Journal of Psychiatric Practice
July 1, 2012
William R. Marchand
309 citations
Mindfulness involves focusing attention on present-moment experience with curiosity, openness, and acceptance. This review describes three mindfulness interventions effective for psychiatric symptoms and pain: Zen meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). Zen is a Buddhist tradition, while MBSR and MBCT are secular, manualized clinical methods. Studies indicate that MBSR and MBCT have broad-spectrum antidepressant and antianxiety effects and reduce general psychological distress. MBCT is strongly recommended as an adjunctive treatment for unipolar depression. Both MBSR and MBCT show efficacy for anxiety symptoms. MBSR benefits general psychological health and stress management in medical, psychiatric, and healthy individuals. MBSR and Zen meditation aid pain management.
Journal of Psychiatric Practice
November 1, 2011
Jonathan P. Stange, Lori Eisner, Britta K. Hölzel et al.
83 citations
People with bipolar disorder often experience cognitive difficulties such as problems with executive functioning, even when their mood is stable. In an open pilot trial of mindfulness-based cognitive therapy (MBCT), participants reported significant improvements in executive functioning, memory, and the ability to start and complete tasks, as measured by the Behavior Rating Inventory of Executive Function and the Frontal Systems Behavior Scale. These cognitive improvements were linked to increases in mindful, nonjudgmental awareness of thoughts and feelings, but not to reductions in depression. Gains tended to fade after treatment ended, though some improvements in executive functioning persisted for three months. MBCT may serve as an adjunct to medication for improving cognition in bipolar disorder.
Journal of Psychiatric Practice
November 1, 2015
Ajay K Parsaik, Balwinder Singh, Darrow Khosh-Chashm et al.
42 citations
A single intravenous dose of ketamine significantly reduces symptoms of treatment-resistant bipolar depression compared with placebo, with maximum improvement observed 40 minutes after infusion. The meta-analysis of three randomized controlled trials (69 subjects) showed a large effect (standardized mean difference -1.01). No serious side effects occurred, and side effects were similar between ketamine and placebo. Individual studies also reported reduced anhedonia and suicidal ideation after ketamine therapy.
Journal of Psychiatric Practice
September 1, 2019
Matthew J Begola, Jason E Schillerstrom
20 citations
A review of the literature on hallucinogens for psychiatric disorders found that substances such as ayahuasca, ibogaine, ketamine, LSD, MDMA, and psilocybin have been studied for conditions including depression, autism, and especially substance use disorders. Most studies reported significant symptom improvement, but the review could not draw definitive conclusions because the research suffered from small sample sizes, inconsistent measures, and poor study design. The authors call for well-designed, standardized studies to properly assess risks and benefits.
Journal of Psychiatric Practice
July 1, 2018
Lai Fong Chan, Choon Leng Eu, Shean Yih Soh et al.
18 citations
In a series of 13 patients with treatment-resistant depression and significant suicide risk, serial maintenance ketamine infusions helped some achieve long-term functional recovery. Two cases reached functional remission: one sustained response for 7 months through a possible synergy with lamotrigine, and another continued treatment for 5 years—possibly the longest reported. In seven other cases, ketamine acutely reduced suicidal ideation but did not produce lasting antidepressant effects. Factors linked to poor long-term response included inadequate mood stabilization in bipolar spectrum disorders, concurrent benzodiazepine use, complex comorbidities, and adverse effects like severe hypertension or dissociation. Controlled studies are needed to confirm safety and efficacy of long-term ketamine maintenance therapy.
Journal of Psychiatric Practice
September 1, 2023
Amir Garakani, Jeanne L Alexander, Calvin R Sumner et al.
6 citations
Public and clinical interest in psychedelics is growing, with many studies underway for depression, anxiety, PTSD, and substance use disorders. This paper focuses on psilocybin, explaining its mechanism, psychedelic effects, and dosing. It reviews treatment studies, primarily for treatment-resistant depression and cancer-related anxiety, and discusses future directions and potential limitations in studying and regulating psilocybin and other psychedelics.
Journal of Psychiatric Practice
March 1, 2024
Brian S. Barnett
5 citations
Intravenous ketamine has rapid antidepressant effects but is rarely covered by insurance because it lacks FDA approval for depression, while intranasal esketamine, which is FDA-approved and still patented, is widely covered. A review of 2023 Ohio Health Insurance Marketplace and Medicaid plans found that no Marketplace or Medicaid plan covered intravenous ketamine for depression, whereas intranasal esketamine was on 72.7% of Marketplace formularies and 100% of Medicaid formularies. This means patients can more easily access esketamine even though intravenous ketamine is more cost-effective and possibly more efficacious.
Journal of Psychiatric Practice
May 1, 2024
Aniruddha Deka, Emmanuel Joseph, Neha Sharma et al.
3 citations
A 72-year-old woman developed serotonin syndrome on two separate occasions after receiving ketamine for electroconvulsive therapy. Serotonin syndrome involves changes in mental status, autonomic function, and neuromuscular control. Electroconvulsive therapy may increase serotonin transmission by transiently opening the blood-brain barrier, raising antidepressant levels in the brain, and by acting on 5-HT1A and 5-HT2A receptors. Ketamine can also boost serotonin release by increasing glutamate activity in the medial prefrontal cortex. A literature review found five prior cases of serotonin syndrome with electroconvulsive therapy and one with ketamine alone. This is the only reported case of recurrent serotonin syndrome from combining both treatments. There is no evidence that adding ketamine to electroconvulsive therapy improves efficacy, so caution is warranted.
Journal of Psychiatric Practice
March 1, 2021
Sheldon H. Preskorn
3 citations
This column reviews the development of intranasal esketamine, focusing on the consistency of clinical trial results. It illustrates methodological issues important to the U.S. Food and Drug Administration approval process, including study design, the nature of the comparator, and the prespecified statistical analysis plan. The column discusses what constitutes a positive versus a supportive study, differences between phase 2 and phase 3 studies, and the rationale for including both in development. While especially relevant to intranasal esketamine, it also serves as a general example of drug development and approval.
Journal of Psychiatric Practice
September 1, 2025
Matteo Carminati, Mattia Tondello, Barbara Barbini et al.
2 citations
In a case series of five patients with treatment-resistant depression who received both intravenous ketamine and later intranasal esketamine, four responded to ketamine but only one responded to esketamine. A better response to ketamine did not predict a good response to esketamine; the one patient who did not respond to ketamine showed a good response to esketamine. All patients had significant reductions in depressive symptoms after both treatments, but none achieved remission. The findings suggest both treatments reduce symptoms, with a generally better response to ketamine, possibly due to the R-ketamine component or the inpatient versus outpatient setting.
Journal of Psychiatric Practice
May 1, 2025
Marc J. Weintraub, David J. Miklowitz, Jessica K Jeffrey
Two patients in a clinical trial of psilocybin-assisted cognitive behavioral therapy for major depressive disorder had markedly different outcomes. One patient experienced powerful, beneficial effects from psilocybin that led to immediate and sustained antidepressant effects over seven months. The other patient faced significant challenges with psilocybin and reported minimal to no antidepressant effects after the drug sessions. The clinicians' experiences treating both patients are also presented. The authors theorize about future research needed to understand how psilocybin can produce the greatest psychiatric benefit, what patient conditions enable or inhibit benefit, and what psychosocial environment best facilitates psilocybin therapy.
Journal of Psychiatric Practice
March 1, 2024
Sheldon H. Preskorn
Intravenous racemic ketamine, which contains both R-ketamine and S-ketamine (esketamine), is not yet FDA-approved for treatment-resistant major depressive disorder. The FDA's typical drug approval process requires three phases: normal volunteer studies, small-scale proof-of-concept trials, and large-scale registration trials that establish efficacy, safety, and tolerability in real-world clinical use. While small academic studies and clinical use abroad supported the unique value of lithium and clozapine for bipolar disorder and treatment-resistant schizophrenia, leading to advocacy and eventual registration trials, comparable registration trials for intravenous racemic ketamine remain to be done. Safety concerns addressed in esketamine's registration trials have not been similarly studied for intravenous racemic ketamine.
Journal of Psychiatric Practice
November 1, 2021
Amir Garakani
Three case reports illustrate challenges in treating treatment-resistant depression (TRD). A 73-year-old man with a liver transplant 26 years earlier responded well to 9 bitemporal electroconvulsive therapy (ECT) sessions despite his transplant history. A 28-year-old woman with chronic TRD who had only partial response to antidepressants and maintenance ECT achieved remission after twice-weekly 90-minute heated yoga sessions. A 52-year-old woman with TRD and chronic migraines, already on antidepressants and migraine medication, presented with agitation and paranoia after receiving intranasal ketamine from multiple providers, suggesting misuse; her symptoms resolved without prescribed antipsychotics. ECT remains safe even after organ transplantation, heated yoga shows promise as an adjunctive treatment, and esketamine requires careful monitoring to prevent misuse.
Journal of Psychiatric Practice
May 1, 2025
Amir Garakani
A 37-year-old man with no prior psychiatric history developed agitation, self-inflicted arm lacerations, paranoia, and hallucinations after about six months of increasing recreational nitrous oxide use. He had low vitamin B12 and anemia, with normal lab results and head imaging. His symptoms suggested psychosis and delirium with withdrawal-like features due to nitrous oxide abuse. He improved with olanzapine, a diazepam taper, and sertraline. The case underscores challenges in identifying and treating nitrous oxide misuse, as there is no drug test and no consensus on classification or management. Further research on both the risks of misuse and potential therapeutic uses of nitrous oxide is needed.
Journal of Psychiatric Practice
May 1, 2011
Norman A Clemens
Drawing on the experience of singing Beethoven's Missa Solemnis, the author examines the emotional states that religious choral music, particularly the Mass, can evoke. These feelings are connected to themes in psychotherapy, including confronting dying and death, the "oceanic feeling" associated with religious experience, the human drive for knowledge, and a longing for an eternal, intelligent, all-knowing entity in ultimate reality.