Other antidepressants Flashcards
What was found to be a novel antidepressant?
Ketamine - first report of a controlled study in patients described a rapid onset antidepressant effect within hours following a single dose of ketamine
What did Zarate at al find?
Studied patients with treatment resistant depression
A rapid antidepressant effect of ketamine compared to saline
A 70% response rate at 24 hours following a single infusion
Effects of IV ketamine in patients with major depression
Less depressed when given ketamine in amount 2 hours
What did Murrough et al find?
Conducted a controlled trial of a single infusion of ketamine controlled to an active placebo controlled condition (midazolam). The main outcome was change in depression severity 24 hours after drug administration and they showed greater improvement 24 hours after treatment - provides support for NMDA receptor modulation as helping chronic depression
What is ketamine?
A NMDA receptor antagonist - but other NMDA receptor antagonists don’t do this
What are the problems with ketamine?
Not safe enough to be used - can be used in a controlled environment like a hospital, because don’t know what will happen. Should be used only in urgent cases such as suicide
What are alternative therapies?
Transcranial magnetic stimulation TMS
Electroconvulsive therapy ECT
What is transcranial magnetic stimulation?
Give an electrical current on the skull, gives electrical pulses to the brain and inactivates some areas - limitations on the specific areas you can play with
What is electroconvulsive therapy?
Older consistent route, lots of people who respond to no drugs
Electrical shocks under aesthetic - but associated with memory loss, so last resort
Why can’t we just use antidepressants?
Because 30% of patients aren’t responsive to any sort of medication
Why is depression not as simple as we think?
It is a heterogenous disorders, with genetic basis
Various antidepressants are available
Monoamine hypothesis is good but too simple, stress diathesis is better
Antidepressants promote neurogenesis in the hippocampus, reverses the symptoms
Ketamine is good as emergency
What is the food for thought?
Over 7 million adults prescribed an antidepressants - doubled since mid-2000’s as has the average amount of time people spend on them. the therapists today are likely to be operating in a new climate from the one which they have been trained, where most their clients have been taking or are taking psychiatric drugs
