This newsletter includes information regarding the SAINT neuromodulation system, which recently received FDA 510(k) clearance for treatment-resistant depression.
We also share practical tips for treating psychotic depression, key points from a presentation on the psychopharmacology algorithm for OCD, and our practical research summaries (Quick Takes).
Also, a special surprise! Now you can access all our content on your favorite podcasting app. Learn more here
The SAINT Neuromodulation System for Treating Major Depressive Disorder
On September 6, the FDA granted 510(k) clearance to the SAINT neuromodulation system for treating major depressive disorder (MDD) in adults who have failed to achieve satisfactory improvement.
- What is the SAINT neuromodulation system?
- It is a new type of rTMS that uses intermittent theta-burst stimulation (iTBS).
- Treatment includes:
- Multiple iTBS sessions per day at optimally spaced intervals.
- Application of a higher overall pulse dose of stimulation.
- Personalized targeting of the stimulation using functional imaging techniques.
- What is FDA 510(k) clearance?
- It is a premarket submission to demonstrate that the marketed device is safe, effective, and substantially equivalent to a legally marketed device.
- Who are eligible candidates for receiving treatment with the SAINT neuromodulation system?
- Adults who have failed to achieve satisfactory improvement from prior antidepressant medications in the current episode.
- What do we know about its efficacy?
- Researchers conducted a controlled trial of 32 participants with treatment-resistant depression: 14 received active treatment and 15 sham treatment.
- The mean percent reduction from baseline in MADRS score 4 weeks after treatment was 52.5% in the active treatment group and 11.1% in the sham treatment group. None of the groups reported serious side effects. Read more here.
- How is it different from other treatments?
- With the SAINT neuromodulation system, remission from depression has been observed in just 5 days.
- With other approaches, it usually takes 6 weeks to achieve remission.
- When will it be available?
- It is expected to be commercially launched by late 2023. However, it will be limited and focused on teaching institutions, hospitals, clinics, and some interested clinicians.
In conclusion, although it has been proven that this novel treatment could be effective, further research in more extensive and representative samples is needed to evaluate the potential for more widespread use of SNT.
The Psychopharmacology Algorithm for Psychotic Depression, With David Osser, M.D.
In this interview, Dr. David Osser discusses an evidence-based psychopharmacology algorithm for treating psychotic depression. He explores various treatment strategies, including the use of electroconvulsive therapy (ECT) and medication combinations.
Interview highlights include the following:
- ECT remains the most effective option for the management of psychotic depression.
- Among the antidepressants, venlafaxine is preferred due to its favorable balance of safety and efficacy.
- Other augmentation agents for treatment-resistant psychotic depression may include lithium and methylphenidate.
Learn more and earn 0.75 CME credits here.
Algorithm for the Pharmacotherapy of Obsessive-Compulsive Disorder
In this presentation, Dr. David Osser guides clinicians on using medications and somatic treatments to manage OCD. He focuses on an algorithm that reviews research on the efficacy of different psychopharmacologic strategies, prioritizing the use of drugs with more evidence. He also discusses the use of noninvasive devices, such as rTMS and dTMS.
Node 4: SSRI Augmentation With SGA
- There are 3 kinds of augmenters after 2 failed SSRI trials.
- Risperidone and aripiprazole are the most studied among SGAs.
- Both are effective but have a significant side-effect burden.
- Quetiapine was inferior to placebo as an augmenter and should be avoided.
- Olanzapine has doubtful effectiveness and major side effects; thus, it should also be avoided.
Learn more and earn 1.25 CME credits here.
Quick Takes: Research, Digested
Metformin for the Prevention of Clozapine-Induced Weight Gain: A Retrospective Naturalistic Cohort Study
- Metformin is clearly protective against weight gain for new users of second-generation antipsychotics, but one must consider starting it very early, almost concomitantly. Learn more.
The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence
- In a rigorous review, Dr. Joanna Moncrieff and colleagues find only very limited evidence for a direct role of serotonin levels and transport in major depression.
- They strongly suggest avoiding further promulgation of the “serotonin hypothesis of depression.”
- In conclusion, Dr. Phelps suggests 2 concrete steps to address the main concerns that gave rise to this new review. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
Launch of New Memberships
We’re very happy to announce that this month we are launching our new memberships: Bronze, Silver, and Gold.
We are also introducing 2 new products:
- CAP Smart Takes: 5 monthly research summaries focused on child and adolescent psychiatry.
- Audio Feed: All our website content available on your favorite podcasting app.
Learn more here and start earning CMEs.
References
- Cole, E. J., Phillips, A. L., Bentzley, B. S., Stimpson, K. H., Nejad, R., Barmak, F., Veerapal, C., Khan, N., Cherian, K., Felber, E., Brown, R., Choi, E., King, S., Pankow, H., Bishop, J. H., Azeez, A., Coetzee, J., Rapier, R., Odenwald, N., … Williams, N. R. (2022). Stanford neuromodulation therapy (SNT): A double-blind randomized controlled trial. American Journal of Psychiatry, 179(2), 132-141.
