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Mental illness
Published in Govert den Hartogh, What Kind of Death, 2023
I will avoid the term ‘treatment-resistant depression’, because, even if we could score a depressive condition on a scale indicating the probability of treatment failure (see Section 13.4), it would still be undecided at which point on the scale we should call the patient's condition ‘treatment-resistant’. And actually there is no consensus about the required number of trials and the evaluation of the patient's response to them.9 It is a substantive normative question when it is legitimate to stop trying additional treatments.10 We should not conceal that question by using quasi-diagnostic labels.
New Understanding of the Nature and Causes of Major Depression
Published in Scott Mendelson, Herbal Treatment of Major Depression, 2019
A low serum level of L-acetylcarnitine is a biomarker of both MDD and insulin resistance. It has been shown that treatment with L-acetylcarnitine produces a rapid antidepressant effect in patients with treatment-resistant depression. It acts in part to reduce insulin resistance, increase BDNF, and modulate glutamatergic activity in the brain resulting in changes somewhat similar to those seen with ketamine.72 Indeed, like ketamine, L-acetylcarnitine treatment can buffer the overactivity of NMDA receptors.73
Electrical Brain Stimulation to Treat Neurological Disorders
Published in Bahman Zohuri, Patrick J. McDaniel, Electrical Brain Stimulation for the Treatment of Neurological Disorders, 2019
Bahman Zohuri, Patrick J. McDaniel
Furthermore, some studies have reported that Electroconvulsive Therapy is only effective for 50% of individuals with treatment-resistant depression, and similar numbers were reported for those suffering from bipolar depression. According to a meta-analysis conducted in June of 2014, ECT treatment appeared to be slightly more effective than rTMS treatment in those individuals suffering from psychotic depression. However, the same meta-analysis also found that the reverse was true with those suffering with non-psychotic depression, where rTMS treatment was shown to be more effective. While it is true that ECT may be helpful in some patients, there is a rapidly growing movement of research and examination into tDCS’s potential to produce similar positive effects, without the associated risks present with ECT. Some researchers believe that certain tDCS montages (specific electrode placements) may have the possibility to help treat illnesses such as treatment-resistant depression with a higher rate of success than ECT.
Past-Year Ketamine Use: Evidence from a United States Population, 2015-2019
Published in Journal of Psychoactive Drugs, 2023
Ketamine has remained a substance with a good safety profile (Green et al. 1998; Krauss and Green 2000; White, Way, and Trevor 1982; WHO, 2016) and low prevalence of misuse. For example, ketamine was responsible for 0.033% of emergency department (ED) visits in 2005, with a slight increase to 0.12% in 2011, compared to drastic increases in other illegal drugs such as cocaine, heroin, and methamphetamine (Substance Abuse and Mental Health Services Administration 2013). Although associated with transient side effects (e.g., distortion of time and space, hallucinations, dissociation; Morgan, Curran, & Independent Scientific Committee on Drugs, 2012), and reported gastro-intestinal toxicity, abdominal pain, and neurological changes resulting from chronic use (Kalsi, Wood, and Dargan 2011), recent medical uses of ketamine have been associated with decreases in treatment-refractory cancer pain (Bredlau et al. 2013) and as a rapid antidepressant for people presenting suicidal symptoms in the emergency department (Larkin and Beautrais 2011). Furthermore, ketamine infusions have been investigated as an effective method of alleviating symptoms of treatment-resistant depression (Salloum et al., 2019).
BDNF blood levels after electroconvulsive therapy in patients with mood disorders: An updated systematic review and meta-analysis
Published in The World Journal of Biological Psychiatry, 2023
Rebeca Pelosof, Leonardo A. dos Santos, Luis C. Farhat, Wagner F. Gattaz, Leda Talib, André R. Brunoni
Depression is a leading cause of disability that affects more than 320 million people in the world (GBD 2019 Diseases and Injuries Collaborators 2020). The initial management of depression in adults involve antidepressant medications (Cipriani et al. 2018), depression-focused psychotherapy (Cuijpers et al. 2021), or a combination of both, with recent evidence indicating psychotherapy or combined treatment may be associated with increased rates of sustained response (Furukawa et al. 2021). Nonetheless, symptoms of depression do not remit after multiple courses of evidence-based therapies for ∼30% of patients (Rush et al. 2006). Treatment resistant depression – i.e. depression that does not remit to two or more adequate trials of antidepressants – is particularly associated with depression burden. Electroconvulsive therapy (ECT) is an effective and safe treatment for the management of treatment-resistant depression because it has been associated with significant reduction in depressive symptoms and suicidality with no evidence of increased risk of serious medical events (UK ECT Review Group 2003). Despite its high efficacy, the mechanisms of action of the antidepressant effects ECT are poorly understood. In line with findings that patients with depression present deficits in neuroplasticity that are restored after successful treatment, it has been hypothesised that antidepressant effects of pharmacological interventions and ECT act via the increasing of neurotrophic factors, such as BDNF (Duman et al. 2000; Duman and Monteggia 2006).
Deep transcranial magnetic stimulation for obsessive compulsive disorder
Published in Expert Review of Neurotherapeutics, 2020
Alexis G. McCathern, David S. Mathai, Raymond Y. Cho, Wayne K. Goodman, Eric A. Storch
Several forms of neuromodulation have been explored as interventions for OCD, ranging from invasive surgical procedures to noninvasive transcranial stimulation [26]. Historically, neurosurgical ablation of the cingulate gyrus or anterior limb of internal capsule has been an option of last-resort, primarily due to the high rate of adverse events following surgery and relatively low response rates [35]. Deep brain stimulation (DBS), another invasive neurosurgical intervention involving placement of stimulating electrodes most commonly in the ventral striatal region, has had similar or greater effectiveness with response achieved in about half of patients but with less adverse events compared to ablative interventions [36]. Electroconvulsive therapy (ECT) has traditionally been used for treatment-resistant depression, but some case studies have examined ECT for the treatment of obsessive-compulsive-related disorders [37–40]. ECT has not been found to be substantially effective, however, and most patients who undergo ECT for OCD experience a relapse of symptoms [41]. Transcranial electric current stimulation (tECS) is a noninvasive treatment option for various psychiatric disorders with varying success on OCD or mood-related symptoms, depending on the brain region targeted for stimulation [32]. Vagus nerve stimulation (VNS), another form of neuromodulation that can be performed in either an invasive or noninvasive manner, was well-tolerated in an open-label pilot study and associated with >50% response in three of seven patients with OCD [42].