Depression and Anxiety
March 25, 2014
Rebecca B Price, Dan V. Iosifescu, James W. Murrough et al.
342 citations
A single subanesthetic dose of intravenous ketamine reduced explicit suicidal thoughts and implicit associations between self and escape in adults with treatment-resistant major depression more than the active placebo midazolam. Twenty-four hours after infusion, 53% of ketamine-treated patients scored zero on all three explicit suicide measures, compared with 24% of the midazolam group. The reductions in explicit suicidal cognition were largest in those with higher baseline suicidal thoughts and were partly explained by decreases in other depressive symptoms. The findings suggest ketamine may offer rapid relief from suicidal cognition beyond what a psychoactive placebo provides.
Depression and Anxiety
April 17, 2013
Anthony P. King, Thane M. Erickson, Nicholas D. Giardino et al.
258 citations
Group mindfulness-based cognitive therapy (MBCT) adapted for combat posttraumatic stress disorder (PTSD) is feasible, acceptable, and associated with clinically meaningful reductions in PTSD symptom severity, particularly avoidance and numbing symptoms, and trauma-related cognitions such as self-blame. In an outpatient VA clinic, veterans with chronic PTSD who completed an 8-week MBCT group showed significant improvement on clinician-rated PTSD symptoms, whereas those in brief treatment-as-usual did not. Homework compliance was good, and drop-out rates were modest. The findings suggest MBCT as a brief adjunctive therapy for combat PTSD, but randomized controlled trials are needed to confirm efficacy.
Depression and Anxiety
March 10, 2014
Ronald S. Duman
213 citations
Stress and depression cause atrophy and loss of neurons in brain regions involved in emotion and cognition, which may contribute to depressive symptoms. Standard antidepressants, which target monoamine neurotransmitters, have limited effectiveness and require long-term use, and they only weakly counteract these stress-induced structural changes. Ketamine, an NMDA receptor antagonist, produces rapid antidepressant effects in difficult-to-treat patients. Preclinical studies show ketamine rapidly increases synaptic connections in the prefrontal cortex by boosting glutamate signaling and activating pathways that control synaptic protein synthesis, and it reverses synaptic deficits caused by chronic stress in rodents. These findings reveal new targets for rapid-acting antidepressants with fewer side effects and improve understanding of stress, depression, and treatment response.
Depression and Anxiety
April 6, 2016
Chadi G. Abdallah, Thomas G. Adams, Benjamin Kelmendi et al.
204 citations
Major depressive disorder is a common psychiatric condition that often responds poorly to traditional antidepressants, which can take weeks to work. Over the past two decades, the NMDA receptor antagonist ketamine has attracted attention because a single low dose produces rapid antidepressant effects in people with treatment-resistant depression. Evidence from animal and human studies suggests that ketamine triggers a surge of glutamate, initiating a cascade that promotes synaptogenesis and reverses stress-related damage, especially in the prefrontal cortex. This review covers the neurobiology of stress-related depression, the safety and efficacy of ketamine, its mechanism of action, and predictors of treatment response, along with research limitations and future directions.
Depression and Anxiety
August 1, 2016
S. Sassano-Higgins, D. Baron, Grace Juarez et al.
200 citations
Ketamine, discovered in the 1960s and released in 1970, is used clinically for analgesia and sedation, and more recently for pain, asthma, and depression. It causes dissociation and emergence delirium, leading to recreational abuse. While death from direct pharmacological effects is rare, disinhibition and altered perceptions increase risk of environmental harm and nonconsensual sexual intercourse. Chronic use may impair memory and cause persistent dissociative, depressive, and delusional thinking, as well as lower urinary tract symptoms, cystitis, and gastric and hepatic pathology including abnormal liver function tests and bile duct dilations. S-ketamine shows hepatotoxicity in vitro. Abstinence is the mainstay treatment; specialized urine testing may be needed for detection.
Depression and Anxiety
December 30, 2018
Naji C. Salloum, Maurizio Fava, Marlene P. Freeman et al.
49 citations
In a double-blind trial, 99 people with treatment-resistant depression received either a single intravenous dose of ketamine (0.1, 0.2, 0.5, or 1.0 mg/kg) or midazolam (0.045 mg/kg). Among them, 45 had high baseline anxiety and 54 did not. No significant difference in depression improvement was found between the ketamine and midazolam groups for either anxious or nonanxious participants at 1 or 3 days after infusion. The results suggest that ketamine may work similarly for both anxious and nonanxious treatment-resistant depression, unlike some traditional antidepressants.
Depression and Anxiety
July 5, 2020
N. Weston, Damian Gibbs, Catherine Bird et al.
38 citations
A systematic review of literature from 1940 to 2000 examined the combined use of psychological therapies and psychedelic drugs for treating ICD-10 anxiety disorders. Twenty studies were included in the final analysis. Three studies reported improvements in anxiety on standardized measures, with two finding a dose-related effect. Among 145 cases of psychoneurotic anxiety reaction, 94 (65%) showed improvement ranging from moderate to full recovery. The majority of studies indicated that combining psychedelic drug administration with psychological therapy was most beneficial; no study suggested that the drug alone was sufficient.
Depression and Anxiety
April 15, 2016
Samuel T. Wilkinson, Gerard Sanacora
38 citations
Ketamine appears to rapidly but transiently reduce suicidal ideation, according to a review of open-label and randomized controlled trials. Some studies showed mixed results at different time points or with different assessments. The existing evidence is very preliminary due to small sample sizes, exclusion of patients with significant suicidal ideation at baseline, and potential functional unblinding when saline is used as a placebo. Ketamine is a promising therapeutic option for patients at imminent risk of suicide, but further controlled trials are needed before meaningful clinical recommendations can be made.
Depression and Anxiety
March 7, 2007
Heather Durdle, Leslie H. Lundahl, Chris‐ellyn Johanson et al.
34 citations
Among 226 MDMA users, 11.5% met lifetime criteria for Major Depressive Disorder. No association was found between the number of MDMA uses and major depression. However, those with lifetime major depression had higher rates of lifetime cannabis use disorder (adjusted odds ratio 2.40). Logistic regression indicated that lifetime cannabis use disorder, but not MDMA use, was significantly associated with lifetime Major Depressive Disorder. For females, a lifetime cannabis use disorder was strongly associated with major depression (adjusted odds ratio 4.99), while for males, neither drug use variable was associated with major depression.
Depression and Anxiety
January 1, 2008
Marcel O Bonn-Miller, Michael J Zvolensky, Amit Bernstein et al.
29 citations
Among 149 young adult marijuana users, those who both used marijuana frequently (past 30 days) and reported using it to cope with negative emotions had the highest levels of anxious arousal, agoraphobic cognitions, and worry. This pattern held after accounting for cigarettes, alcohol, and years of marijuana use. No similar interaction was found for depressive symptoms, suggesting the link is specific to anxiety rather than depression.
Depression and Anxiety
January 1, 2024
Luise Pruessner, Christina Timm, Julia Kalmar et al.
22 citations
Mindfulness helps reduce depression and anxiety symptoms by improving how people regulate their emotions. In 162 patients receiving cognitive-behavioral therapy, decreases in rumination and increases in reappraisal and acceptance explained mindfulness's link to fewer depressive symptoms, while reductions in avoidance explained its link to fewer anxiety symptoms. Adding a brief mindfulness exercise at the start of each therapy session did not change these effects. The findings suggest distinct emotional pathways through which mindfulness alleviates depression versus anxiety.
Depression and Anxiety
January 1, 2024
Ludovic Samalin, Lila Mekaoui, Maud Rothärmel et al.
16 citations
In a French real-world study of 157 patients with treatment-resistant depression who began esketamine nasal spray, most discontinued treatment within about 19 weeks. After one month, 40% of those still on the drug showed clinical response and 20% achieved remission. Adverse events occurred in 69% of patients, with serious events in 17%. The findings align with earlier clinical trials, confirming esketamine's role in treating treatment-resistant depression.
Depression and Anxiety
January 1, 2024
Jelle Lubbers, Dirk E. M. Geurts, Philip Spinhoven et al.
10 citations
Mindfulness-based cognitive therapy (MBCT) added to treatment as usual reduced depressive symptoms and overall functional impairment more than treatment as usual alone in patients with persistent or recurrent major depressive disorder, with medium and small effect sizes respectively. The therapy worked better for those who started with higher levels of rumination and perseverative thinking and lower levels of self-compassion; these traits moderated the treatment's effects. No mediators of MBCT's effects were identified, as the therapy did not change the assessed potential mediators by mid-treatment. Allocating MBCT based on patients' rumination and self-compassion levels could make symptom reduction more efficient.
Depression and Anxiety
January 1, 2023
Thomas H Nassif, Ian A Gutierrez, Carl D Smith et al.
7 citations
A mindfulness and yoga intervention for U.S. Army soldiers in Basic Combat Training reduced positive screens for depression and sleep problems more than standard training alone. Depression screens fell 12.6% in the intervention group versus 7.2% in the control group. Sleep problems decreased 1.4% in the intervention group but increased 2.0% in the control group. Anxiety screens decreased over time in both groups with no significant difference between them. The findings suggest that mindfulness and yoga may help sustain mental health during high-stress military training.
Depression and Anxiety
August 19, 2023
Anna J. Harvey, Stevan Nikolin, Nicholas Chand et al.
4 citations
A single dose of ketamine, compared to an active control (midazolam), did not produce significant changes in most measures of emotional or cognitive processing in people with treatment-resistant depression one day after treatment. However, participants who received ketamine showed a significant improvement on a test of negative processing bias, though this improvement was not significantly linked to changes in depressive symptoms. The study was small and exploratory, and larger trials are needed to confirm the finding.
Depression and Anxiety
January 1, 2025
Camille Piguet, Zeynep Celen, Ben Meuleman et al.
2 citations
A mindfulness-based intervention for young adolescents from the general population did not reduce stress, anxiety, depressive symptoms, or improve emotion regulation, despite being very well accepted and receiving high satisfaction ratings. In a randomized controlled trial, 70 adolescents aged 13 to 15 years were assigned to an 8-week mindfulness program or a waiting list. Self-reported measures showed no benefit on any symptom or affect measure. Trait mindfulness was linked to lower stress and anxiety. Individual responses varied widely. The findings align with evidence that mindfulness programs may be more effective for clinical than nonclinical groups.
Depression and Anxiety
January 1, 2025
Julia Fabienne Sandkühler, Fabian Kahl, Magda Zena Sadurska et al.
2 citations
In a large trial with over a thousand participants, twelve different psychotherapeutic exercises delivered through the Mind Ease app each reduced anxiety more than either a reading control or a no-activity control. The exercises included cognitive restructuring, diaphragmatic breathing, gratitude practice, positive expressive writing, progressive muscle relaxation, guided imagery, and several mindfulness techniques. Effect sizes ranged from medium to very large, with mindfulness exercises generally showing larger effects than cognitive restructuring. Differences between exercises were substantial, with 42% of pairwise comparisons reaching statistical significance. The findings suggest that a variety of brief, app-based exercises can provide immediate anxiety relief.
Depression and Anxiety
March 21, 2022
H. Bringmann, A. Michalsen, M. Jeitler et al.
A new program called Meditation-Based Lifestyle Modification (MBLM), a second-generation mindfulness-based intervention, appears to be an effective, low-risk, and cost-effective option for reducing the burden of depression in outpatients. The program shows promise as a treatment for depressive symptoms.
Depression and Anxiety
November 9, 2021
J. D. de Klerk-Sluis, M. Huijbers, S. Löcke et al.
Mindfulness-based cognitive therapy (MBCT) helps prevent relapse in major depressive disorder by reducing cognitive reactivity and rumination while increasing self-compassion and mindfulness. The authors note that while rumination and mindfulness after MBCT are linked to relapse, no prior research has examined whether these factors—along with cognitive reactivity and self-compassion—are associated with relapse before MBCT begins. This gap suggests that pre-treatment psychological characteristics may influence treatment outcomes, but the study does not report any new empirical data.
Depression and Anxiety
July 22, 2021
E. Daly, I. Turkoz, G. Salvadore et al.
Patients with treatment-resistant depression who also have anxiety tend to respond less well to antidepressants. This analysis of existing trial data examined whether adding esketamine to an antidepressant improves outcomes for such patients. Among those with comorbid anxiety, the combination of esketamine and an antidepressant led to greater improvement in depressive symptoms compared to an antidepressant alone. The benefit was also seen in patients without anxiety, though the difference was less pronounced. The results suggest that esketamine augmentation may be particularly helpful for treatment-resistant depression patients who also struggle with anxiety.
Depression and Anxiety
August 1, 2020
Reilly R Kayser, Margaret Haney, Marissa Raskin et al.
In adults with obsessive-compulsive disorder (OCD), smoked cannabis containing primarily THC or CBD had little acute effect on OCD symptoms and produced smaller reductions in anxiety than placebo. In a randomized, placebo-controlled, within-subjects laboratory study, 12 participants completed three sessions smoking placebo (0% THC/0% CBD), THC (7.0% THC/0.18% CBD), or CBD (0.4% THC/10.4% CBD). Self-reported OCD symptoms and anxiety decreased over time in all conditions, but OCD symptoms did not differ by cannabis varietal. State anxiety was significantly lower immediately after placebo than after either active cannabis. THC increased heart rate, blood pressure, and intoxication relative to placebo and CBD.
Depression and Anxiety
August 8, 2018
M. Cladder-Micus, A. Speckens, J. Vrijsen et al.
Mindfulness-based cognitive therapy (MBCT) is effective for patients with remitted or currently active depression, but its effectiveness for those with chronic, treatment-resistant depression has not yet been established.
Depression and Anxiety
April 1, 2016
Anthony P. King, Stefanie R Block, Rebecca K Sripada et al.
Mindfulness training may help treat PTSD by strengthening connections between brain networks involved in self-focused thought and executive control. In combat veterans with PTSD, a mindfulness-based group therapy reduced symptoms (effect size d = 0.92), though not significantly more than an active control therapy (d = 0.46). Brain scans showed that mindfulness training increased resting-state functional connectivity between the default mode network and regions supporting attention and control, such as the dorsolateral prefrontal cortex and dorsal anterior cingulate cortex. This increased connectivity correlated with improvements in avoidance and hyperarousal symptoms, suggesting a neural mechanism for how mindfulness helps regulate attention and reduce PTSD symptoms.
Depression and Anxiety
April 1, 2013
David Spiegel
Hypnosis can help manage anxiety disorders and anxiety related to medical illness by modulating perception in the brain, particularly through the dorsal anterior cingulate gyrus and dorsolateral prefrontal cortex. The review discusses anxiety as a mind/body problem with reverberating interaction between mental and physical distress. Hypnotizability is a stable trait that varies among individuals. Analogies between hypnosis and dissociative reactions to trauma are presented, and uses in treating posttraumatic stress disorder, stressful situations, and phobias are reviewed. Effects on control of somatic processes and psychosocial support involving Supportive-Expressive Group Therapy and hypnosis on survival time for cancer patients are also evaluated.
Depression and Anxiety
September 1, 2011
D. Spiegel, R. Loewenstein, R. Lewis-Fernández et al.
The authors propose revisions to the diagnostic criteria for Dissociative Disorders in DSM-5 based on a review of clinical, phenomenological, epidemiological, cultural, and neurobiological data. They recommend that Depersonalization Disorder include derealization symptoms, that Dissociative Fugue become a subtype of Dissociative Amnesia, and that the criteria for Dissociative Identity Disorder emphasize disruptive dissociation and amnesia for everyday as well as traumatic events, with possession experiences included in identity disruption. They also suggest placing Dissociative Trance Disorder in the Unspecified Dissociative Disorder category.