Depressive_disorder - Articles - Page 2

Optimal Antidepressant Doses in Major Depression

March 9, 2020

Kristen Gardner, PharmD. Dr. Gardner has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

More is not necessarily better in psychopharmacology. Some medications have plateau effect, while others follow a “U-shaped curve,” causing more problems as the dose goes too high. This metaanalysis looked at 77 dose-response trials with antidepressants to quantify their optimal therapeutic window.

An Answer for Psychotic Depression

February 10, 2020

Randall Moore, MD.

Randall Moore, MD. Dr. Moore has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Research tells us how to start meds, but rarely when to stop them. This study brings some needed answers on discontinuing antipsychotics after recovery from psychotic depression.

Getting Uncomfortable with Esketamine

January 13, 2020

Nolan Williams, MD

Nolan Williams, MD

Director of the Brain Stimulation Lab and Interventional Psychiatry Clinical Research Program; Assistant Professor of Psychiatry at Stanford University, CA. Dr. Williams has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The FDA approval of esketamine (Spravalto) left some unanswered questions, including suicide, addiction, withdrawal, neurotoxicity, and bladder inflammation. Nolan Williams addresses those risks and looks at where esketamine fits among other options like TMS and ECT. Dr. Williams directs the Interventional Psychiatry Clinical Research Program and Brain Stimulation Lab at Stanford University.

Antipsychotic Maintenance: How Long is Enough?

January 13, 2020

Chris Aiken, MD.

Chris Aiken, MD. Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC. Dr. Aiken has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Atypical antipsychotics can work quickly in mood disorders, but their long-term risks give us pause. When is it safe to discontinue them? The answer, it turns out, depends on whether we look to industry-supported or industry-independent trials.

TMS: Deeper is not Better

January 13, 2020

Edmund S. Higgins, MD.

Edmund S. Higgins, MD. Dr. Higgins has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Two devices are available for transcranial magnetic stimulation (TMS). Neurostar came first with the figure-8 coil, which is now off-patent, while Brainsway’s H-coil which claims to reach deeper into the cerebral cortex. See how they compare in the first head-to-head controlled trial, undertaken without industry support.

A Practical Guide to Light Therapy

November 15, 2019

Chris Aiken, MD.

Chris Aiken, MD. Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC.

Few natural therapies perform well when stacked head-to-head with medication. Light therapy is an exception. When used correctly, it can treat winter and non-winter depression and augment antidepressants. Learn which lightboxes work, how to use them, and a new light therapy protocol for bipolar depression.

Mirtazapine Augmentation: Running Low on Rocket Fuel

August 30, 2019

Thomas Jordan, MD and Chris Aiken, MD.

Thomas Jordan, MD and Chris Aiken, MD. Dr. Jordan and Dr. Aiken have disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Dubbed “California Rocket Fuel” by Stephen Stahl, the combination of venlafaxine and mirtazapine seemed to hit all the right receptors. The hype may have gotten a little ahead of the evidence on this one, however, as three new studies reveal.

l-Methylfolate for Depression: Costly Mistake or Good Thinking?

August 1, 2019

Folic acid and l-methylfolate are two versions of the same vitamin. Both are popular for antidepressant augmentation, but one is a expensive prescription. We compared them side-by-side and found that one has a slight advantage.

Esketamine Gets FDA Approval

July 3, 2019

Michael Posternak, MD. Psychiatrist in private practice, Boston, MA. Dr. Posternak has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

On March 5, 2019, the FDA approved esketamine (Spravato) nasal spray as add-on therapy to traditional antidepressant medications for treatment-resistant depression (TRD). In this article, I will describe the events that led to esketamine’s development, review the data submitted to the FDA, and discuss what the future might hold for esketamine.

Risk Evaluation and Mitigation Strategy (REMS) Programs

July 3, 2019

Certain psychiatric treatments require both the healthcare provider and patient to enroll in a Risk Evaluation and Mitigation Strategy (REMS) program before they are administered. Here are links to enroll.