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  1. Article ; Online: Evaluating the use of electroconvulsive therapy in low-middle income countries: A narrative review.

    Daskalakis, Anastasios A / Paric, Angela / Ravindran, Nisha / Ravindran, Arun

    Asian journal of psychiatry

    2023  Volume 91, Page(s) 103856

    Abstract: Background: Electroconvulsive therapy (ECT) is a well-accepted intervention for treatment-resistant, serious mental illnesses. Its acceptability, efficacy, and tolerability are well documented in high-income settings, but less so in lower- and middle- ... ...

    Abstract Background: Electroconvulsive therapy (ECT) is a well-accepted intervention for treatment-resistant, serious mental illnesses. Its acceptability, efficacy, and tolerability are well documented in high-income settings, but less so in lower- and middle-income countries (LMICs). This report is a narrative review of ECT practice in the latter setting.
    Methods: A literature search was conducted using Medline and PubMed. Initial results yielded 81 publications in English. Following the screening, 19 papers were included to evaluate the information on ECT practice and perceptions.
    Results: Reports from LMICs on efficacy, tolerability, and perceptions of ECT were relatively sparse. In general, they confirm its use mostly for treatment-resistant major mental illnesses (i.e., depression, schizophrenia, bipolar disorder). Both modified and unmodified forms of ECT are used and considered equally effective, although the former is better tolerated. Use of unmodified ECT remains significant in LMICs due to its low cost and limited resource requirements. In general, there is satisfaction with ECT and its outcomes. The education of patients and families, content process, and research have been noted as areas to improve.
    Conclusions: ECT is perceived as an effective intervention in LMICs, but use of unmodified ECT remains controversial. There is a need for the development and use of global guidelines to improve clinician training, knowledge sharing with patients and their families, and outcome research.
    MeSH term(s) Humans ; Electroconvulsive Therapy/methods ; Developing Countries ; Schizophrenia/therapy ; Bipolar Disorder/therapy ; Surveys and Questionnaires ; Treatment Outcome
    Language English
    Publishing date 2023-12-05
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2456678-0
    ISSN 1876-2026 ; 1876-2018
    ISSN (online) 1876-2026
    ISSN 1876-2018
    DOI 10.1016/j.ajp.2023.103856
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Treatments for child and adolescent attention deficit hyperactivity disorder in low and middle-income countries: A narrative review.

    Pipe, Amy / Ravindran, Nisha / Paric, Angela / Patterson, Beth / Van Ameringen, Michael / Ravindran, Arun V

    Asian journal of psychiatry

    2022  Volume 76, Page(s) 103232

    Abstract: Background: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects approximately 2-7 % of children globally and is associated with a myriad of difficulties that have long-term consequences. Most children and ... ...

    Abstract Background: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects approximately 2-7 % of children globally and is associated with a myriad of difficulties that have long-term consequences. Most children and adolescents live in low- and middle-income countries (LMICs), but there are few reports and no consolidation of findings on ADHD treatment outcomes in this population. We conducted a review of ADHD treatment literature for children and adolescents living in LMICs.
    Methods: Studies were identified using databases (PsychoINFO, Pubmed, MEDLINER, EMBASE, Global Health, Academic Search Complete, Google Scholar). The initial search produced 139 articles. These were filtered for language, title, abstract, and full-text keyword identification to yield a final 20 articles to be included in this review.
    Results: Reports on outcomes of both psychological and pharmacological treatment were relatively sparse, particularly the former, which mostly referred to parent training and multimodal programs in pre-school children. Most evidence exists for the benefit of methylphenidate-IR with a few reports on other agents, including clonidine, atomoxetine, and lisdexamfetamine. Methylphenidate is the most common agent to treat ADHD in youth in LMICs. Younger age, combined subtype, and comorbid oppositional defiant disorder were associated with poorer treatment outcome.
    Conclusion: Access to treatment for ADHD is overall limited in LMICs and varied among individual countries. Pharmacological treatments were generally more available than psychological interventions. Several barriers including stigma, cost, and lack of resources were reported to impact treatment acceptance. More research in LMICs is needed to improve and expand mental health services in these regions.
    MeSH term(s) Adolescent ; Atomoxetine Hydrochloride ; Attention Deficit Disorder with Hyperactivity/drug therapy ; Attention Deficit Disorder with Hyperactivity/epidemiology ; Central Nervous System Stimulants/therapeutic use ; Child ; Child, Preschool ; Clonidine/therapeutic use ; Developing Countries ; Humans ; Methylphenidate/therapeutic use
    Chemical Substances Central Nervous System Stimulants ; Methylphenidate (207ZZ9QZ49) ; Atomoxetine Hydrochloride (57WVB6I2W0) ; Clonidine (MN3L5RMN02)
    Language English
    Publishing date 2022-08-10
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2456678-0
    ISSN 1876-2026 ; 1876-2018
    ISSN (online) 1876-2026
    ISSN 1876-2018
    DOI 10.1016/j.ajp.2022.103232
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Characteristics of psychomotor retardation distinguishes patients with depression using multichannel near-infrared spectroscopy and finger tapping task.

    Ma, Xiangyun / Liu, Pozi / Law, Samuel / Ravindran, Nisha / Xu, Bo / Fan, Tengteng / Feng, Kun

    Journal of affective disorders

    2022  Volume 318, Page(s) 255–262

    Abstract: Background: Psychomotor retardation (PMR) is frequently noted as a characteristic feature of major depressive disorder (MDD). In patients with depression, it is characterized by retardation of speech, emotion, thinking, and cognition. This study ... ...

    Abstract Background: Psychomotor retardation (PMR) is frequently noted as a characteristic feature of major depressive disorder (MDD). In patients with depression, it is characterized by retardation of speech, emotion, thinking, and cognition. This study explored the activation pattern of the prefrontal cortex (PFC) during the finger-tapping task (FTT) in subjects with MDD, aiming to provide additional understanding on the connection between PMR and PFC activation pattern in depression through the use of near-Infrared Spectroscopy (NIRS). We hypothesized that, through use of NIRS during the FTT, motor retardation in depression would generate a distinct PFC activation pattern, allowing for differentiation between patients with MDD and healthy controls (HCs).
    Methods: Thirty-five patients with MDD and thirty-nine HCs underwent NIRS evaluation during performance of the FTT. The FTT included both left-finger tapping and right-finger tapping performed by a computer screen. Each participant was assessed using a 45-channel NIRS and various clinical scales.
    Findings: During the left-FTT, the left orbitofrontal cortex (OFC) showed higher oxy-hemoglobin (Oxy-Hb) activation in the MDD group when compared to the HCs. During the right-FTT, the right dorsolateral prefrontal cortex (DLPFC) demonstrated lower Oxy-Hb activation, and the dorsomedial prefrontal cortex (DMPFC) showed higher Oxy-Hb activation in the MDD group versus the HC group.
    Conclusion: Our results demonstrated different activation patterns of the PFC between the MDD and HC groups, using FTT as a motor performance task. In particular, the OFC, the DLPFC and the DMPFC areas hold promise as new useful sites for such differentiation in future investigations.
    MeSH term(s) Depression ; Depressive Disorder, Major/diagnostic imaging ; Depressive Disorder, Major/psychology ; Humans ; Oxyhemoglobins/metabolism ; Prefrontal Cortex/diagnostic imaging ; Prefrontal Cortex/metabolism ; Spectroscopy, Near-Infrared/methods
    Chemical Substances Oxyhemoglobins
    Language English
    Publishing date 2022-09-08
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 135449-8
    ISSN 1573-2517 ; 0165-0327
    ISSN (online) 1573-2517
    ISSN 0165-0327
    DOI 10.1016/j.jad.2022.09.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Proteoglycans in breast cancer, identification and characterization by LC-MS/MS assisted proteomics approach: A review.

    Kizhakkeppurath Kumaran, Ajeeshkumar / Sahu, Ankita / Singh, Astha / Aynikkattil Ravindran, Nisha / Sekhar Chatterjee, Niladri / Mathew, Suseela / Verma, Saurabh

    Proteomics. Clinical applications

    2023  Volume 17, Issue 4, Page(s) e2200046

    Abstract: Purpose: Proteoglycans (PGs) are negatively charged macromolecules containing a core protein and single or several glycosaminoglycan chains attached by covalent bond. They are distributed in all tissues, including extracellular matrix (ECM), cell ... ...

    Abstract Purpose: Proteoglycans (PGs) are negatively charged macromolecules containing a core protein and single or several glycosaminoglycan chains attached by covalent bond. They are distributed in all tissues, including extracellular matrix (ECM), cell surface, and basement membrane. They are involved in major pathways and cell signalling cascades which modulate several vital physiological functions of the body. They have also emerged as a target molecule for cancer treatment and as possible biomarkers for early cancer detection. Among cancers, breast cancer is a highly invasive and heterogenous type and has become the major cause of mortality especially among women. So, this review revisits the studies on PGs characterization in breast cancer using LC-MS/MS-based proteomics approach, which will be further helpful for identification of potential PGs-based biomarkers or therapeutic targets.
    Experimental design: There is a lack of comprehensive knowledge on the use of LC-MS/MS-based proteomics approaches to identify and characterize PGs in breast cancer.
    Results: LC-MS/MS assisted PGs characterization in breast cancer revealed the vital PGs in breast cancer invasion and progression. In addition, comprehensive profiling and characterization of PGs in breast cancer are efficiently carried out by this approach.
    Conclusions: Proteomics techniques including LC-MS/MS-based identification of proteoglycans is effectively carried out in breast cancer research. Identification of expression at different stages of breast cancer is a major challenge, and LC-MS/MS-based profiling of PGs can boost novel strategies to treat breast cancer, which involve targeting PGs, and also aid early diagnosis using PGs as biomarkers.
    MeSH term(s) Female ; Humans ; Proteoglycans ; Breast Neoplasms/diagnosis ; Chromatography, Liquid ; Proteomics/methods ; Tandem Mass Spectrometry ; Biomarkers
    Chemical Substances Proteoglycans ; Biomarkers
    Language English
    Publishing date 2023-01-11
    Publishing country Germany
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2261788-7
    ISSN 1862-8354 ; 1862-8346
    ISSN (online) 1862-8354
    ISSN 1862-8346
    DOI 10.1002/prca.202200046
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Randomized, Placebo-Controlled Effectiveness Study of Quetiapine XR in Comorbid Depressive and Anxiety Disorders.

    Ravindran, Nisha / McKay, Martha / Paric, Angela / Johnson, Sunny / Chandrasena, Ranjith / Abraham, Gaby / Ravindran, Arun V

    The Journal of clinical psychiatry

    2022  Volume 83, Issue 3

    Abstract: Objective:: Methods:: Results:: Conclusions:: Trial Registration: ...

    Abstract Objective:
    Methods:
    Results:
    Conclusions:
    Trial Registration:
    MeSH term(s) Adult ; Antipsychotic Agents/adverse effects ; Anxiety Disorders/complications ; Anxiety Disorders/drug therapy ; Anxiety Disorders/epidemiology ; Delayed-Action Preparations/therapeutic use ; Depressive Disorder, Major/complications ; Depressive Disorder, Major/drug therapy ; Depressive Disorder, Major/epidemiology ; Dibenzothiazepines/adverse effects ; Double-Blind Method ; Humans ; Quality of Life ; Quetiapine Fumarate/adverse effects ; Treatment Outcome
    Chemical Substances Antipsychotic Agents ; Delayed-Action Preparations ; Dibenzothiazepines ; Quetiapine Fumarate (2S3PL1B6UJ)
    Language English
    Publishing date 2022-03-21
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 716287-x
    ISSN 1555-2101 ; 0160-6689
    ISSN (online) 1555-2101
    ISSN 0160-6689
    DOI 10.4088/JCP.21m14096
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Prevalence and correlates of suicidal ideation among the general population in China during the COVID-19 pandemic.

    Shi, Le / Que, Jian-Yu / Lu, Zheng-An / Gong, Yi-Miao / Liu, Lin / Wang, Yun-He / Ran, Mao-Sheng / Ravindran, Nisha / Ravindran, Arun V / Fazel, Seena / Bao, Yan-Ping / Shi, Jie / Lu, Lin

    European psychiatry : the journal of the Association of European Psychiatrists

    2021  Volume 64, Issue 1, Page(s) e18

    Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic is a major threat to the public. However, the comprehensive profile of suicidal ideation among the general population has not been systematically investigated in a large sample in the age of ... ...

    Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic is a major threat to the public. However, the comprehensive profile of suicidal ideation among the general population has not been systematically investigated in a large sample in the age of COVID-19.
    Methods: A national online cross-sectional survey was conducted between February 28, 2020 and March 11, 2020 in a representative sample of Chinese adults aged 18 years and older. Suicidal ideation was assessed using item 9 of the Patient Health Questionnaire-9. The prevalence of suicidal ideation and its risk factors was evaluated.
    Results: A total of 56,679 participants (27,149 males and 29,530 females) were included. The overall prevalence of suicidal ideation was 16.4%, including 10.9% seldom, 4.1% often, and 1.4% always suicidal ideation. The prevalence of suicidal ideation was higher in males (19.1%) and individuals aged 18-24 years (24.7%) than in females (14.0%) and those aged 45 years and older (11.9%). Suicidal ideation was more prevalent in individuals with suspected or confirmed infection (63.0%), frontline workers (19.2%), and people with pre-existing mental disorders (41.6%). Experience of quarantine, unemployed, and increased psychological stress during the pandemic were associated with an increased risk of suicidal ideation and its severity. However, paying more attention to and gaining a better understanding of COVID-19-related knowledge, especially information about psychological interventions, could reduce the risk.
    Conclusions: The estimated prevalence of suicidal ideation among the general population in China during COVID-19 was significant. The findings will be important for improving suicide prevention strategies during COVID-19.
    MeSH term(s) Adolescent ; Adult ; COVID-19/epidemiology ; China/epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Pandemics ; Prevalence ; Quarantine/psychology ; Quarantine/statistics & numerical data ; Risk Factors ; SARS-CoV-2 ; Stress, Psychological/epidemiology ; Suicidal Ideation ; Suicide/prevention & control ; Suicide/psychology ; Suicide/statistics & numerical data ; Unemployment/psychology ; Unemployment/statistics & numerical data ; Young Adult
    Language English
    Publishing date 2021-02-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 1074337-6
    ISSN 1778-3585 ; 0767-399X ; 0924-9338
    ISSN (online) 1778-3585
    ISSN 0767-399X ; 0924-9338
    DOI 10.1192/j.eurpsy.2021.5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Duration of Adjunctive Antidepressant Maintenance in Bipolar I Depression.

    Yatham, Lakshmi N / Arumugham, Shyam Sundar / Kesavan, Muralidharan / Ramachandran, Kanchana / Murthy, Nithyananda S / Saraf, Gayatri / Ouyang, Yongdong / Bond, David J / Schaffer, Ayal / Ravindran, Arun / Ravindran, Nisha / Frey, Benicio N / Daigneault, Andrée / Beaulieu, Serge / Lam, Raymond W / Kondapuram, Nithin / Reddy, M S / Bhandary, R P / Ashok, Mysore V /
    Ha, Kyooseob / Ahn, Yong Min / Milev, Roumen / Wong, Hubert / Reddy, Y C Janardhan

    The New England journal of medicine

    2023  Volume 389, Issue 5, Page(s) 430–440

    Abstract: Background: Antidepressants are used to treat acute depression in patients with bipolar I disorder, but their effect as maintenance treatment after the remission of depression has not been well studied.: Methods: We conducted a multisite, double- ... ...

    Abstract Background: Antidepressants are used to treat acute depression in patients with bipolar I disorder, but their effect as maintenance treatment after the remission of depression has not been well studied.
    Methods: We conducted a multisite, double-blind, randomized, placebo-controlled trial of maintenance of treatment with adjunctive escitalopram or bupropion XL as compared with discontinuation of antidepressant therapy in patients with bipolar I disorder who had recently had remission of a depressive episode. Patients were randomly assigned in a 1:1 ratio to continue treatment with antidepressants for 52 weeks after remission or to switch to placebo at 8 weeks. The primary outcome, assessed in a time-to-event analysis, was any mood episode, as defined by scores on scales measuring symptoms of hypomania or mania, depression, suicidality, and mood-episode severity; additional treatment or hospitalization for mood symptoms; or attempted or completed suicide. Key secondary outcomes included the time to an episode of mania or hypomania or depression.
    Results: Of 209 patients with bipolar I disorder who participated in an open-label treatment phase, 150 who had remission of depression were enrolled in the double-blind phase in addition to 27 patients who were enrolled directly. A total of 90 patients were assigned to continue treatment with the prescribed antidepressant for 52 weeks (52-week group) and 87 were assigned to switch to placebo at 8 weeks (8-week group). The trial was stopped before full recruitment was reached owing to slow recruitment and funding limitations. At 52 weeks, 28 of the patients in the 52-week group (31%) and 40 in the 8-week group (46%) had a primary-outcome event. The hazard ratio for time to any mood episode in the 52-week group relative to the 8-week group was 0.68 (95% confidence interval [CI], 0.43 to 1.10; P = 0.12 by log-rank test). A total of 11 patients in the 52-week group (12%) as compared with 5 patients in the 8-week group (6%) had mania or hypomania (hazard ratio, 2.28; 95% CI, 0.86 to 6.08), and 15 patients (17%) as compared with 35 patients (40%) had recurrence of depression (hazard ratio, 0.43; 95% CI, 0.25 to 0.75). The incidence of adverse events was similar in the two groups.
    Conclusions: In a trial involving patients with bipolar I disorder and a recently remitted depressive episode, adjunctive treatment with escitalopram or bupropion XL that continued for 52 weeks did not show a significant benefit as compared with treatment for 8 weeks in preventing relapse of any mood episode. The trial was stopped early owing to slow recruitment and funding limitations. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00958633.).
    MeSH term(s) Humans ; Bipolar Disorder/drug therapy ; Bipolar Disorder/diagnosis ; Mania ; Bupropion/adverse effects ; Depression ; Escitalopram ; Canada ; Neoplasm Recurrence, Local/drug therapy ; Antidepressive Agents/adverse effects ; Double-Blind Method ; Treatment Outcome
    Chemical Substances Bupropion (01ZG3TPX31) ; Escitalopram (4O4S742ANY) ; Antidepressive Agents
    Language English
    Publishing date 2023-08-02
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMoa2300184
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Differentiating between bipolar and unipolar depression using prefrontal activation patterns: Promising results from functional near infrared spectroscopy (fNIRS) findings.

    Feng, Kun / Law, Samuel / Ravindran, Nisha / Chen, Gui-Fang / Ma, Xiang-Yun / Bo, Xu / Zhang, Xiao-Qian / Shen, Chen-Yu / Li, Juan / Wang, Ye / Liu, Xiao-Min / Sun, Jing-Jing / Hu, Shuang / Liu, Po-Zi

    Journal of affective disorders

    2020  Volume 281, Page(s) 476–484

    Abstract: Background: Bipolar depression (BD) is a unique, severe and prevalent mental illness that shares many similarities in symptoms with unipolar depression (UD). Improving precision of their diagnoses would enhance treatment outcome and prognosis for both ... ...

    Abstract Background: Bipolar depression (BD) is a unique, severe and prevalent mental illness that shares many similarities in symptoms with unipolar depression (UD). Improving precision of their diagnoses would enhance treatment outcome and prognosis for both conditions. This study aims to provide evidence from functional Near-Infrared Spectroscopy (fNIRS) as a potential tool to differentiate UD and BD based on their differences in hemodynamic change in the prefrontal cortex during verbal fluency tasks (VFT).
    Methods: We enrolled 179 participants with clinically confirmed diagnoses, including 69 UD patients, 68 BD patients and 42 healthy controls(HC). Every participant was assessed using a 45-channel fNIRS and various clinical scales.
    Findings: Compared with HC, region-specific fNIR leads show UD patients had significant lower hemodynamic activation in 4 particular pre-frontal regions: 1) the left dorsolateral prefrontal cortex (DLPFC), 2) orbitofrontal cortex (OFC), 3) bilateral ventrolateral prefrontal cortex (VLPFC) and 4) left inferior frontal gyrus (IFG). In contrast, BD vs. HC comparisons showed only significant lower hemodynamic activation in the LIFG area. Furthermore, compared to BD patients, UD patients showed decreased hemodynamic activation changes in the VLPFC region.
    Conclusion: Our results show significant frontal lobe activation pattern differences between UD and BD groups. fNIRS can be a potential tool to increase diagnostic precision for these conditions. In particular, the VLPFC area holds promise to be a useful site for such differentiation for further investigations.
    MeSH term(s) Bipolar Disorder/diagnostic imaging ; Depressive Disorder/diagnostic imaging ; Humans ; Prefrontal Cortex/diagnostic imaging ; Spectroscopy, Near-Infrared ; White Matter
    Language English
    Publishing date 2020-12-16
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 135449-8
    ISSN 1573-2517 ; 0165-0327
    ISSN (online) 1573-2517
    ISSN 0165-0327
    DOI 10.1016/j.jad.2020.12.048
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  9. Article ; Online: The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Réseau Canadien Pour Les Traitements De L'humeur Et De L'anxiété (Canmat) Concernant L'utilisation De La Kétamine Racémique Chez Les Adultes Souffrant De Trouble Dépressif Majeur.

    Swainson, Jennifer / McGirr, Alexander / Blier, Pierre / Brietzke, Elisa / Richard-Devantoy, Stéphane / Ravindran, Nisha / Blier, Jean / Beaulieu, Serge / Frey, Benicio N / Kennedy, Sidney H / McIntyre, Roger S / Milev, Roumen V / Parikh, Sagar V / Schaffer, Ayal / Taylor, Valerie H / Tourjman, Valérie / van Ameringen, Michael / Yatham, Lakshmi N / Ravindran, Arun V /
    Lam, Raymond W

    Canadian journal of psychiatry. Revue canadienne de psychiatrie

    2020  Volume 66, Issue 2, Page(s) 113–125

    Abstract: Objective: Patients with major depressive disorder often have limited response to first-line and second-line medications; hence, novel pharmacological treatments are needed for treatment-resistant depression (TRD). Ketamine, an : Methods: A ... ...

    Abstract Objective: Patients with major depressive disorder often have limited response to first-line and second-line medications; hence, novel pharmacological treatments are needed for treatment-resistant depression (TRD). Ketamine, an
    Methods: A systematic review was conducted with computerized search of electronic databases up to January 31, 2020 using combinations of search terms, inspection of bibliographies, and review of other ketamine guidelines and consensus statements. The level of evidence and lines of treatment were assigned according to CANMAT criteria. Recommendations were given in question-answer format.
    Results: Intravenous (IV) racemic ketamine given as a single infusion has Level 1 evidence for efficacy in adults with TRD. The evidence for multiple infusions, given as an acute series or as ongoing maintenance treatment, is limited to Level 3. Adverse events associated with ketamine infusions include behavioral (e.g., dissociative symptoms) and physiological (e.g., hypertension) events. There is only Level 3 or 4 evidence for non-IV formulations of racemic ketamine. Consensus recommendations are given for clinical administration of IV ketamine including patient selection, facility and personnel issues, monitoring, and maintaining response.
    Conclusions: Single-dose IV racemic ketamine is a third-line recommendation for adults with TRD. The need for repeated and maintenance ketamine infusions should be carefully assessed on a case-by-case basis with consideration of potential risks and benefits. Because of limited evidence for efficacy and risk for misuse and diversion, the use of oral and other formulations of racemic ketamine should be limited to specialists with ketamine-prescribing expertise and affiliations with tertiary or specialized centers.
    MeSH term(s) Adult ; Antidepressive Agents/adverse effects ; Anxiety ; Canada ; Depressive Disorder, Major/drug therapy ; Humans ; Ketamine/adverse effects
    Chemical Substances Antidepressive Agents ; Ketamine (690G0D6V8H)
    Language English
    Publishing date 2020-11-11
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ZDB-ID 304227-3
    ISSN 1497-0015 ; 0008-4824 ; 0706-7437
    ISSN (online) 1497-0015
    ISSN 0008-4824 ; 0706-7437
    DOI 10.1177/0706743720970860
    Database MEDical Literature Analysis and Retrieval System OnLINE

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