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Author Archives: Robert Pollack

Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.

Ketamine: A depression drug that researchers have called ‘the most important discovery in half a century’ just got a big lift

Ketamine, which has been called “the most important discovery in half a century,” just got a step closer to becoming the first new depression drug in 35 years.

Johnson & Johnson, one of the pharmaceutical companies pursuing the drug’s fast-acting antidepressant qualities, presented some promising new research on Saturday that could raise the drug’s profile as a potential treatment for the condition.

It’s a dramatic departure for a compound that most people know either as a surgical anesthetic or a party drug. And it’s a seemingly welcome one, according to physicians and psychiatrists who say they’ve grown tired of giving patients the same mediocre drugs for the past four decades.

Johnson & Johnson isn’t the only drugmaker that’s hot on the ketamine trail. Allergan is in the last phase of clinical trials with a drug that acts on the same receptor as ketamine, and San Francisco drugmaker VistaGen is studying a similar ketamine-inspired drug.

J&J’s version of ketamine is a nasal spray made with a compound called esketamine, the chemical mirror image of ketamine. In its latest clinical trial, the company’s neuroscience partner, Janssen Research, wanted to show that the spray was safe, well tolerated, and superior to both a placebo and a traditional antidepressant.

To do it, the researchers had 236 adults with treatment resistant depression — known as one of the hardest forms to treat — take a traditional antidepressant for four weeks alongside a nasal spray. Only half of them got a spray with J&J’s drug in it; the other half got a placebo.

Their results were promising: The people who got the real spray saw significantly better improvements in their depressive symptoms than those who got the placebo, over the course of 28 days. More importantly, it is also the first time a novel treatment has come out on top even when compared to a traditional antidepressant drug.

The findings come roughly a month after J&J published the results of a small, preliminary version of this study which suggested that over the course of a single day, the spray and traditional antidepressant combo was better than a placebo and traditional antidepressant combo. That study, however, suggested the results diminished over the course of four weeks, while the longer and larger study suggests they might not.

The emerging science on ketamine

Depression is one of the world’s leading causes of death. Current treatments for depression, which take roughly five weeks to begin to take effect, may not work well in up to 80% of the people who get them.

Most existing antidepressants, from Abilify to Zoloft, work by plugging up the places where our brain takes up serotonin, a chemical messenger that plays a key role in mood. The result is more free-floating serotonin and, in some people, relief from a dark curtain of depressive symptoms.

tree branches foliage leaves fall colors

Ketamine doesn’t work this way. It capitalizes on a different mechanism in the brain and affects key switches called NMDA receptors.

Like serotonin receptors, those for NMDA play an important role in our mood and help keep our emotions in check. But NMDA receptors also keep our brain’s synapses — the delicate branches that serve as the ecosystem for our thoughts — flexible and resilient.

Potentially because of depression’s damaging effects on these brain switches, it appears to cause our synaptic branches to shrivel up and in some cases even to die. Scientists think existing antidepressants send help to those branches indirectly over time by way of serotonin. Ketamine, by contrast, delivers its aid directly to the source, plugging up NMDA receptors like a cork in a bottle, and nipping depressive symptoms within hours.

2012 study published in the journal Science analyzed ketamine’s rapid ability to reduce depressive symptoms in people who’d failed to respond to other drugs. The authors called ketamine “the most important discovery in half a century.” Five years later, researchers concluded in a study in the American Journal of Psychiatry that the drug’s antidepressant effects appeared to last at least a month.

Still, like any drug, ketamine has a range of unpleasant side effects, the most troublesome of which appears to be its tendency to produce what are known as dissociative, or “out of body,” experiences.

Experts worry those effects could lead patients to either react negatively to the experience and not want to repeat it, or react positively and want to repeatedly use, potentially leading to a drug-use disorder.

In J&J’s most recent study, patients reported other side effects as well, including dizziness, headache, blurred vision, and nausea.

The biggest unanswered question: long-term effects

Besides its immediate side-effects, some researchers approach ketamine with hopeful caution for another reason.

Without a good number of long term studies on ketamine for depression, it’s tough to know what the drug’s effects might look like over the course of several months or years. Its beneficial effects, for example, could wear off; other negative side effects could emerge as well.

Allergan and VistaGen are currently doing long term studies of their new drug candidates, which act on the same pathway as ketamine but appear to have substantially fewer side effects; results from those trials are expected in the next two years.

J&J is also pursuing more research on its nasal spray ketamine formula, some of which will include longer trials. Company representatives told Business Insider that in addition to the research they’ve presented so far, they also have plans to study the nasal spray formula in teens with major depression who are at imminent risk for suicide.

The company is expecting to file for approval of their drug with the US Food and Drug Administration later this year.

May 7, 2018
Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.

A New Study on Theta Burst Stimulation Out of Canada


Three-minute magnetic brain stimulation treatments can reduce depression symptoms: study

A three-minute treatment involving magnetic stimulation of the brain works just as well as the standard form of such therapy for people with hard-to-treat depression, a new study has found.


The success of the intermittent theta-burst stimulation (iTBS) therapy could greatly increase the number of patients treated, according to one Canadian psychiatrist who provides the treatment at Toronto’s Centre for Addiction and Mental Health (CAMH).


“A significant number of people can stand to benefit from this treatment that is an alternative to medications and works when medications have not worked,” Dr. Daniel Blumberger, the co-director of CAMH’s Temerty Centre for Therapeutic Brain Intervention, told CTV News.


Theta-burst stimulation is a more powerful type of repetitive transcranial magnetic stimulation (rTMS), a proven form of treatment for illnesses like depression.


A study co-authored by Dr. Blumberger and published in The Lancet found that theta-burst stimulation can reduce symptoms of severe depression just as well as the standard rTMS treatment.


In the study of about 400 patients from Ontario and British Columbia with treatment-resistant depression, 49 per cent experienced a reduction in symptoms after receiving the three-minute therapy delivered daily over four to six weeks.


On average, the benefits of the treatment lasted between four to six months, the study found.


The original treatment uses a magnetic-field-generating device that subjects the brain to low-frequency magnetic pulses. The pulses elicit a response in the brain’s neurons and change the functioning of the brain circuits involved, according to CAMH.


While rTMS typically takes up to 37.5 minutes per session, the high-frequency theta-burst stimulation, delivered through a hand-held wand, takes only three minutes.


Dr. Blumberger said the standard rTMS treatment can accommodate six to eight patients per day. But the number of patients treated with the more efficient theta-burst stimulation could be “increased by three-to-four fold,” he said.


Shelly Hoffer from Barrie, Ont., 43, said she first sought treatment for depression when she was 21, but nothing really seemed to work until she discovered rTMS three years ago.


“I feel like I’m being more proactive about treatment for my depression than I am being reactive,” she told CTV News. “It’s been a great answer to what I needed.”


Hoffer said rTMS has given her relief from depression without any side-effects of drugs or downtime associated with other types of treatment.


“It is an amazing answer. I don’t get headaches, I can drive myself home,” she said. “It is so much easier on my body and my brain.”


Gail Bellissimo, another patient who has received rTMS therapy, said she has now gone a full year without treatments and feels great.


When she first spoke to CTV News three years ago, the Mississauga, Ont., mother said she had tried “just about every drug out there” to treat her depression, but nothing worked until she tried rTMS.


The latest study offers new hope for an estimated 600,000 people in Canada with treatment-resistant depression.


However, only two provinces currently fund transcranial magnetic stimulation therapies: Saskatchewan and Quebec. Alberta is expected to roll out a TMS program and Dr. Blumberger said that Ontario is looking into funding pilot clinics that offer the therapy.


With a report from CTV’s medical specialist Avis Favaro and producer Elizabeth St. Philip


April 27, 2018
Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.

Music as Medicine: Ancient Wisdom, Modern Science


Healing Then and Now With Music


Therapeutic uses of music date back to antiquity. Healing shrines in Ancient Greece housed both hymn specialists and physicians.[2] Native American tribes chanted, danced, and played drums to heal illness. And early Christian priests used hymns to ease pain in the sick. Today, scientific studies confirm what the ancients seemed to know inherently: that music can be medicinal.[3]


The Ancient Greeks: Musical Wisdom


Hippocrates advocated a “healthy mind in a healthy body,” which included mental health care and art therapy. Music and drama were used to treat illness and improve behavior in his time. The notion was that healing the soul through music would also heal the body, with specific applications. The sounds of the flute and harp, for instance, were a treatment for gout.[5]


What Is Music Therapy? A Contemporary Definition


Today, music therapy aims to influence both emotion and physiology. Music therapy is an established allied healthcare profession that entails a therapeutic relationship between a patient and a board-certified music therapist. Treatment techniques are designed to achieve functional changes in mood, brain, and behavior.[6]


Imaging Studies: The Brain Dances to Music


Music modifies brainwaves, a phenomenon that can be seen through functional MRI (fMRI). Patterns of activity in the nucleus accumbens and auditory cortices indicate whether a person enjoys a particular piece of music or not. Another area of the brain, the superior temporal gyrus, serves as a music-recommendation system that helps people make choices about music they want to listen to and purchase.[8]


Reducing Blood Pressure


Music can influence blood pressure in both directions, based on speed and personal perceptions.[9] One study exposed patients with essential hypertension to 30 minutes of Beethoven’s violin concerto Op. 61, second movement (Larghetto). The results showed that both systolic and diastolic blood pressure were lowered significantly.[10]


Music and Dementia Patients


Recent studies have documented the positive effect that music has on dementia patients. Some scientists hypothesize that music regenerates or stimulates several areas of the brain while slowing down neurodegeneration. Patient choice of music yields the best results, and selections that include vocals tend to show the most promise in dementia treatment.[12,13]


Music and Learning


Companies like Brain.fm are creating music and sounds that condition the brain (brainwave entrainment) to reach specific cognitive states. Brainwave oscillations can be synchronized with music to achieve a desired state, such as relaxation, reduced pain, sleep, contentment, and others.


Music and Autism


Research suggests that music can improve communication, behavior, cognition, social interactions, and emotional regulation in those on the autism spectrum. It appears to do so by stimulating both hemispheres of the brain, organizing the sensory system, and increasing perceptual motor skills.[16]


Music as Sleep Medicine


Music has proven to be highly effective in improving sleep hygiene. One study showed improved sleep in elderly participants over 3 months from listening to slow, sedative music every night. Areas of improvement included sleep latency and efficiency as well as daytime function. Similar studies have shown fewer interruptions in sleep patterns and prolonged REM sleep in adults with insomnia.[18,19]


Depression and Anxiety


Music releases mood-enhancing chemicals into the body, including dopamine and endorphins. Mozart’s music in particular has been shown to promote dopaminergic neurotransmission. Music is consistently successful in treating anhedonia.[20]


Music in Pain Management


Music can be an important tool in chronic pain management. One meta-analysis found that soothing, slow, patient-selected music alleviated a wide variety of pain, including ophthalmologic, urologic, gynecologic, cardiac, and surgical, as measured by significantly reduced pain scores, decreased use of analgesics, and improved vital signs, such as lower cortisol or blood glucose levels.[21]


Music and Social Health


Active engagement with music raises IQ and can influence other processing systems, including motor skills, language, intellectual development, and perceptual cognition. Learning and playing an instrument creates a sense of achievement and builds self-esteem, self-discipline, and social and teamwork skills.[23]


Music’s Influence on Mental State and Mood


Music as a mood modulator is familiar to most people, but it also influences each person in very different ways, based on personal history of listening to and playing music, as well as individual sensitivity, receptivity, and age. Overall, music has a powerful and expedient impact on mood, outlook, motivational levels, and disposition.[24]


A New Frontier


Since the dawn of time, human beings have had an impulse to make music and have used music to heal and to achieve specific states. Today, science has caught up with what we have instinctively known all along, and the data fascinate many researchers. The type of music selected in therapy is crucial to success, as specific intensities and frequencies trigger different emotions and brainwaves in patients. As researchers continue their work to perfect the use of music as medicine, patients and their clinicians can safely experiment with their own music and use existing platforms, such as brainwave entrainment and EEG feedback, to help improve various aspects of health.


[Read the Original Slideshow Here]


March 27, 2018
Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.