Medication Treatment Failure And Ect
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The document discusses medication resistance and its influence on response to electroconvulsive therapy (ECT). It presents findings from several studies that have investigated whether higher levels of medication resistance, as measured by scales like the Antidepressant Treatment History Form (ATHF), impact how well patients respond to ECT. The studies presented found no significant influence of medication resistance on remission rates or response to ECT. Specifically, two studies from 1990 and 1996 found similar response rates to ECT among patients regardless of their level of medication resistance prior to receiving ECT.
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Electroconvulsive therapy (ECT) is a psychiatric treatment where seizures are electrically induced under anesthesia to treat severe mental illnesses. While ECT was originally portrayed as dangerous in media, modern ECT is a safe and effective treatment when other options have failed. ECT involves placing electrodes on the head to deliver a brief electric stimulus while the patient is under anesthesia and muscle relaxation. This causes a seizure and can rapidly relieve severe depression or mania when administered in a series of sessions. While cognitive side effects like temporary confusion and memory loss are risks, ECT is considered low-risk when properly administered by a trained team. It remains a controversial treatment due to its portrayal in media and the small risk of cognitive impacts.
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3) An expert commentary discusses concerns about the use of antidepressants in bipolar disorder given risks of inducing mania or rapid cycling, and lack
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For this Discussion, review the case Learning Resources and the .docx
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
•
Metformin 500mg BID
•
Januvia 100mg daily
•
Losartan 100mg daily
•
HCTZ 25mg daily
•
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post
a response to each of the following:
• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Respond to the these discussions. All questions need to be addressed.
Discussion 2 Me
Treatment of a Patient with Insomnia
The case presented this week, is that of a 75-year-old widow who just lost her spouse 10-months ago. Th patient presents with chief complaints of insomnia. Past medical history of DM, HTN, and MDD is reported. Since the passing of her husband, she states her depression has gotten worse .
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Dr. Cady presented this CME program on depression and TMS (Transcranial magnetic stimulation) to the medical staff of the Community Methodist Hospital in Henderson, KY on February 8, 2012. It reviews accurate diagnosis of depression, use of new medications, cautions on drug-drug interactions, and a review of the new development of TMS in the current treatments of 21st Century psychiatry.
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Lauren D. Asarnow
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Andrew Krystal
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Jack D. Edinger
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Daniel J. Buysse
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Rachel Manber
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assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
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This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
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insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
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For this Discussion, review the case Learning Resources and the .docx
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
•
Metformin 500mg BID
•
Januvia 100mg daily
•
Losartan 100mg daily
•
HCTZ 25mg daily
•
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post
a response to each of the following:
• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Respond to the these discussions. All questions need to be addressed.
Discussion 2 Me
Treatment of a Patient with Insomnia
The case presented this week, is that of a 75-year-old widow who just lost her spouse 10-months ago. Th patient presents with chief complaints of insomnia. Past medical history of DM, HTN, and MDD is reported. Since the passing of her husband, she states her depression has gotten worse .
Crossroads_Gender and Efficacy of ECT for MDD
This study examined whether the efficacy of electroconvulsive therapy (ECT) for treating major depressive disorder differs between males and females. The researcher reviewed charts of 157 patients who received ECT, including 100 females and 57 males. Statistical analyses found no significant differences between males and females in the number of ECT sessions needed or response to treatment. However, the researcher notes there are many potential confounding variables like age, previous medication failures, comorbidities, and use of maintenance drug therapy after ECT that require further investigation.
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Dr. Cady presented this CME program on depression and TMS (Transcranial magnetic stimulation) to the medical staff of the Community Methodist Hospital in Henderson, KY on February 8, 2012. It reviews accurate diagnosis of depression, use of new medications, cautions on drug-drug interactions, and a review of the new development of TMS in the current treatments of 21st Century psychiatry.
Treating Insomnia in Depression Insomnia Related Factors Pred.docx
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
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Electroconvulsiv Therapy Presentation
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Can Ketamine be used for Patients with TRD
Major depressive disorder affects many people and treatment-resistant depression is defined as failing to respond to two antidepressants. Emerging evidence suggests abnormalities in glutamate signaling may be involved in depression. Ketamine, a glutamate receptor antagonist, shows promise in treating treatment-resistant depression based on three studies. The studies found ketamine provided rapid relief of depressive symptoms for up to 2 weeks in 70-71% of patients. While side effects like elevated blood pressure and dissociative symptoms occurred, ketamine may be a safe and effective option for treatment-resistant depression.
Addiction In Pregnancy Ver.2
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This presentation discuss in brief the criteria, predictors and management approaches for treatment resistant psychosis.
The presentation is an overview for readers to search more regarding this important topic.
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Medication Treatment Failure And Ect
- 1. Medication Resistance and ECT. Is there a problem? by Walter van den Broek
- 3. The indication for ECT has changed: Medication Resistant Depression.
- 4. Should you worry about that?
- 5. You’re concerned about medication resistance and response to ECT p =0.004 p <0.05 Prudic, J et al. Journal of Psychiatric Research 1990
- 6. This didn’t help to resolve your concern Prudic, J. et al. Am J Psychiatry, 1996 ATHF<3, n=18 ATHF 3 or more, n=36 Response 94% 64%
- 8. Medication resistance according to the ATHF does not influence remission and response to subsequent ECT
- 9. van den Broek, et al, Journal of Clin Psychopharmacology 2004
- 10. Co variables and their fate
- 11. Characteristics of the treatment TCA Lithium MAO ECT
- 12. Medication resistance with TCA and lithium does not influence remission and response to subsequent ECT
- 13. SSRIs are less efficacious than TCAs with depressed inpatients
- 14. Comparison of imipramine and lithium addition or fluvoxamine and lithium addition
- 15. ECT after Lithium addition Journal of Clin Psychiatry in press
- 16. Others haven’t found an influence of ATHF medication resistance on response to subsequent ECT
- 18. Husain et al, Journal of Affective Disorders, 2004.
- 19. CORE
- 21. p =0.004 p <0.05 Prudic, J et al. Journal of Psychiatric Research 1990
- 22. Prudic, J. et al. Am J Psychiatry, 1996 ATHF<3, n=18 ATHF 3 or more, n=36 Response 94% 64%
- 24. Answers Anyone?
Editor's Notes
- Dr Walter van den Broek, psychiatrist. Erasmus MC, Rotterdam, The Netherlands. Chair of the committee preparing an update of the Dutch Guidelines for ECT Co-founder and secretary of the Dutch Workgroup for ECT.