Esketamine, when added to a mood stabilizer, is associated with a lower risk of suicide-related events in adults with bipolar depression and does not increase the risk of manic switch. In a matched analysis of 2,126 patients, those receiving esketamine had a significantly lower hazard of suicide-related outcomes across intervals from 1–7 days (HR = 0.439) through 1–365 days (HR = 0.754). The risk of manic switch was also lower at 1–180 days (HR = 0.643) and 1–365 days (HR = 0.673). Suicide risk reduction was consistent across age, sex, and racial subgroups, while the lower manic switch risk was significant only in female patients at longer intervals.
Both a modified Mindfulness-Based Stress Reduction (MBSR) programme and a modified Mindfulness-Based Cognitive Therapy (MBCT) programme are feasible and acceptable for family caregivers of people with dementia. In a randomized trial with 57 participants, high attendance (over 70%) and low attrition (3.77%) were observed. Within groups, both interventions reduced perceived stress, depressive symptoms, and subjective caregiver burden, with moderate to large effect sizes. The modified MBCT showed a larger effect on stress reduction than the modified MBSR. The authors suggest MBCT may be more suitable for these caregivers, but note that a future clinical trial is needed to confirm effectiveness.
A new ketamine-like drug called 2-fluorodeschloroketamine (2F-DCK) has been identified in patients, often alongside other similar substances. Between January and July 2019, 20 cases of confirmed 2F-DCK exposure were reported, with 19 involving at least one other ketamine-type drug, most commonly ketamine (90%), deschloroketamine (50%), and 2-oxo-PCE (45%). Six patients had four different ketamine-type drugs in their urine. Clinical effects were primarily neurological (impaired consciousness, agitation, abnormal behavior) and cardiovascular (hypertension, tachycardia); five patients experienced loss of consciousness or convulsions. All patients recovered with supportive care. This is the first clinical case series of 2F-DCK, highlighting the need for awareness of this expanding class of drugs and frequent co-ingestion of multiple analogues.