Tuesday, May 21st, 2013
Michelle Castillo CBSNews-May 20, 2013
Ketamine, a drug also known as Special K or K, may have some untapped benefits for people suffering from treatment-resistant depression.
A clinical trial presented on May 20 at the American Psychiatric Associationannual meeting in San Francisco, Calif. showed that ketamine was able to rapidly treat symptoms in patients who do not respond to antidepressant medications.
Ketamine is a general anesthetic that is used on humans and animals such as cats. It is often abused due to its ability to alter perceptions of sounds and sights, and to create a feeling of detachment from the environment. According to the National Institute of Drug Abuse, ketamine was used by 1 percent eight graders, 1.3 percent of tenth graders and 1.7 percent of twelfth graders, per a 2009 survey.
Ketamine interacts with a glutamate receptor (NMDA receptor), and is usually snorted or injected. Taken at low doses, ketamine can result in impaired attention, learning ability and memory. Higher doses can cause a feeling of dreamlike-states and hallucinations, which is commonly referred to as a “K-hole.” But, taking the drug at extremely high levels can cause delirium, amnesia, impaired motor function, high blood pressure and fatal respiratory problems.
Researchers for the study wanted to explore ketamine’s therapeutic uses. Previous studies have linked the drug with benefits for people with treatment-resistant depression and suicidal depression.
“Ketamine has many identities and certainly it is known as a drug of abuse,” author Dr. James Murrough, assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City, told CBSNews.com. “It’s also a drug that’s used medically as an anesthetic both in humans and veterinary medicine in adults and pediatric patients since the 1950s.”
Murrough and the team were specifically interested in treatment-resistant depression, in which patients do not respond to any form of treatment. Major depression is caused by problems with the communication between nerve cells, which is controlled by chemicals called neurotransmitters. Murrough estimates that about one-third of people diagnosed with depression are somewhat treatment-resistant. Most of them will be able to manage their condition with a mix of different medications and therapies, but they will never be completely well and will have an incomplete response to treatment.
The researchers looked at a group of 72 treatment-resistant patients with depression. For the purposes of the study, patients were deemed treatment-resistant if they didn’t have any improvements after trying at least three different biological treatments, meaning forms of medication and/or physical treatments like electroshock therapy.
The subjects were either given an intravenous infusion of ketamine for 40 minutes or an active placebo of midazolam, an anesthetic which has not been linked to any antidepressant properties.
Patients received 0.5 milligrams of ketamine per 2.2 pounds, meaning a 154-pound person would get about 30 milligrams. That’s about a quarter of an anesthetic dose and much less than a typical recreational dose, Murrough pointed out.
After 24 hours, 63.8 percent of the ketamine group had improved symptoms, compared to 28 percent of the placebo group. Seven days later, 45.7 percent of the ketamine group still had improved symptoms, compared to 18.2 percent of the placebo group.
Neither group had any major side effects.
“We have to be mindful that these patients are seeking treatment for depression,” said Murrough. “We don’t want to give them any more problems.”
The new research is considered preliminary since it was presented at a medical conference, and hasn’t yet been published in a peer-reviewed journal.
Currently, antidepressant drugs like selective serotonin reuptake inhibitors (SSRIs) influence serotonin and noreprenephrine neurotransmitters to treat depression, but they can take a while to work and up to 60 percent of depression patients don’t respond to them, according to the researchers. Murrough is hopeful that ketamine may be one answer to that problem because it affects a different neurotransmitter, glutamine, and works much more rapidly. However, even though there is no evidence that the drug is addictive, some reports have also shown that people often binge on ketamine, and can develop tolerance and cravings for the drug.
“It is a drug of abuse in different parts of the world so we have to be mindful of that,”Murrough said.
Tuesday, May 21st, 2013
By John Gever, Deputy Managing Editor, MedPage Today
May 20, 2013
SAN FRANCISCO — The anesthetic agent ketamine continues to show tantalizing promise in psychiatric disorders, with results from new studies in intractable depression and obsessive-compulsive disorder.
In a 72-patient randomized trial involving patients with major depression who had not responded to standard therapies, mean scores on the Montgomery-Asberg Depression Rating Scale (MADRS) fell by half 1 day after an intravenous infusion with ketamine, significantly more than in an “active placebo” group receiving the benzodiazepine agent midazolam.
The ketamine group continued to show significantly greater improvement for the next 2 days relative to the controls, according to James W. Murrough, MD, of Mount Sinai School of Medicine in New York City.
A second trial in 15 patients diagnosed with obsessive-compulsive disorder (OCD), conducted at Columbia University in New York City, found that the drug was significantly superior to placebo (saline, in this case) in reducing OCD symptoms according to the Yale-Brown rating scale and patient self-assessments.
Both studies were reported here at the American Psychiatric Association annual meeting.
Ketamine for Depression
All current antidepressant drugs — tricyclics, monoamine oxidase inhibitors, and inhibitors of serotonin and/or norepinephrine reuptake — require a minimum of several weeks before clinical benefit is apparent. Suicidal ideation is a recognized risk during this period. Consequently, an antidepressant with a more immediate onset of action would be eagerly welcomed.
Ketamine drew attention as a possible candidate in 2006 when a small placebo-controlled trial conducted by the National Institute of Mental Health (NIMH) researchers found that ketamine induced dramatic improvement in depression scores within 2 hours of IV infusion, and which lasted for a week.
Subsequently, another placebo-controlled study by the NIMH group found nearly instant relief with ketamine in bipolar patients with severe depression.
The depression study by Murrough and colleagues was an attempt to improve on the NIMH studies by using a psychoactive drug as the control instead of saline. Murrough said that blinding in the earlier studies might have failed because of ketamine’s distinctive psychotropic effects.
In fact, ketamine is available on the street because it can produce a “high” marked by out-of-body dissociative sensations along with euphoria and other perceptual effects. These are among the reasons that ketamine has not already gained traction as an antidepressant.
Murrough said he and his colleagues selected midazolam as the control in their study because it could also be perceived by participants as an active drug, yet without either depressant or antidepressant effects. Its mechanism of action is also different from that of ketamine, an antagonist of so-called NMDA glutamate receptors.
Participants in the study, recruited and treated at two different clinical sites, were assigned in a 2:1 ratio to ketamine at 0.5 mg/kg or midazolam at 0.045 mg/kg by IV infusion.
Patients had long histories of major depressive disorder, with mean duration of more than 20 years. About one-third had attempted suicide at least once and half had a history of psychiatric hospitalizations. Participants had failed a mean of five previous antidepressant treatments.
Mean MADRS scores at baseline were 32.6 in the ketamine group and 31.1 among controls. The next day after infusion, the mean scores declined to 16.1 with ketamine versus 22.3 for controls.
After adjusting for baseline differences between groups and the two clinical sites, the difference in change from baseline in MADRS scores between arms was statistically significant at P=0.0014.
Based on Clinical Global Impression scores for improvement and severity, 64% of the ketamine group and 28% of those receiving midazolam were judged to be responders at the 1-day evaluation (P=0.006).
The advantage of ketamine over midazolam was maintained through day three post infusion. At day seven, 46% of the ketamine group was still considered to be responders versus 18% of controls, but the difference was no longer significant.
MADRS scores also rebounded slightly by day seven, enough to render the advantage over midazolam insignificant.
Ketamine for OCD
Carolyn Rodriguez, MD, PhD, of Columbia told MedPage Today that dysregulation of excitatory glutamate receptors appears to play a role in OCD, prompting their look at ketamine as a potential treatment. The drug had already shown promise against OCD in a case study and a small open-label trial.
The Columbia group randomized 15 patients to a single infusion of ketamine or conventional placebo on a crossover basis, with at least 1 week (mean 2.1 weeks) between treatments.
Patients had mean Yale-Brown scores at baseline of 27 (SD 3), indicating moderate to severe illness. They had tried an average of three previous treatments without durable success.
As in the depression studies, the effect was immediate. Using a visual analog scale, patients reported dramatic decreases in their obsessive-compulsive urges midway through the 40-minute infusion. The self-assessed effect remained greater for the drug versus placebo through a full week.
Because the effect appeared to last beyond 1 week, results from second, post-crossover infusions were not used in the analyses.
Rodriguez told MedPage Today that the durability of ketamine’s effects, both in OCD as well as in depression, remains a mystery. The drug has a very short half-life in circulation — measured in minutes — and yet its clinical effects last for a week or more.
Ketamine’s apparent efficacy in OCD also underscores possible similarities to depression in the underlying biology. Currently, the first-line drug treatment for OCD is antidepressants, Rodriguez noted.
For next steps, she said, she was most interested “in elucidating mechanisms — why some people respond to [ketamine] but not all, and what is the mechanism of the rapid effect and what is the mechanism of action of the sustained effect.”
She added that another important follow-up will be to determine whether there are other ways to modulate the NMDA receptor to achieve the same benefits without causing the dissociate symptoms and other unwanted effects.
Murrough said that, in fact, it’s still not entirely clear that ketamine does work through NMDA receptors. Although that appears to be its principal target as an anesthetic, “ketamine is a dirty drug,” he said, with effects on other neurotransmitter systems besides glutamate.
Carlos Zarate, MD, the NIMH researcher who led the earlier studies, told MedPage Today that the ketamine studies were one of the few bright spots on the pharmacological front in all of psychiatry. The dearth of new drug classes for major disorders has been a common lament in recent years.
Although most ketamine studies to date have remained small pilot trials, Zarate said he was not discouraged at the pace of progress.
He said NMDA is a complex target that has proven to be difficult to modulate in exactly the desired way. Drug companies have been trying for decades to develop NMDA-active drugs, and have renewed those efforts as the basis of the ketamine studies.
Although the earlier efforts mostly didn’t pay off, researchers both in and out of industry have many more tools at their disposal, Zarate said. Several promising compounds have been reported by drug firms.
In the meantime, ketamine itself may be clinically acceptable for patients with severe depression, as the benefits could outweigh the adverse effects. He noted that it has been effective in patients unresponsive to electroconvulsive therapy, currently the treatment of last resort for severe depression.
Zarate said the dissociative symptoms are disconcerting during the first treatment, but become less so when patients know what to expect.
Another researcher presenting at the APA meeting, Delisa Guadarrama, MD, of the University of Texas Health Sciences Center in San Antonio, said the dosing regimen is another area to be investigated further.
She reported on a case of severe postpartum depression, in which she and colleagues treated the patient with 2 mg/kg of ketamine — four times the dosage used in most previous studies.
Guadarrama said that the woman was being treated in the center’s pain clinic, where the higher dose was customary. Her patient, as well as patients with other types of depression also treated with 2 mg/kg, showed symptom relief lasting for 3 weeks or longer, in contrast to the 1-week duration of effect seen with the 0.5-mg/kg doses.
Vital signs did not indicate any greater degree of adverse effects than in reports with the lower dose, she said. Whether the dissociative symptoms were more severe would be more difficult to assess, since no quantitative tools for measuring these symptoms are available.
Friday, May 10th, 2013
By Sabrina Bachai | May 03, 2013
Minor studies have shown that a mix of ketamine drug therapy and electroconvulsive therapy (ECT) can give faster results for severe depression treatments.
Researchers at the University of Manchester are coordinating a study to prove these effects on a larger scale in hopes of having these treatments used in clinical practices. While proven effective in treating depression, ECT treatments have also had cases of severe side effects such as long-term memory loss, confusion, and impaired cognitive function.
“ECT is the most effective treatment we have for severe and Treatment Resistant Depression – but it can cause cognitive and memory difficulties as a side-effect,” said Ian Anderson, head of biological research on mood disorders at the University of Manchester.
ECT, formerly known as electroshock therapy, has been a practice used to treat various psychiatric illnesses since the 16th century. Speculatively, if combined with ketamine, the adverse side effects could potentially decrease or even disappear.
Ketamine is used in common medical practice to induce general anesthesia. Also known by its street name “Special K,” it is often time used as a recreational drug. When improperly used, it produces as dissociative state with hallucinatory effects and feelings of euphoria. According to the National Institute on Drug Abuse (NIDA), ketamine can have addictive effects and eventually be lethal.
Researchers are hopeful that these trials will prove the therapeutic benefits that have been found in their studies.
“It’s a great opportunity to really study ECT and see how we can improve it,” said Anderson.
Jo Lowe, project manager for this study, has started recruitment for 160 participants for the clinical trials. The project is being funded by Medical Research Council (MRC).
Friday, May 10th, 2013
Medscape: Fran Lowry(May 2, 2013)— Bilateral prefrontal repetitive transcranial magnetic stimulation (rTMS) is a promising treatment for the negative symptoms of schizophrenia, new research shows.
Preliminary results from a double-blind, randomized controlled trial showed that patients with schizophrenia or schizoaffective disorder who were treated with rTMS had a significant improvement in their negative symptoms, as assessed on the Scale for the Assessment of Negative Symptoms (SANS), that lasted for 4 weeks post treatment.
However, after 4 weeks, this beneficial effect diminished.
The findings were presented here at the 14th International Congress on Schizophrenia Research (ICOSR).
Effective Treatment Urgently Needed
Effective treatment options for the negative symptoms of schizophrenia are urgently needed, said study investigator Jozarni Dlabac-de Lange, MD, from the University of Groningen, the Netherlands.
“The outcome for patients who are suffering from negative symptoms is much worse, and there has not been a lot of research in this subgroup of patients because they are very difficult to include in studies,” she told Medscape Medical News.
In addition, the few studies that have reported on the efficacy of rTMS treatment for negative schizophrenia symptoms have shown inconsistent results, Dr. Dlabac-de Lange said.
Each treatment lasted 20 minutes and was given in the morning and again in the afternoon. Patients were stimulated at 90% of the motor threshold.In the current study, the investigators randomly assigned 32 patients with schizophrenia or schizoaffective disorder and moderate to severe negative symptoms (Positive and Negative Syndrome Scale [PANSS] negative subscale ≥ 15) to receive either real (n = 16 patients) or sham (n = 16 patients) rTMS of the bilateral dorsolateral prefrontal cortex.
The researchers found that there was a significant improvement in the SANS measure of negative symptoms in the rTMS group compared with the sham group 4 weeks after the treatment sessions stopped (P = .04); however, the effects diminished by 3 months (P = .14).
Additionally, there was no significant difference between the 2 groups on the PANSS negative symptom score at 4 weeks (P = .38) and at 3 months (P = .32).
“Results were good at first, so the next step is to try and see how we can enhance these treatment effects, perhaps by combining rTMS with psychosocial interventions, discovering the optimal treatment parameters and learning which of the negative symptoms show a better response to rTMS,” Dr. Dlabac-de Lange said.
Tags: depression, depression treatment, major depression, MDD, negative symptoms, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, schizophrenia, tms, transcranial magnetic stimulation
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Wednesday, April 24th, 2013
By Andrea Petersen
The hunt is on for a faster-acting, more effective antidepressant.
Current treatments for depression, including drugs like Prozac and Celexa, often take a month or more to give patients relief—and they don’t work for everyone. Now, researchers and several pharmaceutical companies are testing medications that early studies are showing can lift mood in just a few days or even within a couple of hours.
“You can control seizures and control hypertension within minutes and hours,” says Carlos A. Zarate, chief of the experimental therapeutics and pathophysiology branch in the intramural research program at the National Institute of Mental Health and a leading researcher in the search for new antidepressant medications. “That is what we should aim for [with depression],” he says.
Some of the fast-acting treatments being studied, such as ketamine and scopolamine, use existing medications in a new way. Ketamine has been used in higher doses as an anesthetic for decades. Small doses of scopolamine delivered via skin patch are used to treat motion sickness. AstraZeneca PLC, the London-based drug company, Naurex Inc., a pharmaceutical firm in Evanston, Ill., and Cerecor Inc., a Baltimore-based biotechnology company, are all developing new drugs for depression that act similarly to ketamine.
It will likely be at least a couple of years before any of the new drugs come to market, since they first need further clinical trials and Food and Drug Administration approval. Some doctors are already using ketamine off label with depressed patients.
Ann Wroth has struggled with depression for more than 30 years and has tried eight different medications. Each time she has a relapse and tries a new medication, she says, it takes at least three to four weeks before she sees any benefit. “The waiting period is very difficult. You’re still in pain. [You think] ‘I’m taking this pill, ‘why isn’t it helping,’ ” says the 53-year-old who trains volunteers at the National Alliance on Mental Illness, an Arlington, Va.-based mental health education and advocacy group.
In a study published in the American Journal of Psychiatry in 2006 of nearly 3,000 patients taking the popular antidepressant citalopram (brand name Celexa) for up to 14 weeks, only about one-third achieved remission from their depression. (About half of the participants responded to the drug, meaning their scores on a survey assessing depression improved by at least 50% during the trial.) For those who did achieve remission or had a response, it generally took about eight weeks of being on the medication.
The new fast-acting drugs act on the brain in an entirely different way than the current popular antidepressants. Ketamine and the new compounds from AstraZeneca and Naurex all act on the brain’s N-methyl-D-aspartate (NMDA) receptors, which are involved in learning and memory. These receptors interact with the neurotransmitter glutamate, the levels of which seem to be out of balance in depression.
Scientists believe glutamate is a much more direct target for depression than serotonin, a neurotransmitter affected by selective serotonin reuptake inhibitor (SSRI) drugs like Prozac and Paxil. The SSRIs’ more indirect method of action is likely the reason why there is a lag time before patients feel relief from depressive symptoms, says Ronald S. Duman, professor of psychiatry and neurobiology at the Yale University School of Medicine in New Haven, Conn.
In a small but groundbreaking study published in 2006 in the Archives of General Psychiatry, 17 people with major depression who had failed to get adequate relief from at least two other antidepressants were given a single injection of ketamine. About one-third of patients went into remission and 71% had a response. Patients began to feel better within two hours and the beneficial effects lasted about a week.
But ketamine has side effects including hallucinations and other “dissociative” feelings during and for a bit after an intravenous infusion. “People may see trails of light, they may feel a bit foggy,” says Dr. Zarate, lead author of the study. Indeed, Ketamine is sometimes abused as a street drug called “special K.” There is also concern that repeated doses of ketamine could be harmful to the brain.
AstraZeneca and Naurex say their new compounds deliver the rapid benefits of ketamine without the disturbing side effects because they act differently on the NMDA receptor. Naurex said the main side effects in a Phase IIa study of its GLYX-13 compound with 116 people with depression were headache and sleepiness, similar to the effects of a placebo saline injection. Patients began feeling relief of their depression symptoms within two hours and the effects lasted at least one week.
Naurex is in the middle of another study with 400 patients. It expects to apply to the FDA for approval of GLYX-13 in early 2016, says Ronald M. Burch, the company’s chief medical officer. While GLYX-13 will likely be indicated for patients who failed to benefit from conventional antidepressants first, the company is also beginning to study an oral version of the drug. That formulation could be used as a first treatment option for depression, Dr. Burch says.
AstraZeneca is in the middle of a second Phase IIb trial of its AZD6765 compound, testing it in 282 people.
Pierre Blier, a professor of psychiatry at the University of Ottawa in Canada has given ketamine to about 25 patients in the last 18 months. “I use it in my severely ill patients who are on medications already,” he says. He only uses it with patients who don’t have a history of addiction, he says, and who he knows well. “When it works it is so striking,” he says.
Some psychiatrists believe ketamine or drugs like it will be helpful in emergency rooms with patients who are actively suicidal. Richard Shelton, a professor in the department of psychiatry and behavioral neurobiology at the University of Alabama at Birmingham has been conducting a small study and has used ketamine this way in 16 people.
“People come in urgently wanting to kill themselves,” he says. After a low-dose ketamine infusion, “the sense of urgency goes away.”
Tags: AstraZeneca, depression, depression treatment, ketamine, major depression, MDD, neuropsychiatry, neurotransmitters, pharmaceutical companies, psychiatrist, psychiatry
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Wednesday, April 24th, 2013
Overview: The standard of care for clinical depression has significant limitations: traditional drugs that focus on monoamine neurotransmitters can take several weeks to be effective, and many patients never respond to any form of treatment. Several clinical trials have demonstrated strikingly better outcomes using the anesthetic ketamine to treat depression. Notably, a single application can have rapid and lasting antidepressant effects in patients who do not respond to other treatments. Because ketamine is an antagonist of NMDA-type glutamate receptors, research is focused on the role of glutamate neurotransmission in depression and on drug development that targets the glutamatergic system. The March 25, 2013, meeting of the Academy’s Biochemical Pharmacology Discussion Group, Treatment-resistant Depression: Glutamate, Stress Hormones, and their Role in the Regeneration of Neurons, presented this new research and the avenues it is opening for the treatment of depression.
Tags: antidepressants, Anxiety, depression, depression treatment, major depression, MDD, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, tms, transcranial magnetic stimulation
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Wednesday, March 27th, 2013
Tuesday, March 26, 2013-Bob Shepard
University of Alabama at Birmingham (UAB) researchers think ketamine, an anesthesia medication in use since the 1970s, might be a valuable tool in treating severe depression and reducing suicidal urges; they have launched two studies to explore the possibility. One of the studies, ketamine is administered to suicidal patients in the UAB Hospital emergency department (ED), is the only such trial actually being conducted in an ED in the nation.
“There is a growing body of evidence that indicates that lower doses of ketamine can reduce suicidal feelings and relieve symptoms of severe depression in a very short period of time, as little as a few hours, which makes it an extremely attractive candidate for treating acute depression,” said Richard Shelton, M.D., professor in the Department of Psychiatry and Behavioral Neurobiology and lead investigator on the studies.
Shelton said ketamine appears to work on depression by blocking a neurotransmitter called glutamate from binding to the NMDA receptor on neurons. Too much glutamate on an NMDA receptor leads to the opening of a calcium ion channel, releasing too much calcium downstream. This then affects a brain chemical, brain derived neurotrophic factor (BDNF), which increases connections between neurons in the brain. These connections help the brain regulate emotions better.
In the trial, patients presenting to the ED with suicidal thoughts can be enrolled in the ketamine trial. The drug is administered via infusion, which takes about five minutes.
“We have seen a decrease in depression scores and suicide scores, sometimes within 15 minutes after giving ketamine,” said Cheryl McCullumsmith, M.D., Ph.D., assistant professor and director of hospital psychiatry. “The antidepressants commonly used to treat depression and suicidal thoughts take weeks or months to begin to show positive effects. When a patient is actively suicidal, we don’t have that much time.”
McCullumsmith said patients entered in the ketamine trial at the ED are admitted to the psychiatric inpatient unit for observation.
“We are attempting to determine just how quickly the drug produces a beneficial result, as well as how long that result lasts,” McCullumsmith said.
Shelton said a second trial, sponsored by Janssen Research & Development, LLC., is a multi-site trial of patients with severe depression and possible suicidal thoughts who are seen in an outpatient setting. Patients receive two or three infusions of ketamine or placebo each week for four-to-six weeks. Patients who do not benefit from study treatment after the first two weeks are offered two weeks of treatment with ketamine without the chance of placebo.
“We’re interested in knowing how long each infusion will sustain the beneficial effect,” said Shelton. “Ketamine does not appear to be curative, and we have a lot of work to do to see if it might be a useful drug for depression and suicide prevention on a long-term, regular-use basis.”
A third trial underway at UAB is testing a compound called Glyx-13, produced by Naurex, Inc. Glyx-13 may produce similar results as ketamine by blocking an amino acid called glycine, which works in tandem with glutamate. Glycine regulates glutamate signaling, so it is like an added layer of fine-tuning. When glycine and glutamate bind to NMDA together, the calcium ion channel opens widely. Blocking glutamate with ketamine can reduce the release of calcium. Blocking glycine with Glyx-13 may achieve the same result, but more subtly and with fewer side effects.
“Glyx-13 may prove to be a more promising candidate than ketamine in terms of potential side effects,” said Shelton. “Glyx-13 is being evaluated with just one infusion per week.”
Ketamine, when used in anesthesia, has some side effects, including hallucinations and psychotic symptoms. It has also been a drug of abuse, known on the street as Special K. Shelton said the dose used in the depression trials is much lower, and given over a longer period. Side effects observed thus far in the ketamine trials have been minimal, he said.
UAB is enrolling patients in the outpatient trials of ketamine and Glyx-13. Male and female patients ages 19-64 with a diagnosis of depression, who have failed two drug regimens for depression, are candidates for the trials. Total time involved in the studies, with treatment and follow-up, is about 13 weeks.
Thursday, March 21st, 2013
Published 18 March, 2013 WBUR’s Here & Now
Researchers, in preliminary research, have found Botox might bring relief to patients suffering from depression or anger issues. Though Botox is typically used cosmetically and for a number of health issues, some hope this means it could be used for mental health reasons in the future.
The emotions we show on our face often mirror the emotion we feel internally. But for people suffering from depression, the emotions shown externally can potentially overpower emotions felt internally.
Dermatologist surgeon Dr. Eric Finzi discovered that, in some patients, injecting Botox into the muscle that normally contracts when a patient frowns helped to relieve depression.
Finzi’s mother battled with depression intermittently throughout her life, and often showed a furrowed brow.
When his mother died, Finzi said he was motivated to find a connection between her facial expressions and a role they might have played in her depression.
Thursday, March 21st, 2013
NEW YORK (WABC) – Imagine finding a new, life changing use for a dangerous street drug, one that has been known for destroying lives.
Now, an experimental treatment could hold life changing promises.
What’s exciting about this drug is that it works fast.
But the studies so far show this one starts to work the very same day.
You may know it as the club drug, Special K, but now researchers say ketamine is a promising new treatment option for depression.
About half the patients get about 50% better with one dose of ketamine,” said Dr. John Mann with NYS Psychiatric Institute.
And that one dose works in just a few hours. Ketamine targets a chemical in the brain called glutamate and unlike most antidepressants which target serotonin. Dr. John Mann is overseeing three ketamine studies at the Columbia Psychiatric Institute.
“This may be a medication that works faster and 2 it may work in some patients who have not had much success in getting better with regular treatments,” he adds.
Todd Landua is one of those patients, he’s battled depression for 4 years.
“Basically I felt fear, sadness or nothing- that was it,” he said.
He took part in the new clinical trial, and says after he got ketamine, he felt an immediate difference.
“I was recovering memories that had been very painful for me but the pain was completely gone,” adds Todd.
But although it’s fast acting, it’s not necessarily long lasting. So far they found the benefits of one dose last about a week.
That could mean needing frequent IV infusions of ketamine, until there’s a better way like a pill. And in large doses, ketamine can cause dangerous symptoms of psychosis, but Dr. Mann says they are working to find the lowest dose possible that works, but with the fewest side effects.
The studies at Columbia are scheduled to go until 2017.
Thursday, March 21st, 2013
By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on March 13, 2013
Those with schizophrenia are often functionally limited by mental or cognitive impairments.
Memory, attention, IQ, and verbal and motor skills are often disrupted, and these deficits tend to compromise the ability to perform normal day-to-day activities.
Scientists have been exploring a variety of strategies to reduce these impairments, including “exercising the brain” with specially designed computer games and medications that might improve the function of brain circuits.
In a new study, Mera Barr, Ph.D., and her colleagues at University of Toronto provide evidence that stimulating the brain using repetitive transcranial magnetic stimulation (rTMS) may be an effective strategy to improve cognitive function.
“In a randomized controlled trial, we evaluated whether rTMS can improve working memory in schizophrenia,” said Barr and senior author Zafiris Daskalakis, M.D.
“Our results showed that rTMS resulted in a significant improvement in working memory performance relative to baseline.”
Transcranial magnetic stimulation is a non-invasive procedure that uses magnetic fields to stimulate nerve cells. It does not require sedation or anesthesia and so patients remain awake, reclined in a chair, while treatment is administered through coils placed near the forehead.
In 2008, rTMS was FDA-approved to treat depression for individuals who don’t respond to pharmacotherapy.
The study is presented in the journal Biological Psychiatry.
“TMS can have lasting effects on brain circuit function because this approach not only changes the activity of the circuit that is being stimulated, but it also may change the plasticity of that circuit, i.e., the capacity of the circuit to remodel itself functionally and structurally to support cognitive functions,” said Dr. John Krystal, editor of the journal.
Experts say that previous studies have shown that rTMS improves working memory in healthy individuals, and a recent open-label trial showed promising findings for verbal memory in schizophrenia patients.
These findings informed the current study to determine if high frequency rTMS could improve memory in individuals with schizophrenia.
Researchers recruited medicated schizophrenia patients who completed a working memory task before and after 4 weeks of treatment.
Research methodology involved a double-blind study, where neither the patients nor the researchers knew who was receiving real rTMS or a sham treatment that was designed to entirely mimic the procedure without actually delivering brain stimulation.
Investigators discovered TMS not only improved working memory in patients after 4 weeks, but the improvement was to a level comparable to healthy subjects.
These findings suggest that rTMS may be a novel, efficacious, and safe treatment for working memory deficits in schizophrenia.
While the current findings are preliminary, researchers hope additional investigations will replicate the findings and provide an approved treatment for cognitive impairments in schizophrenia.
The authors concluded: “Working memory is an important predictor of functional outcome. Developing novel treatments aimed at improving these deficits may ultimately translate into meaningful changes in the lives of patients suffering from this debilitating disorder.”
Tags: Anxiety, dementia, depression, major depression, memories, memory, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, therapy, tms, transcranial magnetic stimulation
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