aid pain management.
This column reviews the development of intranasal esketamine, focusing on the consistency of clinical trial results. It illustrates methodological issues important to the U.S. Food and Drug Administration approval process, including study design, the nature of the comparator, and the prespecified statistical analysis plan. The column discusses what constitutes a positive versus a supportive study, differences between phase 2 and phase 3 studies, and the rationale for including both in development. While especially relevant to intranasal esketamine, it also serves as a general example of drug development and approval.
Three case reports illustrate challenges in treating treatment-resistant depression (TRD). A 73-year-old man with a liver transplant 26 years earlier responded well to 9 bitemporal electroconvulsive therapy (ECT) sessions despite his transplant history. A 28-year-old woman with chronic TRD who had only partial response to antidepressants and maintenance ECT achieved remission after twice-weekly 90-minute heated yoga sessions. A 52-year-old woman with TRD and chronic migraines, already on antidepressants and migraine medication, presented with agitation and paranoia after receiving intranasal ketamine from multiple providers, suggesting misuse; her symptoms resolved without prescribed antipsychotics. ECT remains safe even after organ transplantation, heated yoga shows promise as an adjunctive treatment, and esketamine requires careful monitoring to prevent misuse.