30 Dec 2023 • Successfully treating patients with major depression often is a trial-and-error process. In 2023, randomized trials of several such approaches were published in major medical journals, as follows:

• Ketamine can have antidepressant effects (as well as sedative, analgesic, and anesthetic effects) but also can cause dissociative reactions and hallucinations.
• In 676 patients with treatment-resistant major depression, remission rates with esketamine nasal spray were greater than with daily oral quetiapine at 8 weeks (27% vs. 18%) and 32 weeks 49% vs. 33%.
• Changes in the gut microbiome might play a role in depressive symptoms. Multistrain probiotic recipients were more likely to report “much” or “very much” improvement at 8 weeks in a study.
• A single dose of the psychedelic drug psilocybin was compared with placebo in patients with major depressive disorder. At 6 weeks, psilocybin recipients were more likely than placebo recipients to have sustained response and remission.

At best, remission or response rates for the investigated treatments were ≈50%, and often not much better than the placebo or active comparators.

Bottom line: Primary care physicians aren't in a position to initiate these treatments (with the exception of probiotics), but increasingly, we can expect to see patients who are trying them.

Source: NEJM J-Watch | Read full story