Antidepressants

Research Update

Is Ketamine Just Another Opiate?

Topics: Antidepressants | Depression | Ketamine | Opioids | Research Update

Review of: Williams NR et al, Am J Psychiatry 2018;175:1–11 Type of study: Double-blind, placebo-controlled, crossover study Ketamine’s rapid antidepressant effects have now been demonstrated in over two dozen double-blind, placebo-controlled trials, but how it works is less clear. For many years, NMDA receptor antagonism was thought responsib

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Article

Treatment-Resistant Depression: Some Introductory Tips

Topics: Antidepressants | Bipolar Disorder | Depressive Disorder

Treatment-resistant depression (TRD) has a fairly low barrier of entry. Failure of 2 full antidepressant trials—lasting 6 weeks at a minimally effective dose—is enough to qualify. In this month’s issue of TCPR, we’ll highlight pharmacologic advances that are underutilized and debunk a few that are unlikely to be effective for TRD. But first, we

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Article

Antidepressant Augmentation Strategies: A Basic Guide

Topics: Antidepressants | Free Articles

Here’s a common scenario. You have a patient who has tried three or four antidepressants over the years; all have been somewhat effective at least initially, but eventually that effectiveness waned. Let’s imagine that the patient you’re seeing now is on antidepressant number 4, Lexapro, at a solid 20 mg dose. You could always keep pushing the d

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Article

A Look at the Latest Antidepressant Meta-Analysis

Topics: Antidepressants | Neuroscience in Psychiatry

You may have read about the meta-analysis published in Lancet earlier this year on the efficacy evidence for all antidepressants (Cipriani A et al, Lancet 2018;391(10128):1357–1366). It’s a complicated paper, and in this article, we’ll take a closer look at it and give you our take on the bottom line. The authors did a systematic review and met

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Research Update

Youth, Antidepressant Medications, and Type 2 Diabetes

Topics: Antidepressants | Child Psychiatry | Psychopharmacology Tips

Review of: Burco M et al, JAMA Pediatrics 2017;171(12):1200–1207 Over the last decade, several published studies have reported an increased risk of type 2 diabetes associated with antidepressant use in adults. But does the same hold true for children and adolescents? This paper is the first population-based study to examine the risk of onset of

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Article

An Antidepressant Diet

Topics: Antidepressants

There’s a lot of discussion in the medical journals about nutritional psychiatry, which is the concept that certain diets can prevent or treat psychiatric disorders (Marx W et al, Proc Nutr Soc 2017;76(4):427-436). We’ve covered this topic before (see TCPR August 2010, “Alternative Treatments for Depression”), and since then there has been more

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Research Update

Aripiprazole Augmentation May Improve Remission Rates in MDD

Topics: Antidepressants | Research Updates

Review of: Mohamed S et al, JAMA 2017;318(2):132–145 It seems like an endless debate: When a patient does not respond to the first trial of an antidepressant, what should we do? Switch to something else? Augment with another agent? If the latter, how often should that augmenting agent be an atypical antipsychotic? The VA Augmentation and Switching

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Research Update

A Cautionary Consensus on the Use of Ketamine for Depression

Topics: Antidepressants | Depressive Disorder | Research Update

Review of: Sanacora G et al, JAMA Psychiatry 2017;74(4):399–405. doi:10.1001/jamapsychiatry.2017.0080 Ketamine has become increasingly popular as an off-label medication for rapid onset treatment of refractory depression. Recently, the American Psychiatric Association convened a task force to review the data and come up with some recommendations. T

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Article

Beginning Antidepressant Treatment: A Recommended Approach

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips

How do you start a new patient on antidepressant treatment? We do this countless times in our practices, and reviewing the topic may feel a bit like returning to residency. However, it’s important to revisit our standard operating procedures from time to time to ensure we’re thinking carefully about our decisions during our busy days. If we turn

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Expert Q&A

When First-Line Depression Treatments Don’t Cut It: Newer Antidepressants and Sometimes, Antipsychotics

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips

TCPR: It’s been about 10 years since we last talked with you about the practical use of antidepressants with so many drugs to choose from. Over the last few years, three new antidepressants have come out: vilazodone (Viibryd), vortioxetine (Trintellix), and levomilnacipran (Fetzima). My sense is that an awful lot of clinicians still haven’t changed

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Expert Q&A

When Depression Meds Fail, Transcranial Magnetic Stimulation Might Be Plan B

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips

TCPR: How treatment-resistant does a patient have to be with antidepressants before you should consider trying TMS? Dr. Becker: When TMS initially came out in 2008, it was approved for people who had failed one medication trial. But I’ll tell you, from doing a number of insurance reviews, that health insurers are going to require on average about f

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Research Update

Which Are the Most Dangerous Antidepressants?

Topics: Antidepressants | Psychopharmacology | Research Updates

Review of: Nelson JC and Spyker DA, Am J Psychiatry 2017;174(5):438–450 Study type: Retrospective cohort We often prescribe antidepressants to patients who are suicidal, and unfortunately, some people use these very medications to try to kill themselves. It’s been known for some time that tricyclic antidepressants are among the most toxic in

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Assessing Illness and Medication Treatment in the Perinatal Period