Ketamine, Transcranial Magnetic Stimulation, and Depression Specific Yoga and Mindfulness Based Cognitive Therapy in Management of Treatment Resistant Depression: Review and Some Data on Efficacy

Depression affects about 121 million people worldwide, and major depressive disorder occurs in 6.4% of US adults. Treatment resistant depression (TRD) accounts for 12–20% of depression patients and costs $29–$48 billion annually. Ketamine and repetitive transcranial magnetic stimulation (rTMS) are useful for TRD but their long-term utility is unknown. Yoga and meditation, including mindfulness based cognitive therapy (MBCT), have been useful in treating depression and preventing relapse. This review presents rTMS, ketamine, and MBCT, and reports a depression-specific model of Yoga and MBCT (DepS Y-MBCT) that successfully ameliorated TRD symptoms in 27 out of 32 patients in an open label pilot trial. The authors suggest a tiered approach combining ketamine and rTMS for rapid remission and DepS Y-MBCT for maintaining remission and preventing relapse.

Study at a glance

Abstract

Depression affects about 121 million people worldwide and prevalence of major depressive disorder (MDD) in US adults is 6.4%. Treatment resistant depression (TRD) accounts for approximately 12–20% of all depression patients and costs $29–$48 billion annually. Ketamine and repetitive transcranial magnetic stimulation (rTMS) have useful roles in TRD, but their utility in long term is unknown. As per the latest literature, the interventions using Yoga and meditation including the mindfulness based cognitive therapy (MBCT) have been useful in treatment of depression and relapse prevention. We present a review of rTMS, ketamine, and MBCT and also report efficacy of a depression specific, innovative, and translational model of Yoga and mindfulness based cognitive therapy (DepS Y-MBCT), developed by the first author.DepS Y-MBCTas an adjunctive treatment successfully ameliorated TRD symptoms in 27/32 patients in an open label pilot trial in TRD patients. Considering the limitations of existing treatment options, including those of ketamine and rTMS when used as the sole modality of treatment, we suggest a “tiered approach for TRD” by combining ketamine and rTMS (alone or along with antidepressants) for rapid remission of acute depression symptoms and to useDepS Y-MBCTfor maintaining remission and preventing relapse.