Madhukar Trivedi, MD, and Manish Jha, MD, MBBS, review the evidence on the efficacy of esketamine and ketamine as a treatment for major depressive disorder.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/968556). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.

Resources

Symptom Clusters as Predictors of Late Response to Antidepressant Treatment https://www.psychiatrist.com/jcp/depression/symptom-clusters-predictors-late-response-antidepressant/

Intranasal Esketamine https://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/SPRAVATO-pi.pdf

Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study https://www.nimh.nih.gov/funding/clinical-research/practical/stard

Clinical Results for Patients With Major Depressive Disorder in the Texas Medication Algorithm Project https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482026

Efficacy and Safety of Olanzapine/Fluoxetine Combination vs Fluoxetine Monotherapy Following Successful Combination Therapy of Treatment-Resistant Major Depressive Disorder https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207330/

Esketamine Nasal Spray for Rapid Reduction of Depressive Symptoms in Patients With Major Depressive Disorder Who Have Active Suicide Ideation With Intent: Results of a Phase 3, Double-Blind, Randomized Study (ASPIRE II) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816667/

Esketamine Nasal Spray for the Rapid Reduction of Depressive Symptoms in Major Depressive Disorder With Acute Suicidal Ideation or Behavior https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407443/

Ketamine Versus Midazolam for Recurrence of Suicidality in Adolescents https://clinicaltrials.gov/ct2/show/NCT04592809

Youth Depression and Suicide Research Network (YDSRN) https://clinicaltrials.gov/ct2/show/NCT04572321

The Neurobiology of Depression, Ketamine and Rapid-Acting Antidepressants: Is it Glutamate Inhibition or Activation? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165688/

Effect of Ketamine on Limbic GABA and Glutamate: A Human In Vivo Multivoxel Magnetic Resonance Spectroscopy Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507577/

Identifying Novel Mechanisms and Treatment Targets for Irritability and Aggression in Psychiatric Disorders https://www.nature.com/articles/s41386-021-01166-4

Ketamine Versus Midazolam for Recurrence of Suicidality in Adolescents https://clinicaltrials.gov/ct2/show/NCT04592809

Ketamine for Depression: An Update https://www.biologicalpsychiatryjournal.com/article/S0006-3223(16)32579-3/fulltext

MDMA-Assisted Therapy for Severe PTSD: A Randomized, Double-Blind, Placebo-Controlled Phase 3 Study https://www.nature.com/articles/s41591-021-01336-3

Trial of Psilocybin versus Escitalopram for Depression https://www.nejm.org/doi/full/10.1056/NEJMoa2032994

The Clinical Pharmacology and Potential Therapeutic Applications of 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) https://onlinelibrary.wiley.com/doi/10.1111/jnc.15587

Madhukar Trivedi, MD, and Jonathan Downar, MD, review the evidence on the efficacy of transcranial magnetic stimulation as a treatment for major depressive disorder.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/968557). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.

Resources

Transcranial Magnetic Stimulation https://www.medscape.com/answers/286759-14790/what-is-the-role-of-transcranial-magnetic-stimulation-tms-in-the-treatment-of-major-depressive-disorder-clinical-depression

Treatment-Resistant Depression https://www.medscape.com/viewarticle/431515_7

ECT https://emedicine.medscape.com/article/1525957-overview

Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study https://www.nimh.nih.gov/funding/clinical-research/practical/stard

FDA Clears TMS Device for Resistant Depression https://www.medscape.com/viewarticle/777357

FDA Clears Brain Stimulation Device for OCD https://www.medscape.com/viewarticle/900889

FDA Clears First Brain Stimulation Device to Help Smokers Quit https://www.medscape.com/viewarticle/936234

Neuroanatomy of Decision-making https://www.medscape.com/viewarticle/731957_5

Customized Brain Stimulation: New Hope for Severe Depression https://www.medscape.com/viewarticle/960276

Subcallosal Cingulate Deep Brain Stimulation for Treatment-Resistant Depression: A Multisite, Randomised, Sham-Controlled Trial https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30371-1/fulltext

High-Dose Spaced Theta-Burst TMS as a Rapid-Acting Antidepressant in Highly Refractory Depression https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837258/pdf/awx379.pdf

Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19070720

A pilot study of magnetic seizure therapy for treatment-resistant obsessive-compulsive disorder https://onlinelibrary.wiley.com/doi/10.1002/da.23097

How does the gut microbiome affect the brain? Madhukar Trivedi, MD, and Jane Foster, PhD, discuss the current evidence and clinical takeaways.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/968558). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.

Resources

Microbiome https://www.medscape.com/resource/microbiome

Modulating Brain Function With Microbiota https://www.science.org/doi/10.1126/science.abo4220

A Systematic Review of Gut Microbiota Composition in Observational Studies of Major Depressive Disorder, Bipolar Disorder and Schizophrenia https://www.nature.com/articles/s41380-022-01456-3

Clinicaltrials.gov, search for phase 3 studies, recruiting, and keyword "probiotic" https://clinicaltrials.gov/ct2/results?term=probiotic&Search=Apply&recrs=a&age_v=&gndr=&type=&rslt=&phase=2

Review Article: The Future of Microbiome-Based Therapeutics https://onlinelibrary.wiley.com/doi/10.1111/apt.17049

A Randomized Controlled Trial of Dietary Improvement for Adults With Major Depression (The 'SMILES' Trial) https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y

Consumption of Fermented Milk Product With Probiotic Modulates Brain Activity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839572/

Gut-Microbiota-Targeted Diets Modulate Human Immune Status https://www.cell.com/cell/fulltext/S0092-8674(21)00754-6