The Week in Review: September 11-15

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This week, Psychiatric Times® discussed a wide variety of psychiatric issues and industry updates, from the efficacy of adjunctive TMS for treatment-resistant major depression to a look at adult ADHD. Here are some highlights from the week.

Study Supports Long-Term Efficacy of Esketamine Nasal Spray in Patients With TRD

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Results from a recent study showed that flexibly dosed esketamine nasal spray demonstrated sustained improvements in depressive symptoms in adults with treatment-resistant depression (TRD) for up to 6.5 years. The study investigators shared these results in a poster presentation at Psych Congress 2023.

The poster presentation, titled “Long-Term Efficacy of Esketamine Nasal Spray Dosed in Accordance With US Prescribing Information in Adults With Treatment-Resistant Depression: A Subgroup Analysis of the SUSTAIN-3 Study Up to 6.5 Years,” described some of the results from the SUSTAIN-3 clinical trial titled “A Long-Term Safety Study of Esketamine Nasal Spray in Treatment-Resistant Depression (SUSTAIN-3),” a phase 3, open-label, long-term extension study. Continue Reading

Meta-Analysis of Adjunctive TMS in Treatment-Resistant Major Depression

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MDD is the fourth leading cause of global disease burden. More than half of patients with MDD do not have adequate response/remission with psychopharmacological and psychotherapeutic treatments. Repetitive transcranial magnetic stimulation (rTMS) is a neuro-modulatory treatment method with evidence for efficacy in treatment-resistant depression (TRD).

However, the generalizability of these findings are limited by methodological issues, including heterogeneous patient populations, definitions of TRD, response and remission, and rTMS treatment protocols. Continue Reading

Psychodynamic Telepsychiatry After the Pandemic

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In August 2022, my article “Virtual Psychiatry is Here to Stay” was published online in Psychiatric Times. I predicted that psychiatric treatment would continue to be provided on virtual platforms after the COVID-19 pandemic had ended. The COVID-19 pandemic was declared over in the United States in May 2023 by President Joe Biden although, as we know, variants of the COVID-19 virus persist and will probably continue to do so into the indefinite future. In this article, I will look at the practice of telepsychiatry after the official end of the pandemic from the perspective of a psychodynamic psychiatrist.

A Brief History of Psychodynamic Telepsychiatry

Psychodynamic psychiatry includes a combination of psychodynamic psychotherapy, the application of psychopharmacology and other somatic psychiatric treatments, and attention to the social context of the patient. It has been summarized as the bio-psycho-social approach to psychiatric treatment. Continue Reading

The Making of Adult ADHD: The Rapid Rise of a Novel Psychiatric Diagnosis

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As recently as 2 decades ago, the consensus view in American academic psychiatry was that attention-deficit/hyperactivity disorder (ADHD) rarely, if ever, persists into adulthood. For decades, ADHD was considered a disorder of childhood; adult cases were seen uncommonly and the diagnosis was rarely made. DSM-IV-TR, published in 2000, describes a condition existing in children and makes only scant reference to adults.

Fast-forward to 2023, and adult ADHD is the diagnosis du jour; rates of diagnosis are skyrocketing at an alarming rate as are prescriptions for psychostimulants, the drugs that purportedly treat the condition. The history of psychiatry is a history of fads in theory, diagnosis, and treatment. Such rapid shifts in conceptualization—such as the emergence of the concept of adult ADHD—almost always warrant informed critical examination. Continue Reading

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