A middle aged man with depression came in today for his first psychiatric evaluation. He had lots of questions about the relationship between cortisol and depression, because his first serious depression, at age 45, occurred in the context of a severe work stress. And this work stress was associated with many physical manifestations of stress – fatigue, severely disrupted sleep, …
Huge Victory on Mental Health Parity in California
On September 10th the California Supreme Court let stand a California Appeals Court decision that the California mental health parity law requires coverage of treatment that may have no equivalent in other medical specialties. Specifically, the Appeals Court held that Blue Shield of California must cover residential treatment for eating disorders. The Court noted that residential treatment was among the …
Genetic Testing Guides Treatment for Bipolar or Depression
We have been using a relatively new assay from a company called Genomind (the Genecept test) in some of our patients with bipolar and/or depression. The test involves a saliva sample which is analyzed for ten gene variants that may be useful in guiding treatment. So far we find that in about half of the patients with treatment resistant depression …
Treatment of Fatigue in Patients with Depression or Bipolar
Treatment of depression in patients with depression or bipolar is often complicated. If medications are prescribed, will they make mood symptoms worse, or have other significant adverse effects? And yet fatigue is common in people with a history of depression (it occurs in up to 10% of the general population and is much more common in women, who have a …
Low Frequency Magnetic Stimulation is Rapid Antidepressant
There is a lot of interest in an article that just appeared in Biological Psychiatry about a new magnetic stimulation technique that may be associated with rapid antidepressant effects in both unipolar and bipolar depression. Researchers at McLean Hospital were studying Low Frequency Magnetic Stimulation as a way of imaging the brains of bipolar patients and discovered that many of …
Depression Costs US 200 Billion Dollars Per Year
A meta-analysis of more than 60 clinical studies covering almost 60,000 adult patients estimates that the total cost in the United States of the treatment of patients with depression is in the range of $188 billion to $200 billion. Roughly a third of all costs ($64 billion) are related to people with treatment-resistant depression, who represent only a fraction of all cases. The article, “A Review of the Clinical, Economic, …
Biomarker for Suicidality
A just published study by Jerry Guintivano, et al, in the July issue of the American Journal of Psychiatry reports having identified a gene that seemed to predict suicide. The study used one population to identify the risk association and then confirmed it prospectively in a second population. Zachary Kaminsky, Ph.D., an assistant professor of psychiatry and behavioral sciences at …
TMS Not Effective for Depressed Patients with Anhedonia
TMS is a revolutionary treatment for major depression that is being significantly underutilized, but it is also a very expensive treatment that does not work for many patients with treatment resistant depression. One of the major issues impeding the use of TMS is the difficulty identifying patients who are likely to respond to treatment. In an earlier blog post we …
Lithium Treats Bipolar Depression
In a special symposium on bipolar disorder at the 2014 meeting of the American Psychiatric Association, researcher Mike Bauer reviewed a new meta-analysis that showed lithium not only has significant effects in preventing manias, but also depressions. Mike Bauer is currently the Director and Executive Chair of the Department of Psychiatry and Psychotherapy, and the Physician-in-Chief, at the Psychiatric Hospital …
Antidepressants are not Effective for Bipolar Depression
Mark Frye, Chairman of the Department of Psychiatry at the Mayo Clinic, gave a lecture on antidepressants in bipolar illness at the 2014 meeting of the American Psychiatric Association. The newest data from meta-analyses indicate that traditional antidepressants that are effective in unipolar depression are not effective in bipolar depression. Some patient groups, especially those with very early onset depression …