we were once... infants, helpless, dependent on love.. on safety...at times too much or may be too little.. too close or too far..survival set in, stay.. run..fight, flight or freeze... found our ways... the end is predictable...the in between matters
Intranasal ketamine delivers a rapid antidepressant effect in patients with treatment-resistant major depressive disorder (MDD), new research shows.
Investigators report that the N-methyl-D-asparate (NMDA) glutamate receptor, administered via intranasal spray, had a significant antidepressant effect within 24 hours of administration. If confirmed in larger studies, the researchers say these findings may herald a new antidepressant drug class.
"What we have here is a proof-of-concept study, and we consider the results very promising. We hope to see this line of research further developed so that we have more treatments to offer patients with severe, difficult-to-treat major depressive disorder," study investigator Dennis S. Charney, MD, Icahn School of Medicine at Mount Sinai in New York City, said in a release.
A US Food and Drug Administration (FDA)–approved anesthetic that has been in common use for years, ketamine has also been subverted as a drug of abuse and can lead to serious psychiatric or cognitive problems when misused.
Previous research conducted by the same group of investigators and reported by Medscape Medical News has shown that low-dose intravenous ketamine has a rapid effect on patients with resistant depression.
To determine the safety and efficacy of an intranasal formulation of the drug, the investigators conducted a small, double-blind, crossover study. A total of 20 patients with MDD who had failed to respond to at least 1 trial of antidepressants were randomly assigned to receive a single 50-mg dose of ketamine or saline 7 days apart.
In each treatment period, study participants were assessed at 40 minutes, 120 minutes, 240 minutes, 24 hours, 48 hours, 72 hours, and 7 days following treatment intervention.
The study's primary outcome was change in depression severity, as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS). Secondary outcomes included durability of response, changes in self-reports of depression, anxiety, and the proportion of responders.
The investigators also measured potential psychotomimetic, dissociative, hemodynamic, and general adverse effects.
Study results based on 18 participants revealed greater improvement in depressive symptoms at 24 hours following ketamine administration compared with placebo [t = 4.39, P < .001; estimated mean MADRS score difference of 7.6 ± 3.7 (95% confidence interval, 3.9 - 11.3).
The researchers also found that 8 of 18 patients (44%) met response criteria 24 hours following ketamine administration vs 1 of 18 (6%) following placebo (P = .033).
The investigators also found that intranasal ketamine was "well tolerated with minimal psycotomimetic or dissociative effects and was not associated with clinically significant hemodynamic parameters."
Dr. James Murrough
"One of the primary effects of ketamine in the brain is to block the NMDA. There is an urgent clinical need for new treatments for depression with novel mechanisms of action. With further research and development, this could lay the groundwork for using NMDA-targeted treatments for major depressive disorder," principal investigator James Murrough, MD, said in a release.
"To our knowledge, this study represents the first controlled investigation of intranasal administration for an NMDA antagonist in depression. While these findings are suggestive of efficacy and of a favorable tolerability profile, much more research is required before the true efficacy and safety of this intervention can be assessed.
"Future studies designed to optimize dosing while identifying relapse prevention strategies and biomarkers of treatment response will provide additional needed data to maximize benefit for patients and minimize side effects," the investigators conclude.
Three hours is enough to help prevent mental health issues in teens
October 3, 2013
Université de Montréal
The incidence of mental health issues amongst 509 British youth was reduced by 25 to 33% over the 24 months following two 90-minute group therapy sessions. Almost one-in-four American 8 to 15 year olds has experienced a mental health disorder over the past year. We know that these disorders are associated with a plethora of negative consequences. This study shows that teacher delivered interventions that target specific risk factors for mental health problems can be immensely effective at reducing the incidence of depression, anxiety and conduct disorders in the long term.
Uncovering a new angle on mental distance: Feeling closer leads to poor judgement of space
April 10, 2014
Association for Psychological Science
Why does the second hour of a journey seem shorter than the first? Research suggests that the answer lies in how we're physically oriented in space. Research has demonstrated that a person's orientation -- the direction they are headed -- changed how they thought of an object or event. "Feeling close to or distant from something impacts our behavior and judgment," says the lead author. "We feel more socially connected, more emotionally engaged, and more attuned to the present when something is perceived as close."
Researchers search for earliest roots of psychiatric disorders
April 10, 2014
A single molecular mechanism in the developing brain has been identified that sheds light on how cells may go awry when exposed to a variety of different environmental insults. The findings suggest that different types of stressors prenatally activate a single molecular trigger in brain cells that may make exposed individuals susceptible to late-onset neuropsychiatric disorders.