Ketamine May Relieve Depression By Restoring Brain Cell Connections

The NPR (10/5, Hamilton) “Shots” blog reports that “scientists say they have figured out how an experimental drug called ketamine is able to relieve major depression in hours instead of weeks.” Ketamine is an FDA-approved anesthetic. It’s also a popular club drug that can produce out-of-body experiences and hallucinations. Not exactly what you’d want from a depression drug.  “It’s exciting,” says Ron Duman, a a psychiatarist and neurobiologist at Yale University. “The hope is that this new information about ketamine is really going to provide a whole array of new targets that can be developed that ultimately provide a much better way of treating depression.”  In stressed mice, a dose of ketamine was able to “rapidly increase  connections and also to rapidly reverse the deficits that are caused by stress,” Duman says.   Research is intended to produce drugs that will work like ketamine, but without the hallucinations.  Several of these alternative drugs are already being tried in people.

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Vilazodone Submitted to FDA for Approval.

The Boston Business Journal (3/23, Donnelly, http://tinyurl.com/vilazodone)  reported that “Clinical Data Inc. has filed an application with the U.S. Food and Drug Administration seeking approval for its drug target for the treatment of major depressive disorder.  Vilazodone is an anti-depressant that has two different mechanisms — it is both a selective-serotonin re-uptake inhibitor (SSRI) along the lines of other common depression treatments such as Prozac and Zoloft, while it also includes a so-called 5-HT1A receptor partial agonist, which is the mechanism in several other anti-depressant treatments on the market including buspirone.  The most common adverse reactions included diarrhea, nausea and insomnia.”

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Antidepressant Combinations May Double the Likelihood of Remission.

According to a study done by Blier et al published in the American Journal of Psychiatry (http://tinyurl.com/mirtazapine-combo) “the use of antidepressant combinations from treatment initiation may double the likelihood of remission compared with use of a single medication”. Various classes of antidepressant medications generally induce remission of major depressive disorder in only about one-third of patients. In a previous study using  mirtazapine or paroxetine alone or in combination from treatment initiation, the rate of patients who remitted within a 6-week period was twice that of patients using either drug alone. In the current study “remission rates (defined as a HAM-D score of 7 or less) were 25% for fluoxetine, 52% for mirtazapine plus fluoxetine, 58% for mirtazapine plus venlafaxine, and 46% for mirtazapine plus bupropion”.  “The study results, which add to a growing body of evidence, suggest that use of antidepressant combinations from treatment initiation may double the likelihood of remission compared with use of a single medication”.

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Antidepressants May Work Immediately to Elevate Mood and Alleviate Depression

BBC News (10/26, Roberts) reports that, according to research (http://tinyurl.com/antidepressants-work-fast) published in the American Journal of Psychiatry, “antidepressants get to work immediately to lift mood,” even though “patients may not notice the effects until months into the therapy.” Researchers from the UK’s Oxford University “closely studied the reactions of 33 depressed patients and 31 healthy controls given either an antidepressant or a” placebo, finding that “depressed patients who took the active” medicine “showed positive improvements in three specific measures within three hours of taking them.” In an accompanying editorial psychiatrist Michael Thase, MD, characterized the study’s findings as “potentially ‘paradigm-changing,'” but called for further research.

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Researchers use brain wave measuring device to predict patient response to antidepressant.

MIT’s Technology Review (9/22, Kremen) reported that, according to a study published this month in the journal Psychiatry Research, researchers at the University of California-Los Angeles found that “brain waves measured using a simple device just one week into treatment can indicate whether a depressed patient should continue taking a medication or be switched to another.” For the study, the team “used a customized version of a quantitative electroencephalography (QEEG) system to study the brainwave patterns of 375 people suffering from major depression” in order “to predict which patients would respond to escitalopram.” The investigators used “an algorithm that considers various QEEG characteristics, called the antidepressant treatment response (ATR) index,” and “found that they could accurately predict whether the patient would respond to the escitalopram 74 percent of the time.”

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Groups issue guidelines for treatment of depression during pregnancy.

Following a Wall Street Journal article, the Los Angeles Times (9/18, Healy) reports that the American Psychiatric Association and the American College of Obstetricians and Gynecologists “have issued the first guidelines for the treatment of depression during pregnancy.” The groups say that “for women with serious, recurring depression or suicidal inclinations, the dangers of under-treatment may well outweigh the risks that antidepressants may pose to a developing fetus. At the same time, the guidelines stress that for many pregnant women suffering from depression, ‘talk therapy’ alone may be the best option, and should be routinely offered.”

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Imaging tests, electrophysiologic studies may help predict antidepressant efficacy.

The Los Angeles Times (9/16) “Booster Shots” blog reported that in a study appearing in the journal Psychiatry Research, researchers tested “noninvasive ways — such as imaging tests and electrophysiologic studies– to assess how the brain responds to” antidepressants. In “375 depressed people,” researchers “measured brain wave patterns before — and after — a week of Lexapro [escitalopram] use” to find “changes in brain activity that come well before a depressed person’s mood actually improves.” They “were able to predict medication effectiveness with 74 percent accuracy.”

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