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Mellon N, Robbins B, van Bruggen R, Zhang Y. A systematic review and meta-analysis of the preclinical and clinical results of low-field magnetic stimulation in cognitive disorders. Rev Neurosci 2024; 35:619-625. [PMID: 38671560 PMCID: PMC11297417 DOI: 10.1515/revneuro-2024-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
Cognitive disorders such as major depressive disorder and bipolar disorder severely compromise brain function and neuronal activity. Treatments to restore cognitive abilities can have severe side effects due to their intense and excitatory nature, in addition to the fact that they are expensive and invasive. Low-field magnetic stimulation (LFMS) is a novel non-invasive proposed treatment for cognitive disorders. It repairs issues in the brain by altering deep cortical areas with treatments of low-intensity magnetic stimulation. This paper aims to summarize the current literature on the effects and results of LFMS in cognitive disorders. We developed a search strategy to identify relevant studies utilizing LFMS and systematically searched eight scientific databases. Our review suggests that LFMS could be a viable and effective treatment for multiple cognitive disorders, especially major depressive disorder. Additionally, longer, more frequent, and more personalized LFMS treatments tend to be more efficacious.
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Affiliation(s)
- Nicholas Mellon
- Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Brett Robbins
- Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Rebekah van Bruggen
- Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Yanbo Zhang
- Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, T6G 2E1, Canada
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2
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Njenga C, Ramanuj PP, de Magalhães FJC, Pincus HA. New and emerging treatments for major depressive disorder. BMJ 2024; 386:e073823. [PMID: 38977279 DOI: 10.1136/bmj-2022-073823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Major depressive disorder (MDD) affects a substantial portion of the population; however, much is still unknown about the pathophysiology of this disorder. Treatment resistance highlights the heterogeneous nature of MDD and the need for treatments to target more than monoamine neurotransmission. This review summarizes research into the new and emerging targets of MDD. These include drugs such as psychedelics, antibiotics, opioid modulators, neuropeptides, and onabotulinumtoxin. Neuromodulatory treatments such as light based therapies and neuromodulation involving either magnetic or electrical stimulation are also discussed. Almost all interventions, pharmacological and neuromodulation, were trialed as adjunctive treatments to an antidepressant. Most research has been conducted on psychedelics, with trials suggesting rapid antidepressant and anti-suicidal effects. Trial findings, tolerability, study design limitations and quality of research have been considered throughout this review. There remains challenges in forming recommendations with the current research at present. With there being considerable interest into the research of new and emerging treatments-in particular, psychedelics-there may be scope in the future to form more robust recommendations.
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Affiliation(s)
| | | | | | - Harold Alan Pincus
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
- RAND Corporation, Pittsburgh, PA, USA
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3
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Havlik JL, Wahid S, Teopiz KM, McIntyre RS, Krystal JH, Rhee TG. Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023. Curr Psychiatry Rep 2024; 26:176-213. [PMID: 38386251 DOI: 10.1007/s11920-024-01494-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW We review recent advances in the treatment of treatment-resistant depression (TRD), a disorder with very limited treatment options until recently. We examine advances in psychotherapeutic, psychopharmacologic, and interventional psychiatry approaches to treatment of TRD. We also highlight various definitions of TRD in recent scientific literature. RECENT FINDINGS Recent evidence suggests some forms of psychotherapy can be effective as adjunctive treatments for TRD, but not as monotherapies alone. Little recent evidence supports the use of adjunctive non-antidepressant pharmacotherapies such as buprenorphine and antipsychotics for the treatment of TRD; side effects and increased medication discontinuation rates may outweigh the benefits of these adjunctive pharmacotherapies. Finally, a wealth of recent evidence supports the use of interventional approaches such as electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation for TRD. Recent advances in our understanding of how to treat TRD have largely expanded our knowledge of best practices in, and efficacy of, interventional psychiatric approaches. Recent research has used a variety of TRD definitions for study inclusion criteria; research on TRD should adhere to inclusion criteria based on internationally defined guidelines for more meaningfully generalizable results.
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Affiliation(s)
- John L Havlik
- Yale University School of Medicine, New Haven, CT, USA
| | - Syed Wahid
- The University of Chicago, Chicago, IL, USA
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Department of Public Health Sciences, University of Connecticut, Farmington, CT, USA.
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Funatsuki T, Ogata H, Tahara H, Shimamoto A, Takekita Y, Koshikawa Y, Nonen S, Higasa K, Kinoshita T, Kato M. Changes in Multiple microRNA Levels with Antidepressant Treatment Are Associated with Remission and Interact with Key Pathways: A Comprehensive microRNA Analysis. Int J Mol Sci 2023; 24:12199. [PMID: 37569574 PMCID: PMC10418406 DOI: 10.3390/ijms241512199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Individual treatment outcomes to antidepressants varies widely, yet the determinants to this difference remain elusive. MicroRNA (miRNA) gene expression regulation in major depressive disorder (MDD) has attracted interest as a biomarker. This 4-week randomized controlled trial examined changes in the plasma miRNAs that correlated with the treatment outcomes of mirtazapine (MIR) and selective serotonin reuptake inhibitor (SSRI) monotherapy. Pre- and post- treatment, we comprehensively analyzed the miRNA levels in MDD patients, and identified the gene pathways linked to these miRNAs in 46 patients. Overall, 141 miRNA levels significantly demonstrated correlations with treatment remission after 4 weeks of MIR, with miR-1237-5p showing the most robust and significant correlation after Bonferroni correction. These 141 miRNAs displayed a negative correlation with remission, indicating a decreasing trend. These miRNAs were associated with 15 pathways, including TGF-β and MAPK. Through database searches, the genes targeted by these miRNAs with the identified pathways were compared, and it was found that MAPK1, IGF1, IGF1R, and BRAF matched. Alterations in specific miRNAs levels before and after MIR treatment correlated with remission. The miRNAs mentioned in this study have not been previously reported. No other studies have investigated treatment with MIR. The identified miRNAs also correlated with depression-related genes and pathways.
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Affiliation(s)
- Toshiya Funatsuki
- Department of Neuropsychiatry, Kansai Medical University, Osaka 573-1191, Japan; (T.F.); (H.O.); (Y.T.); (Y.K.); (T.K.)
| | - Haruhiko Ogata
- Department of Neuropsychiatry, Kansai Medical University, Osaka 573-1191, Japan; (T.F.); (H.O.); (Y.T.); (Y.K.); (T.K.)
| | - Hidetoshi Tahara
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima 734-8533, Japan;
| | - Akira Shimamoto
- Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Sanyo-Onoda 756-0084, Japan;
| | - Yoshiteru Takekita
- Department of Neuropsychiatry, Kansai Medical University, Osaka 573-1191, Japan; (T.F.); (H.O.); (Y.T.); (Y.K.); (T.K.)
| | - Yosuke Koshikawa
- Department of Neuropsychiatry, Kansai Medical University, Osaka 573-1191, Japan; (T.F.); (H.O.); (Y.T.); (Y.K.); (T.K.)
| | - Shinpei Nonen
- Department of Pharmacy, Hyogo Medical University, Nishinomiya 650-8530, Japan;
| | - Koichiro Higasa
- Institute of Biomedical Science, Department of Genome Analysis, Kansai Medical University, Osaka 573-1191, Japan;
| | - Toshihiko Kinoshita
- Department of Neuropsychiatry, Kansai Medical University, Osaka 573-1191, Japan; (T.F.); (H.O.); (Y.T.); (Y.K.); (T.K.)
| | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka 573-1191, Japan; (T.F.); (H.O.); (Y.T.); (Y.K.); (T.K.)
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Naito M, Kato M, Koshikawa Y, Bandou H, Sakai S, Takekita Y, Nishida K, Kinoshita T. Personality as a basis for antidepressant selection for patients with depression: A two-point outcome study at 4 and 8 weeks. J Affect Disord 2022; 314:27-33. [PMID: 35798178 DOI: 10.1016/j.jad.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The treatment course for depression is multifactorial, and the gold standard method for antidepressant selection remains unclear. Therefore, we focused on patients' personality as a possible indicator of the treatment response to mirtazapine and selective serotonin reuptake inhibitors (SSRIs) and whether it can contribute to antidepressant selection. METHODS One hundred one patients with major depressive disorder were randomized at baseline to receive either mirtazapine or SSRI treatment. Their personality was measured using the NEO Five-Factor Inventory at baseline, and depressive symptoms were evaluated using the Hamilton Rating Scale for Depression at baseline and 4 and 8 weeks. Stepwise multivariable logistic regression and receiver operating characteristic analyses were performed to determine the association of personality traits with remission and better antidepressant selection. RESULTS Neuroticism had the substantial influence on remission at 4 and 8 weeks among the entire sample. The cutoff T-score of neuroticism for predicting remission at 4 weeks was 62.5. The patients with moderate neuroticism (scores below the cutoff) were more likely to experience remission after 4-week mirtazapine treatment (remission rate: 73.7 %) than after SSRI treatment (40.0 %); those with high neuroticism (scores above the cutoff) were more likely to experience remission after 8-week SSRI treatment (74.1 %) than after mirtazapine treatment (35.7 %). LIMITATIONS The small sample size increased the confidence intervals. CONCLUSIONS The treatment response of the patients with depression differed according to the type of antidepressants and degree of neuroticism. Measuring personality traits at treatment initiation may help in selecting better antidepressants and predicting the time to remission.
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Affiliation(s)
- Minami Naito
- Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho Moriguchi-city, Osaka 570-8506, Japan
| | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho Moriguchi-city, Osaka 570-8506, Japan.
| | - Yosuke Koshikawa
- Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho Moriguchi-city, Osaka 570-8506, Japan
| | | | - Shiho Sakai
- Kamehiro Memorial Medical Society, Kansai Kinen Hospital, Hirakata, Osaka, Japan
| | - Yoshiteru Takekita
- Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho Moriguchi-city, Osaka 570-8506, Japan
| | - Keiichiro Nishida
- Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho Moriguchi-city, Osaka 570-8506, Japan
| | - Toshihiko Kinoshita
- Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho Moriguchi-city, Osaka 570-8506, Japan
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van Belkum SM, de Boer MK, Opmeer EM, Kortekaas R, Mulder T, Woonings F, Hoenders HJR, Kamphuis H, Aleman A, Schoevers RA. No antidepressant effects of low intensity transcranial pulsed electromagnetic fields for treatment resistant depression. J Affect Disord 2021; 294:679-685. [PMID: 34333176 DOI: 10.1016/j.jad.2021.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/15/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Noninvasive neurostimulation with transcranial Pulsed Electromagnetic Fields (tPEMF) may be a promising method for treatment resistant depression (TRD). Studies shown substantial improvement of depressive symptoms in patients with TRD, but there is no information on long-term antidepressant effects. The aim of this study was to investigate the short- and long-term efficacy of tPEMF in participants with TRD. METHODS Eligible participants with TRD in this sham-controlled double-blind multicenter trial were randomly assigned to five weeks either daily active or sham tPEMF. Severity of depression and anxiety was assessed pre- and directly post-treatment and five and fifteen weeks post-treatment. Primary outcome was change on the 17-item Hamilton depression rating scale directly post-treatment. Secondary outcome was change on the Hamilton-17 during follow-up and change on the Inventory of Depressive Symptomatology Self-Report and the Beck Anxiety Index. RESULTS Of the 55 included participants, 50 completed the treatment protocol. Depressive symptoms improved over time in both groups. The improvement continued until the last follow-up measure. There was no difference in outcome between the active and the sham group on change in depression post-treatment or on any secondary measure. CONCLUSION Treatment with this type of active tPEMF was not superior to sham in patients with TRD. This is in contrast to a previous study using a similar design and power calculation, but a higher magnetic field strength, that reported improvement of depression after treatment with tPEMF compared to sham. An important limitation of our study was the fact that no different dosing regimens were tried.
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Affiliation(s)
- Sjoerd M van Belkum
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands.; University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands..
| | - Marrit K de Boer
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands
| | - Esther M Opmeer
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | - Rudie Kortekaas
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | - Tim Mulder
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | | | | | - Hans Kamphuis
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands.; University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands.; GGZ Drenthe, the Netherlands,; Lentis, Center for Integrative Psychiatry, the Netherlands.; PsyQ Groningen, the Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands
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7
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High-Frequency and Low-Intensity Patterned Transcranial Magnetic Stimulation over Left Dorsolateral Prefrontal Cortex as Treatment for Major Depressive Disorder: A Report of 3 Cases. Case Rep Psychiatry 2021; 2021:5563017. [PMID: 33828869 PMCID: PMC8004358 DOI: 10.1155/2021/5563017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 11/17/2022] Open
Abstract
Current transcranial magnetic stimulation devices apply intense (near 1 tesla) repetitive magnetic pulses over a specific area of the skull at relatively lower frequencies (1-50 Hz). Nevertheless, different studies have shown that very small magnetic fields, at higher frequencies (50-1000 Hz.), produce therapeutic effects in major depressive disorder. We report the application of high-frequency and low-intensity patterned magnetic pulses over the left prefrontal dorsolateral cortex in three subjects diagnosed with clinical major depressive disorder. All three patients showed sharp changes in their self-reports as well as in the standardized clinical assessment. Hypothesized mechanisms of action of this new variant of magnetic stimulation are discussed.
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8
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Deng ZD, Luber B, Balderston NL, Velez Afanador M, Noh MM, Thomas J, Altekruse WC, Exley SL, Awasthi S, Lisanby SH. Device-Based Modulation of Neurocircuits as a Therapeutic for Psychiatric Disorders. Annu Rev Pharmacol Toxicol 2020; 60:591-614. [PMID: 31914895 DOI: 10.1146/annurev-pharmtox-010919-023253] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Device-based neuromodulation of brain circuits is emerging as a promising new approach in the study and treatment of psychiatric disorders. This work presents recent advances in the development of tools for identifying neurocircuits as therapeutic targets and in tools for modulating neurocircuits. We review clinical evidence for the therapeutic efficacy of circuit modulation with a range of brain stimulation approaches, including subthreshold, subconvulsive, convulsive, and neurosurgical techniques. We further discuss strategies for enhancing the precision and efficacy of neuromodulatory techniques. Finally, we survey cutting-edge research in therapeutic circuit modulation using novel paradigms and next-generation devices.
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Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA; .,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | - Bruce Luber
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Nicholas L Balderston
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Melbaliz Velez Afanador
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Michelle M Noh
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Jeena Thomas
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - William C Altekruse
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Shannon L Exley
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Shriya Awasthi
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA; .,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina 27710, USA
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Vlaicu A, Bustuchina Vlaicu M. New neuromodulation techniques for treatment resistant depression. Int J Psychiatry Clin Pract 2020; 24:106-115. [PMID: 32069166 DOI: 10.1080/13651501.2020.1728340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the treatment of depression, when pharmacotherapy, psychotherapy and the oldest brain stimulation techniques are deadlocked, the emergence of new therapies is a necessary development. The field of neuromodulation is very broad and controversial. This article provides an overview of current progress in the technological advances in neuromodulation and neurostimulation treatments for treatment-resistant depression: magnetic seizure therapy; focal electrically administered seizure therapy; low field magnetic stimulation; transcranial pulsed electromagnetic fields; transcranial direct current stimulation; epidural cortical stimulation; trigeminal nerve stimulation; transcutaneous vagus nerve stimulation; transcranial focussed ultrasound; near infra-red transcranial radiation; closed loop stimulation. The role of new interventions is expanding, probably with more efficacy. Nowadays, still under experimentation, neuromodulation will probably revolutionise the field of neuroscience. At present, major efforts are still necessary before that these therapies are likely to become widespread.Key pointsThere is a critical need for new therapies for treatment resistant depression.Newer therapies are expanding. In the future, these therapies, as an evidence-based adjunctive treatments, could offer a good therapeutic choice for the patients with a TRD.The current trend in the new neuromodulation therapies is to apply a personalised treatment.These news therapies can be complementary.That treatment approaches can provide clinically significant benefits.
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Affiliation(s)
- Andrei Vlaicu
- Psychiatry Department, CHHM, Hospital Andre Breton, Saint-Dizier, France
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10
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Opioid system modulation with buprenorphine/samidorphan combination for major depressive disorder: two randomized controlled studies. Mol Psychiatry 2020; 25:1580-1591. [PMID: 30374191 PMCID: PMC7303008 DOI: 10.1038/s41380-018-0284-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/03/2018] [Indexed: 12/17/2022]
Abstract
The endogenous opioid system is thought to play an important role in the regulation of mood. Buprenorphine/samidorphan (BUP/SAM) combination is an investigational opioid system modulator for adjunctive treatment of major depressive disorder (MDD). To confirm results from early studies, we report the efficacy and safety of BUP/SAM as adjunctive treatment in patients with MDD and an inadequate response to antidepressant therapy (ADT) in FORWARD-4 and FORWARD-5: two phase 3, randomized, double-blind, placebo-controlled studies that utilized the same sequential parallel-comparison design. Efficacy was measured using the Montgomery-Åsberg Depression Rating Scale (MADRS). FORWARD-5 achieved the primary endpoint and demonstrated that adjunctive BUP/SAM 2 mg/2 mg was superior to placebo (average difference change from baseline to week 3 through end of treatment [EOT] in MADRS-6 and -10 versus placebo: -1.5, P = 0.018; -1.9, P = 0.026, respectively). FORWARD-4 did not achieve the primary endpoint (change from baseline in MADRS-10 at week 5 versus placebo: -1.8, P = 0.109), although separate analyses showed significant treatment differences at other timepoints using traditional, regulatory-accepted endpoints such as reduction in MADRS-10 at EOT. The pooled analysis of the two studies demonstrated consistently greater reduction in MADRS-10 scores from baseline for BUP/SAM 2 mg/2 mg versus placebo at multiple timepoints including EOT and average change from baseline to week 3 through EOT (-1.8, P = 0.010; -1.8, P = 0.004, respectively). The overall effect size (Hedges' g) in the pooled analyses for MADRS-10 change from baseline to EOT was 0.22. Overall, BUP/SAM was generally well tolerated, with most adverse events (AEs) being mild or moderate in severity. The most common AEs, occurring in ≥5% of patients in the BUP/SAM 2 mg/2 mg treatment group, which was more frequently than the placebo group, included nausea, constipation, dizziness, vomiting, somnolence, fatigue, and sedation. There was minimal evidence of abuse, and no evidence of dependence or opioid withdrawal by AEs or objective measures. This report describes adjunctive BUP/SAM 2 mg/2 mg combination, a therapy with a novel opioidergic mechanism of action, as a potential new treatment option for patients with MDD who have an inadequate response to currently available ADT.
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Chen CH, Chang CH, Hsu TW, Pan CC. Add-on subanesthetic ketamine in electroconvulsive therapy: A case report of a patient with bipolar depression. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_16_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Jha MK, Murrough JW. Psychopharmacology and Experimental Therapeutics for Bipolar Depression. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:232-237. [PMID: 32047368 PMCID: PMC6999209 DOI: 10.1176/appi.focus.20190009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bipolar disorder is a chronic illness that affects 2%-4% of U.S. adults during their lifetime. The course of bipolar disorder is commonly characterized by prolonged periods of depression interspersed with manic-hypomanic episodes. Management of depression among patients with bipolar disorder is challenging because of the limited number of medications currently approved by the Food and Drug Administration, the high proportion of patients who do not respond to these medications, and the metabolic and other side effects associated with long-term use of these medications. In addition to reviewing the clinical options available to patients with bipolar depression and their treatment providers, this article presents an evidence-based management approach and discusses the off-label uses of currently available treatments and experimental therapeutics under development.
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Affiliation(s)
- Manish K Jha
- Depression and Anxiety Center for Discovery and Treatment and Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York City
| | - James W Murrough
- Depression and Anxiety Center for Discovery and Treatment and Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York City
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Model structure for protocol adherence utilizing a manualized therapeutic massage intervention. ACTA ACUST UNITED AC 2019; 16:/j/jcim.ahead-of-print/jcim-2016-0118/jcim-2016-0118.xml. [DOI: 10.1515/jcim-2016-0118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 07/12/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
The Protocol Training and Assessment Model (Model) was developed through collaboration between Emory University School of Medicine and Atlanta School of Massage to minimize intra- and inter-therapist variability for two research massage therapist (rMT) applied intervention arms in the Massage for Cancer-Related Fatigue (MCRF) early-phase study. The Model was followed to maintain and assess protocol integrity for the study’s manualized Swedish massage therapy (SMT) and light touch (LT) interventions.
Methods
The Model includes initial rMT training, quarterly retraining sessions, accessible resources (scripts, treatment guides, weekly research personnel meetings), and ongoing monitoring. Model efficacy was assessed by monitoring data collected at retraining sessions, through audio recording review, and through subject and rMT reporting.
Results
Model application resulted in a high level of intervention consistency throughout the study. Protocol-related session comment rate by subjects was 2.7%. Few study participants reported intra-rMT or inter-rMT treatment delivery differences. Observation during retraining sessions indicated massage therapists continued to adhere to protocols. Importantly rMTs increased their participation beyond core duties, suggesting additional ways to standardize subject treatment experience.
Conclusions
Through systematic application of the Protocol Training and Assessment Model, continuous and collaborative quality improvement discussions between scientists and research massage therapists resulted in reliable, standardized SMT and LT interventions for the MCRF early-phase study. Future research can apply the Model to support and assess consistent rMT-delivered intervention applications.
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Dubin MJ, Ilieva IP, Deng ZD, Thomas J, Cochran A, Kravets K, Brody BD, Christos PJ, Kocsis JH, Liston C, Gunning FM. A double-blind pilot dosing study of low field magnetic stimulation (LFMS) for treatment-resistant depression (TRD). J Affect Disord 2019; 249:286-293. [PMID: 30784726 PMCID: PMC6486658 DOI: 10.1016/j.jad.2019.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/24/2019] [Accepted: 02/11/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Low field magnetic stimulation is a potentially rapid-acting treatment for depression with mood-enhancing effects in as little as one 20-min session. The most convincing data for LFMS has come from treating bipolar depression. We examined whether LFMS also has rapid mood-enhancing effects in treatment-resistant major depressive disorder, and whether these effects are dose-dependent. OBJECTIVE/HYPOTHESIS We hypothesized that a single 20-min session of LFMS would reduce depressive symptom severity and that the magnitude of this change would be greater after three 20-min sessions than after a single 20-min session. METHODS In a double-blind randomized controlled trial, 30 participants (age 21-65) with treatment-resistant depression were randomized to three 20-min active or sham LFMS treatments with 48 h between treatments. Response was assessed immediately following LFMS treatment using the 6-item Hamilton Depression Rating Scale (HAMD-6), the Positive and Negative Affect Scale (PANAS) and the Visual Analog Scale. RESULTS Following the 3rd session of LFMS, the effect of LFMS on VAS and HAMD-6 was superior to sham (F (1, 24) = 7.45, p = 0.03, Bonferroni-Holm corrected; F (1, 22) = 6.92, p = 0.03, Bonferroni-Holm corrected, respectively). There were no differences between sham and LFMS following the initial or second session with the effect not becoming significant until after the third session. CONCLUSIONS Three 20-min LFMS sessions were required for active LFMS to have a mood-enhancing effect for individuals with treatment-resistant depression. As this effect may be transient, future work should address dosing schedules of longer treatment courses as well as biomarker-based targeting of LFMS to optimize patient selection and treatment outcomes.
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Affiliation(s)
- Marc J Dubin
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA.
| | - Irena P Ilieva
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jeena Thomas
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ashly Cochran
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Kamilla Kravets
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Benjamin D Brody
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Paul J Christos
- Department of Healthcare Policy and Research, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - James H Kocsis
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Conor Liston
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Sackler Institute for Developmental Psychobiology, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Institute of Geriatric Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
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15
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Schoenfeld DA, Doros G, Fava M. A commentary on: statistical inference problems in sequential parallel comparison designs. J Biopharm Stat 2019; 29:1130-1133. [PMID: 30794042 DOI: 10.1080/10543406.2019.1584207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A Sequential Parallel Comparison Design has two stages, the first comparing drug to placebo and the second comparing drug to placebo among patients who did not respond to placebo in the first stage. The paper, Statistical Inference Problems in Sequential Parallel Comparison Designs, claims that the estimate of the treatment difference in the second stage is biased and that under certain circumstances, a suggested hypothesis test will reject the null hypothesis when it should be accepted. This rejoinder argues that the estimate in the second stage is not biased when the true target of estimation (estimand) is properly understood. Further, the null hypothesis that the authors posit is not the correct null hypothesis for clinical trials, and in the situation, they describe that the treatment should be considered to be effective.
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Affiliation(s)
- David Alan Schoenfeld
- Massachusetts General Hospital (MGH), Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Gheorghe Doros
- Biostatistics Department, Boston University School of Public Health, Boston, MA, USA
| | - Maurizio Fava
- Massachusetts General Hospital (MGH), Clinical Trials Network and Institute (CTNI), Boston, MA, USA
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16
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Kinrys G, Gold AK, Pisano VD, Freeman MP, Papakostas GI, Mischoulon D, Nierenberg AA, Fava M. Tachyphylaxis in major depressive disorder: A review of the current state of research. J Affect Disord 2019; 245:488-497. [PMID: 30439676 DOI: 10.1016/j.jad.2018.10.357] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/08/2018] [Accepted: 10/27/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with major depressive disorder (MDD) often experience a re-emergence or worsening of symptoms despite ongoing treatment with previously effective antidepressant pharmacotherapy. This lost or reduced antidepressant response during maintenance, referred to as tachyphylaxis, negatively impacts treatment outcomes and quality of life for patients with MDD. This review assesses the prevalence of antidepressant tachyphylaxis as well as the evidence for interventions to manage it. METHODS We searched PubMed/Medline for the relevant clinical trials and meta-analyses on antidepressant tachyphylaxis up to January 2017. Search terms included "depression" paired with "treatment" (n = 186,674), "tachyphylaxis" paired with "depression" (n = 112), "tachyphylaxis" paired with "major depressive disorder" (n = 21), and "antidepressant" paired with "tachyphylaxis" (n = 68). Studies were included if they reported on a clinical trial or meta-analysis exploring tachyphylaxis in MDD and were excluded if the sample population did not have a primary DSM diagnosis of MDD. RESULTS Rates of tachyphylaxis varied from 9% to 57% depending on the patient population and duration of follow-up. Limited evidence suggests potentially beneficial strategies for managing tachyphylaxis, including change in antidepressant dosing, switch of class of antidepressant medication, augmentation or combination pharmacotherapy, and psychotherapy. LIMITATIONS Studies of antidepressant tachyphylaxis are largely heterogeneous in nature and employ strict inclusion/exclusion criteria; thus, these findings may not be generalizable to all depressed populations. CONCLUSION Few established treatment strategies exist to manage antidepressant tachyphylaxis. Further interventional research is needed to provide symptomatic relief for patients with tachyphylaxis in MDD.
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Affiliation(s)
- Gustavo Kinrys
- Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Alexandra K Gold
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Vincent D Pisano
- Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Marlene P Freeman
- Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - George I Papakostas
- Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - David Mischoulon
- Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Maurizio Fava
- Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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17
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Zajecka JM, Stanford AD, Memisoglu A, Martin WF, Pathak S. Buprenorphine/samidorphan combination for the adjunctive treatment of major depressive disorder: results of a phase III clinical trial (FORWARD-3). Neuropsychiatr Dis Treat 2019; 15:795-808. [PMID: 31040679 PMCID: PMC6459143 DOI: 10.2147/ndt.s199245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The endogenous opioid system is a fundamental regulator of mood in humans. Previously reported clinical trials have demonstrated the efficacy of the investigational agent buprenorphine/samidorphan (BUP/SAM) combination, an opioid-system modulator, for the adjunctive treatment of major depressive disorder. We present here a third phase III study of different design. METHODS Adult patients with major depressive disorder and inadequate response to antidepressant therapy were enrolled in this double-blind, placebo-controlled, placebo run-in study to evaluate the efficacy, safety, and tolerability of adjunctive BUP/SAM 2 mg/2 mg. Patients with baseline Hamilton Depression Rating Scale score $20 received double-blind placebo in addition to background antidepressant therapy for 4 weeks. Nonresponders were randomized to receive adjunctive BUP/SAM 2 mg/2 mg or placebo for 6 weeks. The primary end point was change in Montgomery-Åsberg Depression Rating Scale (MADRS)-10 total score from randomization at baseline to the end of the 6-week treatment period. RESULTS Least-squares mean change in MADRS-10 score at end of treatment was -4.8 (SE 0.67) in the BUP/SAM 2 mg/2 mg group and -4.6 (SE 0.66) in the placebo group (mean difference -0.3 [SE 0.95], P=0.782). There were no differences in MADRS-based response or remission rates. Overall, 42.9% of the BUP/SAM 2 mg/2 mg group and 34.5% of the placebo group experienced at least one treatment-emergent adverse event during the 6-week treatment period, most of which were mild or moderate in severity. There were no clinically important changes in laboratory parameters, weight, or vital signs and no evidence of abuse potential during treatment or opiate-withdrawal symptoms post treatment. CONCLUSION Efficacy results in FORWARD-3 measured by change in MADRS-10 score did not meet the primary end point, but postbaseline improvement in MADRS-10 in the BUP/SAM 2 mg/2 mg group was consistent with that seen in previously reported trials. BUP/SAM 2 mg/2 mg was well tolerated.
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Affiliation(s)
- John M Zajecka
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA, .,Psychiatric Medicine Associates, LLC, Skokie, IL, USA,
| | | | - Asli Memisoglu
- Department of Biostatistics, Alkermes, Inc., Waltham, MA, USA
| | | | - Sanjeev Pathak
- Department of Clinical Research, Alkermes, Inc., Waltham, MA, USA
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