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Response to intravenous racemic ketamine after switch from intranasal (S)-ketamine on symptoms of treatment-resistant depression and post-traumatic stress disorder in Veterans: A retrospective case series.

BACKGROUND: Racemic (R,S)-ketamine is a glutamatergic drug with potent and rapid acting antidepressant effects. An intranasal formulation of (S)-ketamine was recently approved by the US Food and Drug Administration (FDA) to be used in individuals with treatment-resistant depression (TRD). There are no data directly comparing outcomes on depression or other comorbidities between these two formulations of ketamine. However, recent meta-analyses have suggested that IV racemic ketamine may be more potent than IN-(S)-ketamine. METHODS: We retrospectively analyzed clinical outcomes in 15 Veterans w

Cushing's Syndrome Masquerading as Treatment Resistant Depression.

Treatment resistant depression (TRD) is a common clinical occurrence among patients treated for major depressive disorder. A significant proportion of patients remain significantly depressed in spite of aggressive pharmacological and psychotherapeutic approaches. Management of patient with treatment resistant depression requires thorough evaluation for physical causes. We report a case of recurrent depressive disorder, who presented with severe depressive episode without psychotic symptoms, not responding to multiple adequate trials of antidepressants, who on investigation was found to have Cu

Depression roundtable: Is there a role for BoNT?

Depression can occur in the context of major depressive disorder or bipolar disorder. There are many effective and well-tolerated treatment options for most patients experiencing major depressive episodes, but for patients with treatment-resistant major depressive disorder or bipolar depression, current pharmacologic and non-pharmacologic options can be less efficacious, well tolerated, or accessible. Botulinum neurotoxin (BoNT) offers a novel approach to treating depression that is both safe and well-tolerated. Several potential mechanisms of action in depression are theorized, and studies su

Evolving refractory major depressive disorder diagnostic and treatment paradigms: toward closed-loop therapeutics.

Current antidepressant therapies do not effectively control or cure depressive symptoms. Pharmaceutical therapies altogether fail to address an estimated 4 million Americans who suffer from a recurrent and severe treatment-resistant form of depression known as refractory major depressive disorder. Subjective diagnostic schemes, differing manifestations of the disorder, and antidepressant treatments with limited theoretical bases each contribute to the general lack of therapeutic efficacy and differing levels of treatment resistance in the refractory population. Stimulation-based therapies, suc

Increased Serum Levels of Oxytocin in 'Treatment Resistant Depression in Adolescents (TRDIA)' Group.

OBJECTIVE: 'Treatment-resistant depression' is depression that does not respond to an adequate regimen of evidence-based treatment. Treatment-resistant depression frequently becomes chronic. Children with treatment-resistant depression might also develop bipolar disorder (BD). The objective of this study was to determine whether serum levels of oxytocin (OXT) in treatment-resistant depression in adolescents (TRDIA) differ from non-treatment-resistant depression in adolescents (non-TRDIA) or controls. We also investigated the relationships between serum OXT levels and the clinical symptoms, sev

[Bipolarity in treatment-resistance depression-preliminary results from the TRES-DEP study].

AIM: The study aimed to analyse the bipolarity features between patients with treatment-resistant depression and patients with remission of a depressive episode. METHODS: The population studied included patients aged 18-65 who had a diagnosis of first or recurrent major depressive disorder. Each psychiatrist included 5 consecutive patients, from all the patients he is treating, where the depressive episode was assessed as treatment-resistant (TR) and 5 consecutive patients with a depressive episode in remission (RE). One thousand and fifty-one patients entered the study: 570 in the treatment-

[Peripheral prognostic biomarkers of response in treatment-resistant depression].

Major depressive disorder is a serious mental health disorder of high prevalence and the leading cause of disability worldwide. While there are several classes of therapeutic agents with proven antidepressant efficacy, only about 40-60% of patients respond to initial antidepressant monotherapy, and 30-40% of patients may even show resistance to treatment even under optimal antidepressant pharmacotherapy. Despite the existence of international guidelines, there are still no clear and widely accepted treatment algorithms, no established predictive biomarkers of response to treatment, while the m

Impact of dissociation on treatment of depressive and anxiety spectrum disorders with and without personality disorders.

OBJECTIVE: The central goal of the study was to analyze the impact of dissociation on the treatment effectiveness in patients with anxiety/neurotic spectrum and depressive disorders with or without comorbid personality disorders. METHODS: The research sample consisted of inpatients who were hospitalized in the psychiatric department and met the ICD-10 criteria for diagnosis of depressive disorder, panic disorder, generalized anxiety disorder, mixed anxiety-depressive disorder, agoraphobia, social phobia, obsessive compulsive disorder, posttraumatic stress disorder, adjustment disorders, disso

[A Practical aspects of managing treatment-resistant depression - with a focus on esketamine].

It is relatively common for patients suffering from major depressive disorder to experience no significant improvement in their depressive symptoms despite trying several antidepressants and/or other treatment methods. This phenomenon is referred to in the scientific literature and clinical jargon as "treatment-resistant depression" (TRD). In our review paper, we attempt to present various definitions of TRD and conceptually related categories (e.g., "therapy-refractory depression"; "difficult-to-treat depression") and to discuss the risk factors, differential diagnosis, and treatment options

Rapid decrease in depressive symptoms with an N-methyl-d-aspartate antagonist in ECT-resistant major depression.

BACKGROUND: Ketamine rapidly improves depressive symptoms in patients with treatment-resistant major depressive disorder (MDD) who do not respond to multiple standard antidepressants. However, it remains unknown whether ketamine is equally effective in patients with MDD who previously also did not respond to electroconvulsive therapy (ECT). METHODS: This study compared 17 patients with treatment-resistant MDD who previously did not respond to ECT and 23 patients with treatment-resistant MDD who had not previously received ECT. All subjects received a single open-label infusion of ketamine (0.

Электроконвульсивная терапия (ЭКТ) и репетитивная транскраниальная магнитная стимуляция (rTMS), пособия и вредные последствия для пациентов с депрессией: обзор.

Справочная информация: Серьезное депрессивное расстройство, особенно в его стойкой к лечению форме, остается одной из основных причин инвалидности во всем мире. В тех случаях, когда фармакотерапия и психотерапия не дают результатов, все шире используются такие методы нейромодуляции, как электроконвульсивная терапия (ЭКТ) и повторяющаяся транскраниальная магнитная стимуляция (rTMS). Однако изменчивость протоколов и отчетности о результатах по-прежнему вызывает неопределенность в отношении их сравнительных преимуществ и характеристик безопасности. Цель: Всеобъемлющий анализ и обобщение имеющихся

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… Eligible diagnoses included major depressive disorder, treatment-resistant depression, unipolar depressive disorder, bipolar depression in the depressive phase, postpartum depression, vascular depression, late-life depression, refractory or medication-resistant depression, and depressive syndromes associated …

Factors associated with pharmaco resistance in major depressive disorder.

BACKGROUND: Depressive disorder is a common psychiatric disorder that represents a major public health problem. The failure of pharmacological treatment remains frequent, resulting in significant socio-professional disability and high economic costs. The objective of our work was to specify the rates of resistance and remission under antidepressants and to determine the factors associated with drug resistance in this disorder. METHODS: It was a prospective, longitudinal, analytical study conducted in the psychiatry department of the Military Hospital of Tunis in patients consulting for a depr

Endocrinological Treatment Targets for Depressive Disorder.

Depressive disorder exhibits heterogeneity in clinical presentation, progression, and treatment outcomes. While conventional antidepressants based on the monoamine hypothesis benefit many patients, a significant proportion remains unresponsive or fails to fully recover. An individualized integrative treatment approach, considering diverse pathophysiologies, holds promise for these individuals. The endocrine system, governing physiological regulation and organ homeostasis, plays a pivotal role in central nervous system functions. Dysregulations in endocrine system are major cause of depressive

Case Report: rTMS for recurrent major depressive disorder and generalized anxiety disorder comorbid with atrial fibrillation.

This paper examines the utilization of repetitive transcranial magnetic stimulation (rTMS) to treat recurrent Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) in a patient comorbid with atrial fibrillation (AF), a type of common heart arrhythmia. Symptoms of AF can increase the risk of MDD and GAD, negatively impacting quality of life. Repetitive Transcranial Magnetic Stimulation (rTMS) is an FDA-approved modality for treatment-resistant major depressive disorder (MDD) and has shown promise for off-label treatment of anxiety disorders. Quantitative psychometric questionna

Translocator Protein Distribution Volume Predicts Reduction of Symptoms During Open-Label Trial of Celecoxib in Major Depressive Disorder.

BACKGROUND: Gliosis is common among neuropsychiatric diseases, but the relationship between gliosis and response to therapeutics targeting effects of gliosis is largely unknown. Translocator protein total distribution volume (TSPO VT), measured with positron emission tomography, mainly reflects gliosis in neuropsychiatric disease. Here, the primary objective was to determine whether TSPO VT in the prefrontal cortex (PFC) and anterior cingulate cortex (ACC) predicts reduction of depressive symptoms following open-label celecoxib administration in treatment-resistant major depressive disorder.

The effectiveness of ketamine on anxiety, irritability, and agitation: Implications for treating mixed features in adults with major depressive or bipolar disorder.

OBJECTIVE: To determine the effectiveness of intravenous (IV) ketamine on anxiety, irritability, agitation, and suicidality, in adults with treatment-resistant major depressive disorder (MDD) or bipolar disorder (BD). METHOD: Adults (N = 201) with treatment-resistant MDD or BD received repeat-dose IV ketamine treatment at a community-based clinic. Mixed features were measured using symptoms of anxiety, irritability, and agitation (AIA), as measured by the Generalized Anxiety Disorder-7 (GAD-7) scale. The Quick Inventory for Depressive Symptomatology Self-Report-16 (QIDS-SR16 ) was used to mea

[The analysis of bipolar spectrum features in drug resistant unipolar depression patients as compared to depressive patients who responded to standard antidepressant treatment. A pilot study].

AIM: This is a pilot study of the multicenter TRES-DEP (Treatment Depression) Project. Its' aim was the detection and analysis of bipolar spectrum features in drug resistant unipolar depression patients in comparison to depressive patients who responded to standard antidepressant treatment and remitted. Sociodemographic and clinical parameters of the patients were also described. METHOD: 50 drug-resistant (group 1) and 50 non-drug resistant (group 2) 18-65 year old patients, fulfilling ICD-10 criteria for depressive episode or recurrent depressive disorder were included in the study. The main

Risperidone Augmentation in Antidepressant-Resistant Somatic Symptom Disorder.

Chronic somatic symptoms are hallmarks of somatic symptom disorder (SSD), characterized by notable disruptions in the day to day lives of affected patients. Risperidone is an effective augmenting agent for treatment-resistant major depressive and obsessive-compulsive disorders. Although various antidepressants have been used for the pharmacotherapy of SSDs, no guidelines have been formulated for treatment-resistant or severe SSDs. To date, the efficacy of risperidone augmentation for the treatment of antidepressant-resistant SSD has not been reported. Here, we report the case of a 68-year-old

Treatment options for bipolar depression.

Bipolar disorder is often misdiagnosed as major depressive disorder because of the high frequency of depressive symptomatology in many patients with bipolar disorder. Depressive episodes that are resistant to treatment may also be associated with a worse course of illness in bipolar disorder, but we do not yet understand all the factors in the connection between bipolar disorder and depression. The data on the effectiveness of antidepressants in the treatment of depression in bipolar disorder vary greatly, and there have been few prospective, randomized studies on the subject. From the data so

[Contribution of serotonin 5-HT2A receptor to antidepressant effect of serotonergic psychedelics].

Major depressive disorder presents a substantial global health burden, and at least 30-40% of patients exhibit treatment resistance to antidepressants. Ketamine, an NMDA receptor antagonist, is used as an anesthetic agent. In 2019, the U.S. Food and Drug Administration (FDA) approved esketamine (the S-enantiomer of ketamine) as a therapeutic agent for treatment-resistant depression; however, this drug has reportedly been associated with serious side effects such as dissociative symptoms, thus limiting its clinical use as an antidepressant. Recently, various clinical studies have reported that