The edition · Psychiatry
rTMS linked to better outcomes than augmentation in older adults with resistant depression
A pooled analysis of 758 adults over 60 from two trials favoured rTMS over aripiprazole, bupropion augmentation or a switch. Also: a Class III olanzapine recall, positive childhood experiences and adult mental disorder, and a consensus on antipsychotic access.
The edition in brief
An observational analysis of individual data from two randomised trials compared bilateral rTMS with aripiprazole augmentation, bupropion augmentation and switching to bupropion in 758 adults aged 60 or over with treatment-resistant depression. After propensity weighting, rTMS was associated with MADRS scores about 4 to 6 points lower at 10 weeks and roughly four-fold odds of response, with more headache. Because the arms came from different trials, this is not a randomised comparison. The FDA classified a recall of one lot of olanzapine 5 mg tablets made by Macleods as Class III, for impurities above specification; it is a quality action, not a safety signal. In the Avon birth cohort, each additional positive childhood experience was associated with 11% lower odds of a psychiatric disorder at 24, mainly depression. A Lancet Psychiatry consensus set out a method for prioritising antipsychotics in four African countries. The pearl covers when to draw a lithium level.
Positive childhood experiences and lower odds of adult depression
Ask about positive childhood experiences as well as adversity when assessing a young person's risk of depression.
Class III recall of one olanzapine 5 mg lot for impurities
Reassure patients on olanzapine that a Class III impurity recall is not a reason to stop treatment.
A method for choosing which antipsychotics to prioritise in low-resource settings
Treat this consensus as a template for prioritising antipsychotics where access is limited, not as an Indian prescribing list.
Draw lithium levels 12 hours after the dose
Take lithium levels as 12-hour troughs, or the result cannot be read against the reference range.
rTMS against augmentation for late-life resistant depression
Consider offering rTMS earlier in late-life treatment-resistant depression, before stacking further drugs.
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