Treatment-resistant depression has become a growing public health problem due to high relapse, hospitalization, and mortality rates, along with diminished quality of life. A review of literature up to May 2022 on PubMed, PsychInfo, and Cochrane Library examined advances in recognizing and treating this condition. Patients who do not respond to antidepressants require additional pharmacological and instrumental therapies. Recently, esketamine and psilocybin have drawn particular clinical interest, alongside instrumental treatments such as vagus nerve stimulation, deep brain stimulation, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, epidural cortical stimulation, and electroconvulsive therapy. Future research should establish valid criteria and provide reliable data on benefits, risks, and costs of these therapies.
Abruptly stopping cannabis use can trigger psychotic symptoms in vulnerable individuals. An analysis of four patients seen between 2019 and 2023 describes psychotic features that emerged after sudden cannabis withdrawal. The report suggests that withdrawal, not only chronic use, may be a risk factor for precipitating psychosis, especially in susceptible patients. Clinicians should be aware of this potential risk.
A 25-year-old woman in a medically induced coma for 20 days after a severe traumatic brain injury reported a frightening near-death experience (NDE) with an out-of-body experience that included accurate perceptions of events while she was unconscious, later verified by medical staff. The NDE scored 28/32 on the Greyson NDE Scale. After recovery, her pre-accident suicidal ideation completely resolved. This case challenges conventional models of consciousness and highlights the transformative potential of distressing NDEs.
Depressed patients often have disturbed, negatively toned dreams. In 27 women with major depressive disorder starting escitalopram, dream recall and quality were impaired at baseline. After 8 weeks of treatment, alongside reduced depression severity, patients reported significant improvements in the quantity and quality of dream recall, dream emotional content, and dream complexity. Patients with less clinical improvement continued to report impaired dream experiences. Changes in specific dream characteristics—such as subjective recall, recall quality, emotional content, and complexity—appear to be reliable markers of antidepressant therapy effectiveness.