scholarly journals New approaches to treating resistant depression

2015 ◽  
Vol 21 (5) ◽  
pp. 315-323 ◽  
Author(s):  
Philip J. Cowen ◽  
Ian M. Anderson
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Treatment Plan ◽  
Treatment Strategies ◽  
Therapeutic Modalities ◽  
Recommended Treatment ◽  
Therapeutic Engagement ◽  
Experimental Approaches ◽  
Resistant Depression ◽  
Combine Drug ◽  
Subsequent Relapse

SummaryPersistent major depression that does not respond to adequate first- or second-line treatment is a common problem in psychiatry. This article updates evidence on recommended treatment strategies and reviews the prospects of more experimental approaches. The main pharmacological development in recent years has been the demonstration that several atypical antipsychotic drugs are effective adjunctive agents in improving symptoms in depression unresponsive to selective serotonin reuptake inhibitors, although their adverse effect burden is high. There is optimism about novel pharmacological strategies based on glutamatergic and anti-inflammatory mechanisms. It is important to combine drug and psychological treatments whenever possible. With persistent therapeutic engagement, the majority of patients remit eventually, but subsequent relapse remains a problem. Clinicians should pursue an active and collaborative treatment plan that makes use of all effective therapeutic modalities and continues into the relapse-prevention phase.

scholarly journals Noninterventional Therapies for the Management of Knee Osteoarthritis

2018 ◽  
Vol 32 (01) ◽  
pp. 046-054 ◽  
Author(s):  
Joseph Dadabo ◽  
Julia Fram ◽  
Prakash Jayabalan
Keyword(s):  
Weight Loss ◽  
Knee Osteoarthritis ◽  
Treatment Plan ◽  
Treatment Strategies ◽  
Therapeutic Modalities ◽  
Knee Oa ◽  
Oral Analgesic ◽  
Individualized Approach ◽  
Oral Supplements

AbstractThe goal of the practitioner managing a patient with knee osteoarthritis (OA) is to minimize pain and optimize their function. Several noninterventional (noninjectable) therapies are available for these individuals, each having varying levels of efficacy. An individualized approach to the patient is most beneficial in individuals with knee OA and the treatment plan the practitioner chooses should be based on this principle. The focus of this article is to provide an up-to-date overview of the treatment strategies available, evidence to support them, and in whom these treatments would be most appropriate. These include exercise (aerobic and resistance), weight loss, bracing and orthotics, topical and oral analgesic medications, therapeutic modalities, and oral supplements.

scholarly journals Prognostic Indicators and Treatment Strategies for Diffuse Midline Glioma: a Systematic Review

2021 ◽  
Author(s):  
Michael Fiorino ◽  
Nathan Kostick ◽  
Caroline Baughn ◽  
Alexander Bolufer ◽  
Takuma Iwai ◽  
...  
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Treatment Plan ◽  
Treatment Strategies ◽  
Prognostic Indicators ◽  
Search Term ◽  
Medical Subject Headings ◽  
Therapeutic Modalities ◽  
Dismal Prognosis ◽  
Diffuse Midline Glioma

Abstract IntroductionDiffuse Midline Gliomas (DMGs) are a class of grade IV gliomas associated with a very dismal prognosis. Despite many decades of research, a cure for DMG has yet to be found. In this paper, we will review the drugs and therapeutic techniques published in the scientific literature for DMG.MethodsA comprehensive search of current literature was conducted in MEDLINE/PubMed. Relevant studies were identified among those in the English language published after 1990 to the present. The Medical Subject Headings (MeSH) search term consisted of the singular phrase “diffuse midline glioma”. Prior to completion of the full-text review, a total of 298 articles were identified as of 26 April 2021. For this systematic review, 20 studies were included after review.ResultsRecent genetic testing has identified a H3K27M mutation that is characteristic of DMGs. This finding has helped pave the way in developing new therapeutic agents and techniques for DMG. Although these newer drugs and therapeutic modalities have not been shown to cure DMG, some of them have been shown to increase overall survival and reduce symptom severity in select patients.ConclusionsAt this point in time, there is no best treatment agent/modality for patients with DMG; rather, the treatment plan should be tailored to the patient’s specific type of DMG. More research is needed to develop better therapeutics and provide improved outcomes to patients.

scholarly journals Novel Treatments and Technologies Applied to the Cure of Neuroblastoma

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 482
Author(s):  
Irene Paraboschi ◽  
Laura Privitera ◽  
Gabriela Kramer-Marek ◽  
John Anderson ◽  
Stefano Giuliani
Keyword(s):  
Research Effort ◽  
Treatment Strategies ◽  
Adverse Outcomes ◽  
Treatment Protocols ◽  
Ongoing Research ◽  
Hematopoietic Stem ◽  
Novel Treatments ◽  
Therapeutic Modalities ◽  
High Risk Disease ◽  
Novel Treatment Strategies

Neuroblastoma (NB) is the most common extracranial solid tumour in childhood, accounting for approximately 15% of all cancer-related deaths in the paediatric population1. It is characterised by heterogeneous clinical behaviour in neonates and often adverse outcomes in toddlers. The overall survival of children with high-risk disease is around 40–50% despite the aggressive treatment protocols consisting of intensive chemotherapy, surgery, radiation therapy and hematopoietic stem cell transplantation2,3. There is an ongoing research effort to increase NB’s cellular and molecular biology knowledge to translate essential findings into novel treatment strategies. This review aims to address new therapeutic modalities emerging from preclinical studies offering a unique translational opportunity for NB treatment.

scholarly journals Evaluation of deformable image registration (DIR) methods for dose accumulation in nasopharyngeal cancer patients during radiotherapy

2017 ◽  
Vol 51 (4) ◽  
pp. 438-446 ◽  
Author(s):  
Wannapha Nobnop ◽  
Imjai Chitapanarux ◽  
Hudsaleark Neamin ◽  
Somsak Wanwilairat ◽  
Vicharn Lorvidhaya ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Image Registration ◽  
Treatment Plan ◽  
Nasopharyngeal Cancer ◽  
Treatment Strategies ◽  
Deformable Image Registration ◽  
Organ Dose ◽  
Target Dose ◽  
Dose Accumulation ◽  
The Impact

Abstract Introduction Deformable image registration (DIR) is used to modify structures according to anatomical changes for observing the dosimetric effect. In this study, megavoltage computed tomography (MVCT) images were used to generate cumulative doses for nasopharyngeal cancer (NPC) patients by various DIR methods. The performance of the multiple DIR methods was analysed, and the impact of dose accumulation was assessed. Patients and methods The study consisted of five NPC patients treated with a helical tomotherapy unit. The weekly MVCT images at the 1st, 6th, 11th, 16th, 21st, 26th, and 31st fractions were used to assess the dose accumulation by the four DIR methods. The cumulative dose deviations from the initial treatment plan were analysed, and correlations of these variations with the anatomic changes and DIR methods were explored. Results The target dose received a slightly different result from the initial plan at the end of the treatment. The organ dose differences increased as the treatment progressed to 6.8% (range: 2.2 to 10.9%), 15.2% (range: -1.7 to 36.3%), and 6.4% (range: -1.6 to 13.2%) for the right parotid, the left parotid, and the spinal cord, respectively. The mean uncertainty values to estimate the accumulated doses for all the DIR methods were 0.21 ± 0.11 Gy (target dose), 1.99 ± 0.76 Gy (right parotid), 1.19 ± 0.24 Gy (left parotid), and 0.41 ± 0.04 Gy (spinal cord). Conclusions Accuracy of the DIR methods affects the estimation of dose accumulation on both the target dose and the organ dose. The DIR methods provide an adequate dose estimation technique for observation as a result of inter-fractional anatomic changes and are beneficial for adaptive treatment strategies.

scholarly journals THERAPY OF ENDOCRINE DISEASE: Novel protection and treatment strategies for chemotherapy-associated ovarian damage

2021 ◽  
Vol 184 (5) ◽  
pp. R177-R192
Author(s):  
Jiaqiang Xiong ◽  
Liru Xue ◽  
Ya Li ◽  
Weicheng Tang ◽  
Dan Chen ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Ovarian Tissue ◽  
Life Quality ◽  
Treatment Strategies ◽  
Reproductive Function ◽  
Ovarian Tissue Cryopreservation ◽  
Ovarian Protection ◽  
Protection Method ◽  
Fertility Protection ◽  
Ovarian Damage

Fertility and ovarian protection against chemotherapy-associated ovarian damage has formed a new field called oncofertility, which is driven by the pursuit of fertility protection as well as good life quality for numerous female cancer survivors. However, the choice of fertility and ovarian protection method is a difficult problem during chemotherapy and there is no uniform guideline at present. To alleviate ovarian toxicity caused by anticancer drugs, effective methods combined with an individualized treatment plan that integrates an optimal strategy for preserving and restoring reproductive function should be offered from well-established to experimental stages before, during, and after chemotherapy. Although embryo, oocyte, and ovarian tissue cryopreservation are the major methods that have been proven effective and feasible for fertility protection, they are also subject to many limitations. Therefore, this paper mainly discusses the future potential methods and corresponding mechanisms for fertility protection in chemotherapy-associated ovarian damage.

Depressive illness

2019 ◽  
pp. 241-314
Author(s):  
David Semple ◽  
Roger Smyth
Keyword(s):  
Outpatient Treatment ◽  
Historical Perspective ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Depressive Illness ◽  
Treatment Resistant Depression ◽  
Clinical Presentations ◽  
Depression Management ◽  
Resistant Depression ◽  
Psychotic Features ◽  
Pharmaceutical Interventions

This chapter covers depression. After a historical perspective, it describes the symptoms, caseness, and clinical presentations to aid in diagnosis. Epidemiology and aetiology of the disease are both covered, and specific investigations for diagnosis are outlined. The course and prognosis are discussed, and management principles are covered. Both inpatient and outpatient treatment are covered. Treatment methods for depression both with and without psychotic features are defined, and treatment-resistant depression management is also discussed. Antidepressants, including schedules for swapping or stopping drugs, are covered, including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs), as well as assorted other pharmaceutical interventions. Electroconvulsive therapy (ECT) is covered in detail.

scholarly journals Oral esketamine for treatment-resistant depression: rationale and design of a randomized controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sanne Y. Smith-Apeldoorn ◽  
Jolien K. E. Veraart ◽  
Jeanine Kamphuis ◽  
Antoinette D. I. van Asselt ◽  
Daan J. Touw ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Treatment Strategies ◽  
Repeated Administration ◽  
Additional Treatment ◽  
Racemic Mixture ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Routes Of Administration ◽  
Antidepressant Efficacy ◽  
Resistant Depression

Abstract Background There is an urgent need to develop additional treatment strategies for patients with treatment-resistant depression (TRD). The rapid but short-lived antidepressant effects of intravenous (IV) ketamine as a racemic mixture have been shown repeatedly in this population, but there is still a paucity of data on the efficacy and safety of (a) different routes of administration, and (b) ketamine’s enantiomers esketamine and arketamine. Given practical advantages of oral over IV administration and pharmacodynamic arguments for better antidepressant efficacy of esketamine over arketamine, we designed a study to investigate repeated administration of oral esketamine in patients with TRD. Methods This study features a triple-blind randomized placebo-controlled trial (RCT) comparing daily oral esketamine versus placebo as add-on to regular antidepressant medications for a period of 6 weeks, succeeded by a follow-up of 4 weeks. The methods support examination of the efficacy, safety, tolerability, mechanisms of action, and economic impact of oral esketamine in patients with TRD. Discussion This is the first RCT investigating repeated oral esketamine administration in patients with TRD. If shown to be effective and tolerated, oral esketamine administration poses important advantages over IV administration. Trial registration Dutch Trial Register, NTR6161. Registered 21 October 2016.

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