The edition · Psychiatry
rTMS was linked to better outcomes than drug strategies in late-life resistant depression, and SSRIs in pregnancy come back into focus
A pooled analysis of 758 older adults favoured rTMS over aripiprazole or bupropion strategies. Also: what treating perinatal depression now means, adjunctive antipsychotic choice, and electroacupuncture with CBT-I.
The edition in brief
An individual-participant analysis of two trials in 758 adults aged 60 or older with treatment-resistant depression found bilateral rTMS was associated with MADRS scores 4 to 6 points lower at 10 weeks than aripiprazole augmentation, bupropion augmentation or switching to bupropion, with higher response rates and more headache. The comparison is observational across trials, so it supports considering rTMS earlier rather than proving superiority. A JAMA Psychiatry review argues that once confounding by depression itself is accounted for, SSRIs in pregnancy carry little or no risk of serious adverse outcomes, and that untreated or undertreated depression carries real maternal and fetal risk. An expert panel reviewing two network meta-analyses of adjunctive atypical antipsychotics found the evidence broadly concordant but did not favour any single agent. A 76-patient sham-controlled trial found electroacupuncture added to CBT for insomnia improved sleep quality and anxiety in women with gynaecological cancer on chemotherapy. The FDA recorded a supplement to a generic olanzapine application, an administrative action with no new safety finding.
rTMS linked to better scores than drug strategies in late-life resistant depression
In late-life treatment-resistant depression, consider offering rTMS alongside augmentation rather than after it.
Adjunctive antipsychotics in depression: no agent singled out
When adding an atypical antipsychotic in depression, select by tolerability and patient profile; the evidence does not single out one agent.
Electroacupuncture plus CBT-I eased insomnia and anxiety on chemotherapy
CBT-I remains first line; adding electroacupuncture improved sleep and anxiety in one small sham-controlled trial.
FDA records a supplement to a generic olanzapine application
An administrative FDA supplement to a generic olanzapine application; no prescribing change.
Before stopping an antidepressant, ask about discontinuation symptoms
Taper antidepressants, warn about discontinuation symptoms, and do not mistake them for relapse.
Treating depression in pregnancy is the priority, not avoiding SSRIs
For moderate to severe depression in pregnancy, discuss continuing an effective SSRI rather than stopping it by default.
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