Harvard Review of Psychiatry
August 1, 2010
Carlos A. Zarate, Rodrigo Machado‐Vieira, Ioline D. Henter et al.
226 citations
Mood disorders like bipolar disorder and major depressive disorder are common, chronic, and recurrent, affecting millions worldwide. Existing antidepressants and mood stabilizers are insufficient for many, with low remission rates, delayed action, residual symptoms, and relapses. New therapeutic agents with faster and sustained effects are urgently needed. The glutamatergic system has been implicated in the pathophysiology of these disorders, with evidence confirming the role of modulators riluzole and ketamine as proof-of-concept agents. Trials with diverse glutamatergic modulators are underway, and this system holds promise for developing next-generation therapeutics.
Harvard Review of Psychiatry
January 1, 2002
Alonso Montoya, Renée Sorrentino, Scott E. Lukas et al.
102 citations
Repeated use of the recreational drug ecstasy (MDMA) is linked to sleep, mood, and anxiety disturbances, elevated impulsiveness, memory deficits, and attention problems that may persist for up to 2 years after stopping. Experimental studies in animals and humans indicate that MDMA damages serotonergic neurons. In a subset of humans, particularly adolescents, serotonin depletion from MDMA use may hasten or enhance vulnerability to a range of neuropsychiatric problems. The reviewed studies provide substantial evidence that MDMA causes neuronal damage, but more research is needed to determine if this destruction can have long-term or permanent neuropsychiatric consequences.
Harvard Review of Psychiatry
February 21, 2018
Ioline D. Henter, Rafael Teixeira de Sousa, Carlos A. Zarate
94 citations
Glutamatergic system dysfunction is implicated in bipolar depression and major depressive disorder. Subanesthetic doses of ketamine produce rapid reductions in depressive symptoms, prompting the development of other glutamatergic modulators. This review highlights evidence for antidepressant effects of broad modulators (ketamine, esketamine, dextromethorphan, dextromethorphan-quinidine, AVP-786, nitrous oxide, AZD6765), NR2B-specific NMDA receptor antagonists (traxoprodil, MK-0657), glycine-site partial agonists (D-cycloserine, GLYX-13, sarcosine, AV-101), and metabotropic glutamate receptor modulators (AZD2066, basimglurant, JNJ40411813, RG1578).
Harvard Review of Psychiatry
July 1, 2018
Johannes Graser, Ulrich Stangier
67 citations
A review of the evidence for mindfulness-based interventions, compassion-based interventions (CBIs), and loving-kindness meditation (LKM) finds that while mindfulness-based stress reduction and mindfulness-based cognitive therapy are well-supported by many trials, only seven randomized controlled trials have been completed on CBIs and LKM. In those trials, CBIs were effective for psychotic disorders, affective disorders with psychotic features, major depressive disorder, eating disorders, and patients with recent suicide attempts; LKM was effective for chronic pain; and a combination helped borderline personality disorder. Nonrandomized studies suggest CBIs and LKM may also help depression, anxiety, chronic pain, and PTSD, but more research is needed to confirm these effects and determine their role as standalone or adjunct treatments.
Harvard Review of Psychiatry
March 1, 2022
Igor D. Bandeira, Daniel H. Lins-Silva, Vitor Breseghello Cavenaghi et al.
35 citations
Ketamine shows potential for fast onset of action and good tolerability in treating obsessive-compulsive disorder (OCD), but results have been erratic. The systematic review included nine articles: three randomized controlled trials, three case reports, two open-label trials, and one retrospective chart review. Most studies used only single-session racemic ketamine administered intravenously. No evidence demonstrates whether racemic ketamine, S-ketamine, or R-ketamine has the best efficacy, and only sparse evidence suggests combining ketamine with psychotherapy could benefit patients. Future randomized, double-blind, placebo-controlled trials with larger samples, multiple sessions, and appropriate washout periods are needed.