The Journal of clinical psychiatry
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Esketamine, the S-enantiomer of ketamine, was recently approved as a rapid-acting intranasal therapy for depression and is currently under development for suicidality. The authors sought to determine the efficacy of adjunctive intranasal esketamine in major depressive disorder (MDD). ⋯ Adjunctive intranasal esketamine for patients with MDD who are either treatment-resistant or acutely suicidal appears to be an effective treatment strategy.
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Review Meta Analysis
The Association Between Antenatal Exposure to Selective Serotonin Reuptake Inhibitors and Autism: A Systematic Review and Meta-Analysis.
This systematic review and meta-analysis examines the relationship between antenatal selective serotonin reuptake inhibitor (SSRI) exposure and child autism, with specific attention to maternal mental illness (MMI) as a potential confounding factor. ⋯ It remains unclear whether the association between first trimester SSRI exposure and child autism that was present in the case-control studies even after adjustment for MMI is a true association or a product of residual confounding. Future studies require robust measurement of MMI prior to and during pregnancy.
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The nocebo effect, when a harmless substance creates harmful effects in a person who takes it, is a clinically salient yet seldom studied phenomenon that may be associated with poorer treatment outcomes, perceived adverse events, and treatment discontinuation. The covert presence of nocebo responders in clinical trials may contribute to outcome variance in both placebo and active treatment arms for important primary and secondary endpoints. Nocebo effects are thought to be driven by expectancy and conditioning. ⋯ The nocebo effect is a common, covert, and poorly understood driver of clinical outcomes that requires further investigation.
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Meta Analysis
Ketamine safety and tolerability in clinical trials for treatment-resistant depression.
Ketamine has demonstrated rapid antidepressant effects in patients with treatment-resistant depression (TRD); however, the safety and tolerability of ketamine in this population have not been fully described. Herein we report the largest study to date of the safety, tolerability, and acceptability of ketamine in TRD. ⋯ In this relatively large group of patients with TRD, ketamine was safe and well tolerated. Further research investigating the safety of ketamine in severe and refractory depression is warranted.
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Meta Analysis
The effects of mind-body interventions on sleep in cancer patients: a meta-analysis of randomized controlled trials.
To examine the effect of mind-body interventions (MBIs) on sleep quality among cancer patients, the moderating effects of the intervention components, subject characteristics, and methodological features of the relationship between MBIs and sleep. ⋯ This meta-analysis confirms that the MBIs yielded a medium effect size on sleep quality and the effect was maintained for up to 3 months. The findings support the implementation of MBIs into the multimodal approach to managing sleep quality in patients with cancer.