A highlight from What Works Best in Treatment Resistant Depression Part 2

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These complementary options. Don't get his used as much as they should. So we have a detailed guide to light therapy and methyl fully on website. And we ought to do one on sammy to if sami was copyrighted. It would probably be classified. As an antidepressant it enhances dopamine serotonin and norepinephrine transmission much like the fabled triple reuptake inhibitor. That companies have been trying to develop for years and sammy can cause mania in bipolar disorder. So that's what we know that works after. One failed antidepressant trial and remember treatment. Failure here doesn't mean that there was no response to the antidepressant. It just means the medication didn't finish the job. It only worked part of the way or it didn't work at all but one failed. Trial is not really treatment resistant depression. You need to failures to reach that level. So what works. Best when to anti-depressants have failed to work ec t and t m s definitely fit there and today will report on a new study that ranks all the other strategies for this full level of treatment resistant. Depression a group of british and canadian. Researchers led by alan young published a new analysis of therapies for treatment resistant depression. What makes their analysis unique that they focused only on patients with treatment resistant. Depression at least two failed antidepressant trials. They did not look at t. Msnbc t but they did include ketamine and psychotherapy own all that gathered twenty seven medication trials and three psychotherapy trials and analyze the data to different ways into papers. I i looked at how each treatment change depressive symptoms comparing the pre and post treatment depression for every treatment including placebo. The second paper was a network meta analysis that looted how each treatment fared against a common placebo arm. Here's what they found. I the typical anti psychotics worked specifically arab peppers all a bill. Fi and five studies brex peppers all salty in five studies career. Zine ray lahr in one study alan bean as sim box in combination with vauxhall team in one study and could taya pains circle into studies. It's hard to tell about lithium. Because they lumped in with lamotrigine and these as a group worked in one of the analyses but not the other. That's not too surprising so far. We see the lineup for two antidepressant failures as we so for one antidepressant failure where things get more interesting is what they found with the group of medications they classified as turgid. These are also called. N methyl. D aspartame or an mda antagonists. They included ketamine and to repurpose antibiotics. Minocycline and cyclists syrian note that the fda approved s ketamine. Bravado was not included. Just regular ketamine in. Both of dr young's analyses. These meds had a much bigger effect than the others. The effect size was large zero point nine compared to the small effect around zero point. Two of the atypical anti psychotics. These luma turgid meds were not included in the earlier analysis by dr sowell's group. The one from two thousand fifteen. That looked at what works after one failed antidepressant mainly because the studies were not out. Then it's rare to say any treatment in psychiatry stand out more effective than the others. We can say that about causa peanut schizophrenia. Lithium in some forms of bipolar and suicide -ality nec teen depression in two thousand analysts. None of the meds really stand out more potent than the others. So this new finding about the glutamate Really stands out. But can we trust it. We can't really trust it. These network meta analyses give us a signal but they are not the truth. We need to see head to head trials of these strategies before we hang our hat on them. But if what young found holds up then we may need to rethink what. We're doing in psychiatry. Because most of the effective treatments here ketamine minocycline and decide. Aseren are rarely ever used while we await more research clarify the role of these an md. Antagonists here's what we know about them. So far i. The big effect of this class was not simply due to ketamine minocycline and cyclists. Aaron also had large effects on their own although there were fewer studies supporting them. This analysis brought in three ketamine trials but only one mono cycling trial and one. D cyclists airing trial. another thing. To point out is that there are some limitations here with ketamine ketamine is well known in psychiatry and no doubt it has a large rapid effect in depression but it's not clear that that rapid effect sustains most of the ketamine studies are short term often only looking after one dose or one week of treatment and its isomer cousin s ketamine provo- although it was studied long-term may actually fade out after its initial antidepressant. Burst in a meta analysis of spray bottles clinical trials. It did not work any better than placebo after one month of regular use. We can't assume that the robust effects of ketamine saying hair will translate to s ketamine. When people say kademi they made the race. Simic mixture of ketamine. Which has made a fifty percent s ketamine and fifty percent are ketamine. Even though his ketamine is fda approved there are animal studies suggesting the r isomer is the more potent of the two and their studies of this are ketamine underway. That may earn. It's fda approval another limitation of. Dr young's analysis is that we don't really know the mechanism of these drugs. So it's a bit arbitrary to lump them together as an md a antagonists. Let's turn now to two of them. That are new to the psychiatric. Seen minus cycling and

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