Among adults with treatment-resistant depression, combining esketamine with an SNRI was associated with lower all-cause mortality (5.3% vs 9.1%), fewer hospitalizations (0.1% vs 0.2%), and fewer depression relapses (14.8% vs 21.2%) compared to combining esketamine with an SSRI. However, the esketamine plus SSRI group had a slightly lower incidence of suicide attempts (0.3% vs 0.5%). Overall rates of these outcomes were low in both groups. The findings come from a large real-world analysis of electronic medical records from over 90 health care centers across 20 countries.
Dissociative disorders involve disruptions in memory, consciousness, perception, motor control, and identity. This systematic review of 13 functional neuroimaging studies, conducted on 51 patients with dissociative identity disorder (DID), 28 with depersonalization disorder, 24 with dissociative amnesia, and 6 with other or unspecified dissociative disorders, identifies common brain activation patterns. Prefrontal cortex dysfunction appears prominent across these disorders. In DID, changes in the caudate's neural network relate to altered identity states, and dysfunction of the anterior cingulate gyrus also plays a role. Other affected regions include parietal, temporal, and insular cortices, along with subcortical areas. Further research is needed to clarify neurofunctional correlates for better tailored treatments.