PurposeThe aim of the study was to assess the effectiveness, tolerability, and safety of oral ketamine as an antidepressant treatment in adults with treatment-resistant depression.MethodsWe reviewed retrospective data on 22 patients with treatment-resistant depression, who failed at least 3 adequate antidepressant treatment trials and 1 adequate trial of repetitive transcranial magnetic stimulation; subsequently, they received open-label treatment with oral ketamine, commenced at a dose of 50 mg every 3 days, titrated up by 25 mg every 3 days, according to response and tolerability. The primary outcome measure was the Beck Depression Inventory II, which was used to rate subjective mood improvement at baseline and then at each follow-up visit. Data about adverse effects related to ketamine and a self-harm risk assessment were also obtained.FindingsOver the course of treatment, 18% of the patients showed greater than 50% reduction in the Beck Depression Inventory II scores, 14% reported partial improvement in mood symptoms, while 45% had no response to ketamine and 23% showed a mild worsening in their depressive symptoms. The most frequent adverse effects were acute dissociation, dizziness, blurred vision, numbness and sedation. Neither serious adverse effects, nor any cases of abuse or dependence were observed.ConclusionsAlthough this case series found oral ketamine to be safe and well tolerated, the findings also showed rather modest effectiveness of oral ketamine in treatment-resistant depression, with only approximately 30% reporting some benefit and approximately 70% reporting no change or worsening of mood. However, bearing in mind the limitations of this small, open-label case series, further exploration of the effectiveness of oral ketamine is warranted.

This study investigated the effect of a music-based intervention on depression and associated symptoms. Twenty individuals formally diagnosed with Major Depressive Disorder and in a current Major Depressive Episode (11 females and 8 males; aged between 26 and 65 years) undertook a 5 weeks intervention consisting of music listening combined with rhythmic sensory stimulation. Participants listened to a set of designed instrumental music tracks embedded with low-frequency sounds (30–70 Hz). The stimuli were delivered for 30 min, 5 times per week, using a portable consumer device with built-in stereo speakers and a low-frequency transducer, which allowed the low-frequency sounds embedded in the music to be experienced as a mild vibrotactile sensation around the lower back. Changes from baseline to post-intervention in measures of depression symptoms, sleep quality, quality of life, anhedonia, and music-reward processing were assessed with clinician-based assessments as well as self-reports and a monetary incentive behavioral task. The study results indicated that there were significant changes from baseline in measures of depression and associated symptoms, including sleep quality, quality of life, and anhedonia. However, individual differences in treatment response need to be considered. These findings corroborate previous evidence that music-based intervention, when added to standard care, is a promising adjunctive treatment for Major Depressive Disorder, and open new avenues to investigate the effect of music-based therapy to ameliorate anhedonia-specific dysfunction in major depressive disorder and other neuropsychiatric disorders.

Brexpiprazole, a novel atypical antipsychotic agent, has recently been approved as an adjunctive treatment for major depressive disorder (MDD) when monotherapy only provides a partial response. The mechanism of action is likely related to its partial agonist activity at D 2 and 5-HT 1A receptors, as well as potent 5-HT 2A antagonist effects. The purpose of this systematic review is to provide a detailed overview available evidence on its role in treating MDD, based on all clinical publications in the English language between January 1, 2014 and April 30, 2017 identified from PubMed, Google Scholar, Scopus, Web of Science, PsycINFO, and ClinicalTrials.gov. Two primary pivotal trials are reviewed in detail and a further 10 supporting reviews and open-label studies are discussed. Brexpiprazole is compared with aripiprazole according to pharmacologic and clinical activities. Overall, this appears to be a useful antidepressant adjunctive therapy with a favorable side effect profile and comparable efficacy with existing agents.