Low Frequency rTMS for Treatment-Resistant Auditory Hallucinations in Schizophrenia
Highlights from Posters Presented at the Society of Biological Psychiatry Meeting, April 27-29, 2023 in San Diego:
J. Brunelin gave patients “30 sessions of 1 Hz rTMS (repetitive Transcranial magnetic stimulation) over 3 weeks (360 pulses per sessions delivered with 60 sec ‘on’ and 30 sec ‘off’ at 110% of the resting motor threshold, 2 sessions per day). Stimulations were applied over the left temporoparietal junction.” Severity of auditory verbal hallucinations decreased (p=0.003) including in the 9 patients included with clozapine-resistant symptoms.
An Open Label Study of Synthetic Psilocybin in Bipolar Type II Depression
Highlights from Posters Presented at the Society of Biological Psychiatry Meeting, April 27-29, 2023 in San Diego
Scott Aaronson reported on patients receiving a single dose of synthetic psilocybin. All subjects had three preparatory sessions prior to dosing and three integration sessions post dosing and were followed for 12 weeks.
“At the three week primary outcome measure, 11 of 14 participants (78.6%) met remission criteria.” They concluded: “Most subjects reported significant improvement in chronic depressive symptoms without hypomania or suicidality and durability lasting for three months follow-up.”
The Addition of Fish Oil to Cognitive Behavioral Case Management is Not Effective for Youth Depression
In a relatively large placebo-controlled study adding a combination of 840 mg of eicosapentaenoic acid (EPA) and 560 mg of docosahexaenoic acid (DHA) versus placebo did not help treat depressed youth undergoing cognitive behavioral case management (CBCM) (Amminger et al, Biol. Psychiatry, June 22, 2023).
These findings add to the ongoing inconsistency of the effectiveness of Omega 3 Fatty Acids in treating depression. It had appeared more effective in younger than older depressed patients, but now even this trend appears unreliable.
A meta analysis does support use Omega 3 Fatty Acids for ADHD, however.
Vortioxetine Improves Cognition, Major Depression in Early Dementia
Vortioxetine (5mg then 10mg) significantly improves depressive symptoms, cognitive performance, functioning, and quality of life at 12 weeks in patients with both major depressive disorder (MDD) and early-stage dementia. In addition to blocking 5HT (serotonin) reuptake vortioxetine antagonizes 5 serotonin receptors with 5HT3 and 5HT7 likely accounting for the positive effects on processing speed and cognitive functioning.
Serotonin is Back
A review by Moncrieff et al in Molecular Psychiatry 2022 concluded that : “there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity.” This was widely reported in the news media.
A new analysis by 26 experts in the field finds many faults with this analysis (Jauhar et al 2023). Instead, they conclude “A more accurate, constructive conclusion would be that acute tryptophan depletion and decreased plasma tryptophan in depression indicate a role for 5-HT in those vulnerable to or suffering from depression, and that molecular imaging suggests the system is perturbed. The proven efficacy of SSRIs in a proportion of people with depression lends credibility to this position.” Long live serotonin’s role in depression.
Probiotic as an adjunct to an antidepressant
Viktoriya L. Nikolova, et al reported in JAMA Psychiatry (2023) that the probiotic Bio-Kult Advanced; ADM Protexin was more effective than placebo as an adjunct to antidepressants for depression and anxiety.
Cannabis Use Disorder Increases Risk of Subsequent Unipolar Depression and Bipolar Disorder
Jefsen et al report in JAMA Psychiatry. that in “[6,651,765] individuals in Demark, cannabis use disorder was associated with an increased risk of (subsequent) both psychotic and nonpsychotic unipolar depression and bipolar disorder….Associations between CUD and subsequent affective disorders were estimated as hazard ratios (HRs) using Cox proportional hazards regression with time-varying information on CUD, adjusting for sex; alcohol use disorder; substance use disorder; having been born in Denmark; calendar year; parental educational level (highest attained); parental cannabis, alcohol, or substance use disorders; and parental affective disorders….Cannabis use was associated with an increased risk of bipolar disorder in men (HR, 2.96; ) and women (HR, 2.54; )”, and was highest for psychotic bipolar disorder (HR, 4.05; 95% CI, 3.52-4.65).
Editors Note: Marijuana is not a benign substance. “In all, 60,?696 individuals received a diagnosis of (cannabis use disorder) during follow-up, and 260,?746 (3.9%) developed an affective disorder.”
Projected Health Outcomes Associated With 3 US Supreme Court Decisions in 2022 on COVID-19 Workplace Protections, Handgun-Carry Restrictions, and Abortion Rights
Adam Gaffney et al reported in JAMA New. Open (2023) reported “In this decision analytical modeling study, the model projected that the Supreme Court ruling to invalidate COVID-19 workplace protections was associated with?1402 deaths in early 2022. The model also projected that the court’s decision to end handgun-carry restrictions will result in 152 additional firearm-related deaths annually, and that its decision to revoke the constitutional right to abortion will result in 6 to 15 deaths and hundreds of cases of peripartum morbidity each year.
Meaning: These findings suggest that over a decade, “the 3 Supreme Court decisions examined here will contribute to the loss of nearly 3000 US lives and possibly many more.”
Risk of Attempted or Completed Suicide in Borderline Personality Disorder: Reduced with ADHD meds; Increased with Benzodiazepines
Johannes Lieslehto et al 2023 reported in JAMA New. Open on the comparative effectiveness in 22,601 individuals with BPD that “ADHD medication was the only pharmacological treatment associated with reduced risk of suicidal behavior among patients with BPD. Conversely, the findings suggest that benzodiazepines should be used with care among patients with BPD due to their association with increased risk of suicide.” Mood stabilizers had no effect while antipsychotics minimally and antidepressants moderately increased risk of suicide attempts or completed suicide.
