Oral racemic ketamine for common clinical contexts in patients with major depressive disorder: An important intervention that treatment guidelines may never include

2021 ◽  
Author(s):  
Chittaranjan Andrade
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Treatment Guidelines ◽  
Major Depressive ◽  
Racemic Ketamine

scholarly journals The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Réseau Canadien Pour Les Traitements De L’humeur Et De L’anxiété (Canmat) Concernant L’utilisation De La Kétamine Racémique Chez Les Adultes Souffrant De Trouble Dépressif Majeur

2020 ◽  
pp. 070674372097086
Author(s):  
Jennifer Swainson ◽  
Alexander McGirr ◽  
Pierre Blier ◽  
Elisa Brietzke ◽  
Stéphane Richard-Devantoy ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Task Force ◽  
Nmda Receptor Antagonist ◽  
Major Depressive ◽  
Level Of Evidence ◽  
Consensus Statements ◽  
Racemic Ketamine ◽  
Level 3 ◽  
Third Line

Objective: Patients with major depressive disorder often have limited response to first-line and second-line medications; hence, novel pharmacological treatments are needed for treatment-resistant depression (TRD). Ketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, has demonstrated rapid antidepressant effects in patients with TRD. The Canadian Network for Mood and Anxiety Treatments (CANMAT) convened a task force to review the evidence for efficacy and safety of racemic ketamine and to provide recommendations for its use in clinical practice. Methods: A systematic review was conducted with computerized search of electronic databases up to January 31, 2020 using combinations of search terms, inspection of bibliographies, and review of other ketamine guidelines and consensus statements. The level of evidence and lines of treatment were assigned according to CANMAT criteria. Recommendations were given in question–answer format. Results: Intravenous (IV) racemic ketamine given as a single infusion has Level 1 evidence for efficacy in adults with TRD. The evidence for multiple infusions, given as an acute series or as ongoing maintenance treatment, is limited to Level 3. Adverse events associated with ketamine infusions include behavioral (e.g., dissociative symptoms) and physiological (e.g., hypertension) events. There is only Level 3 or 4 evidence for non-IV formulations of racemic ketamine. Consensus recommendations are given for clinical administration of IV ketamine including patient selection, facility and personnel issues, monitoring, and maintaining response. Conclusions: Single-dose IV racemic ketamine is a third-line recommendation for adults with TRD. The need for repeated and maintenance ketamine infusions should be carefully assessed on a case-by-case basis with consideration of potential risks and benefits. Because of limited evidence for efficacy and risk for misuse and diversion, the use of oral and other formulations of racemic ketamine should be limited to specialists with ketamine-prescribing expertise and affiliations with tertiary or specialized centers.

scholarly journals Efficacy of brief dynamic interpersonal therapy in patients with major depressive disorder: a prospective, multicenter randomized controlled trial protocol

2020 ◽  
Author(s):  
Lanlan Wang ◽  
Qian Wang ◽  
Wenhui Jiang ◽  
Jianfeng Luo ◽  
Jun Tong ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Rating Scale ◽  
Treatment Guidelines ◽  
Controlled Trial ◽  
Treatment Phase ◽  
Major Depressive ◽  
Randomized Controlled ◽  
Multicenter Randomized Controlled Trial

Abstract Background: In China, psychodynamic psychotherapies are widely used as a treatment for depression. However, very few efficacy studies of psychodynamic therapies have been conducted with the Chinese population. This paper describes a study protocol of a multicenter randomized controlled trial of Dynamic Interpersonal Psychotherapy (DIT), a brief manualized depression-focused intervention, in Chinese adults with major depressive disorder (MDD). Methods: Recruitmemt is planned in five hospitals. 240 patients with MDD will be randomly allocated on a 1:1:1 basis to either medication plus DIT, medication plus an active control psychotherapy, or medication alone. Patients will be assessed at baseline and at weeks 2, 4, 8, 12, 16 during the acute treatment phase, and 1, 3, 6 and 12 months posttreatment. The primary outcome is change from baseline in the 17-item Hamilton Depression Rating Scale, administered by independent raters who are blind to treatment allocation. The Hamilton Anxiety Rating Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, response, remission and relapse rates, self-assessment of overall efficacy and satisfaction of patients, and side effect profiles are secondary measures. Discussion: This will be the first multicentered RCT in China to assess the efficacy of a brief psychodynamic intervention for MDD. The study has the potential to inform clinical treatment guidelines for the treatment of depression in China. Trial registration: ChiCTR，ChiCTR1800016970， Registered on July 5th 2018. Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=28786.

The Potential Role of Pharmacogenomics in Optimizing Drug Regimens for Older People with Major Depressive Disorder

2021 ◽  
Vol 36 (6) ◽  
pp. 276-282
Author(s):  
Jarvett M. Cox ◽  
Leisa L. Marshall
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Older People ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Treatment Guidelines ◽  
Older Individuals ◽  
Major Depressive ◽  
First Line Therapy ◽  
Drug Regimens ◽  
Older Populations

Major depressive disorder (MDD) is a mood disorder common in older individuals. While many clinical guidelines endorse the use of selective serotonin reuptake inhibitors (SSRIs) as first-line therapy in the treatment of MDD, the use of SSRIs in older populations can result in medication-related adverse events. The use of pharmacogenomic (PGx) testing as a personalized tool to determine optimal SSRI therapy could offer a means to decrease morbidity and improve overall quality of life in older people. This manuscript will review the epidemiology and criteria of MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), discuss the prevalence of MDD in older individuals, review the clinical treatment guidelines for the use of SSRIs in MDD, provide a brief overview of PGx testing, and present evidence for SSRI therapy modifications based on PGx testing.

scholarly journals Clinical Correlates and Outcome of Major Depressive Disorder and Comorbid Migraine: A Report of the European Group for the Study of Resistant Depression

2020 ◽  
Vol 23 (9) ◽  
pp. 571-577
Author(s):  
Gernot Fugger ◽  
Markus Dold ◽  
Lucie Bartova ◽  
Marleen M M Mitschek ◽  
Daniel Souery ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Functional Disability ◽  
Treatment Guidelines ◽  
Antidepressant Treatment ◽  
Clinical Information ◽  
Binary Logistic Regression ◽  
Major Depressive ◽  
Caucasian Origin ◽  
Male Patients

Abstract Background The present multicenter study aimed at defining the clinical profile of patients with major depressive disorder (MDD) and comorbid migraine. Methods Demographic and clinical information for 1410 MDD patients with vs without concurrent migraine were compared by descriptive statistics, analyses of covariance, and binary logistic regression analyses. Results The point prevalence rate for comorbid migraine was 13.5% for female and 6.2% for male patients. MDD + migraine patients were significantly younger, heavier, more likely female, of non-Caucasian origin, outpatient, and suffering from asthma. The presence of MDD + migraine resulted in a significantly higher functional disability. First-line antidepressant treatment strategy revealed a trend towards agomelatine. Second-generation antipsychotics were significantly less often administered for augmentation treatment in migraineurs. Overall, MDD + migraine patients tended to respond worse to their pharmacotherapy. Conclusion Treatment guidelines for comorbid depression and migraine are warranted to ensure optimal efficacy and avoid possible pitfalls in psychopharmacotherapy, including serotonin syndrome.

Factors Impacting the Selection of Antidepressant Treatment in Patients With Major Depressive Disorder at Risk for Nonadherence

CNS Spectrums ◽  
2009 ◽  
Vol 14 (S12) ◽  
pp. 15-19 ◽  
Author(s):  
Charles Shelton
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Treatment Guidelines ◽  
Patient Adherence ◽  
Antidepressant Treatment ◽  
Major Depressive ◽  
Patient Nonadherence ◽  
Subsequent Relapse ◽  
Selection Of

AbstractTreatment with the newer generation antidepressants is considered generally effective for most patients with major depressive disorder when taken in accordance with treatment guidelines. However, multiple clinical studies have demonstrated that rates of patient adherence to antidepressants are inadequate, specifically with regard to long-term maintenance treatment. Tolerability issues associated with antidepressants can increase the risk for patient nonadherence and result in subsequent relapse of depressive symptoms. Comorbid symptoms of anxiety also influence psychiatrists' choice of antidepressants for patients with depression. Physicians can improve long-term patient outcomes for patients with major depressive disorder by considering the possibility of drug-drug interactions before prescribing a specific antidepressant.

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