Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions

World Psychiatry, Journal Year: 2023, Volume and Issue: 22(3), P. 394 - 412

Published: Sept. 15, 2023

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD demonstrated predictive utility in terms clinical decision-making outcomes does not currently exist. Instead, a plethora definitions have been proposed, which vary significantly their conceptual framework. The absence hampers precise estimates the prevalence TRD, also belies efforts to identify risk factors, prevention opportunities, effective interventions. In addition, it results heterogeneity practice decision-making, adversely affecting quality care. US Food Drug Administration (FDA) European Medicines Agency (EMA) adopted most used (i.e., inadequate response minimum two antidepressants despite adequacy treatment trial adherence treatment). It estimated that at least 30% persons meet this definition. significant percentage are actually pseudo-resistant (e.g., due inadequacy trials or non-adherence Although sociodemographic, clinical, contextual factors known negatively moderate depression, very few regarded as non-response across modalities treatment. Intravenous ketamine intranasal esketamine (co-administered an antidepressant) established efficacious management TRD. Some second-generation antipsychotics aripiprazole, brexpiprazole, cariprazine, quetiapine XR) proven adjunctive treatments partial responders, but only olanzapine-fluoxetine combination has studied FDA-defined Repetitive transcranial magnetic stimulation (TMS) FDA-approved for individuals accelerated theta-burst TMS recently showing efficacy. Electroconvulsive therapy acute maintenance intervention preliminary evidence suggesting non-inferiority intravenous ketamine. Evidence extending antidepressant trial, medication switching combining mixed. Manual-based psychotherapies on own offer symptomatic relief when added conventional antidepressants. Digital therapeutics under study represent potential future vista population.

Language: Английский

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Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes

The Canadian Journal of Psychiatry, Journal Year: 2024, Volume and Issue: 69(9), P. 641 - 687

Published: May 6, 2024

Background The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines the management of major depressive disorder (MDD) in 2016. Owing to advances field, an update was needed incorporate new evidence provide revised recommendations assessment MDD adults. Methods CANMAT convened a editorial group comprised academic clinicians patient partners. A systematic literature review conducted, focusing on reviews meta-analyses since 2016 guidelines. Recommendations were organized by lines treatment, which informed CANMAT-defined levels supplemented support (consisting expert consensus safety, tolerability, feasibility). Drafts based partners, peer review, defined process. Results updated comprise eight primary topics, question-and-answer format, that map care journey from selection evidence-based treatments, prevention recurrence, strategies inadequate response. adopt personalized approach emphasizes shared decision-making reflects values, preferences, treatment history with MDD. Tables psychological, pharmacological, lifestyle, complementary alternative medicine, digital health, neuromodulation treatments. Caveats limitations are highlighted. Conclusions 2023 evidence-informed MDD, clinician-friendly format. These emphasize collaborative, personalized, will help optimize outcomes adults

Language: Английский

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Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(3), P. e240953 - e240953

Published: March 6, 2024

Importance Postpartum depression (PPD) is one of the most common mental health conditions during perinatal and postpartum periods, which can have adverse effects on both mother infant. Objective To investigate efficacy perioperative adjunctive esketamine administration after cesarean deliveries in prevention PPD. Design, Setting, Participants A single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to 2023, at Fujian Provincial Hospital among 298 women aged 18 40 years, with an American Society Anesthesiologists grade I III classification singleton full-term pregnancies who were scheduled for elective deliveries. Primary analyses performed a modified intention-to-treat basis. Interventions Patients randomly assigned (n = 148) control 150) groups. Those group received single intravenous injection 0.25 mg/kg immediately fetal delivery, followed by 50 mg as adjuvant patient-controlled analgesia 48 hours surgery. Saline given patients. Main Outcomes Measures The primary outcome assessments PPD symptoms using Edinburgh Postnatal Depression Scale (EPDS) day 7. Positive screening defined score 10 or more points EPDS. In addition, EPDS analyzed continuous variable evaluate depressive symptoms. Secondary outcomes included Numeric Rating (NRS) postoperative pain, along safety evaluations including events days 14, 28, 42. Results total pregnant included, 150 (median age, 31.0 years [IQR, 29.0-34.0 years]) 148 28.0-34.0 years]). prevalence significantly lower patients compared controls (23.0% [34 148] vs 35.3% [53 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P .02) also showed change scores (difference least-squares means [SE], −1.17 [0.44]; −2.04 −0.31; effect size, 0.74; .008). However, there no differences between groups incidence positive results changes baseline There NRS rest movement except 72 postoperatively, when (median, 3.0 2.0-3.0] 3.0-3.5]; median difference, 0 [95% 0-0]; .03). Conclusions Relevance These suggest that period delivery improve early period. this antidepression may not be universally applicable low scores. Trial Registration Chinese Clinical Registry Identifier: ChiCTR2100054199

Language: Английский

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The impact of perioperative ketamine or esketamine on the subjective quality of recovery after surgery: a meta-analysis of randomised controlled trials

British Journal of Anaesthesia, Journal Year: 2024, Volume and Issue: 132(6), P. 1293 - 1303

Published: April 12, 2024

Language: Английский

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Benefits and Challenges of Ultra-Fast, Short-Acting Psychedelics in the Treatment of Depression

American Journal of Psychiatry, Journal Year: 2025, Volume and Issue: 182(1), P. 33 - 46

Published: Jan. 1, 2025

Unlike classical antidepressants, psychedelics such as psilocybin have been shown to induce a rapid antidepressant response. In the wake of this development, interest has emerged in ultra-fast, short-acting 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) and N,N-dimethyltryptamine (DMT) with expectation that these can produce effects following an intense but brief psychedelic intervention. The current paper reviews clinical pharmacology 5-MeO-DMT DMT their potential benefits challenges treatment depression. Both compounds display affinities for variety monoamine receptors transporters, mostly so serotonergic (5HT) receptors, including 5HT

Language: Английский

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Esketamine Nasal Spray in Major Depressive Disorder: A Meta‐Analysis of Randomized Controlled Trials

Clinical Pharmacology & Therapeutics, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 10, 2025

Despite being approved by the US FDA and EU European Medicines Agency, performance of esketamine nasal spray as an adjunctive therapy with antidepressant in major depressive disorder is still controversial. Comprehensive retrieval Embase, Pubmed, Web Science was conducted to identify randomized controlled trials comparing versus control or treatment‐resistant depression. The primary efficacy outcome a reduction Montgomery‐Asberg Depression Rating Scale, from baseline Day 2 28 for patients without suicidal ideation, respectively. long‐term relapse rate who achieved stable remission. certainty evidence assessed according Cochrane recommendation. Esketamine superior placebo Scale ideation (standardized mean difference: −0.24, 95% confidence interval: −0.38, −0.09, P = 0.001, I 24%), on −0.30, −0.47, −0.12, 0.0008, 0%). significantly lower group than placebo/quetiapine (risk ratio: RR: 0.60, 0.45–0.80, similar between two groups. graded “moderate” “high” abovementioned results. conjunction effectively controls short‐term symptoms depression, manageable trade‐off safety.

Language: Английский

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Effects of different doses of esketamine intervention on postpartum depressive symptoms in cesarean section women: A randomized, double-blind, controlled clinical study

Journal of Affective Disorders, Journal Year: 2023, Volume and Issue: 339, P. 333 - 341

Published: July 11, 2023

Language: Английский

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Treadmill exercise prevents stress-induced anxiety-like behaviors via enhancing the excitatory input from the primary motor cortex to the thalamocortical circuit

Nature Communications, Journal Year: 2025, Volume and Issue: 16(1)

Published: Jan. 22, 2025

Physical exercise effectively prevents anxiety disorders caused by environmental stress. The neural circuitry mechanism, however, remains incomplete. Here, we identified a previously unrecognized pathway originating from the primary motor cortex (M1) to medial prefrontal (mPFC) via ventromedial thalamic (VM) nuclei in male mice. Besides anatomical evidence, both ex vivo and recordings showed enhanced excitability of M1-VM inputs prelimbic (PrL) region mPFC upon 14-day treadmill on chronic restraint stress (CRS) mouse model. Further functional interrogations demonstrated that activation this circuit is necessary sufficient direct anxiolytic effect training CRS Our findings provide more insights into circuits connecting mental regions under paradigm implicate potential targets for neuromodulation treating disorders. relieves disorders, while authors show input cortex, nuclei.

Language: Английский

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Hemispheric asymmetries in mental disorders: evidence from rodent studies

Journal of Neural Transmission, Journal Year: 2023, Volume and Issue: 130(9), P. 1153 - 1165

Published: Feb. 26, 2023

Abstract The brain is built with hemispheric asymmetries in structure and function to enable fast neuronal processing. In neuroimaging studies, several mental disorders have been associated altered or attenuated asymmetries. However, the exact mechanism linking not known. Here, studies animal models of render important insights into etiology alterations both atypical asymmetry. this review, current literature rats mice focusing on anxiety fear, anhedonia despair, addiction substance misuse, neurodegenerative as well stress exposure, summarized. Results indicate overall increased right-hemispheric activity a left-sided behavioral bias symptoms anxiety, anhedonia, despair exposure. Addiction behavior right-sided transgenic Alzheimer’s disease an asymmetrical accumulation fibrillar plaques. Most focused changes bilateral amygdala frontal cortex. Across two crucial factors influencing arose independently disorder modeled: sex developmental age. conclusion, demonstrate similar findings patients. Particularly, greater were found across applying stress-based paradigms. sex- age-dependent effects are present that require further investigation. Animal analysis molecular level which may be most effective detect early alterations.

Language: Английский

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Advantages of Sedation With Remimazolam Compared to Midazolam for the Removal of Impacted Tooth in Patients With Dental Anxiety

Journal of Oral and Maxillofacial Surgery, Journal Year: 2023, Volume and Issue: 81(5), P. 536 - 545

Published: Feb. 25, 2023

Language: Английский

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