Repeated, escalating doses of intravenous ketamine augmentation were preliminarily found to be feasible, efficacious and well tolerated. Interaction with concomitant medications and elevated level of treatment resistance are possible factors for non-response.

Objective To examine the comparative antidepressant efficacy of S-adenosyl-L-methionine (SAMe) and escitalopram in a placebo-controlled, randomized, double-blind clinical trial. Methods 189 outpatients (49.7% female, mean age 45 ± 15 years) with DSM-IV-diagnosed major depressive disorder (MDD) were recruited from 4/13/05-12/22/09 at the Massachusetts General Hospital and at Butler Hospital. Patients were randomized for 12 weeks to SAMe 1600-3200 mg/day, escitalopram 10-20 mg/day, or placebo. Doses were escalated at 6 weeks in the event of non-response. The main outcome measure was the Hamilton Depression Rating Scale (HAM-D-17). Tolerability was assessed by the Systematic Assessment for Treatment Emergent Effects-Specific Inquiry (SAFTEE-SI). Results All 3 treatment arms demonstrated a significant improvement of about 5-6 points in HAM-D-17 scores (p < 0.001 for all), and no significant differences were observed between the treatment arms (p > 0.05 for all). Response rates in the intent-to-treat (ITT) sample were 36% for SAMe, 34% for escitalopram, and 30% for placebo. Remission rates were 28% for SAMe, 28% for escitalopram, and 17% for placebo. No comparisons between treatment groups attained significance (p > 0.05 for all). Tolerability was good, with gastrointestinal side effects (19% for stomach discomfort and 20% for diarrhea) as the most common in the SAMe arm. No significant differences in side effects were observed between treatment groups (p > 0.05 for all). Conclusions The results fail to support an advantage over placebo for either the investigational treatment SAMe or the standard treatment escitalopram.

The emergence and rapid growth of the coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the U.S. criminal justice system as federal and state governments consider allowing the early release of select currently incarcerated individuals to mitigate the pandemic's spread. As a result, the number of incarcerated individuals released into the community is likely to increase abruptly. COVID-19 has drastically altered the communities to which reentering individuals are returning, and the needs of reentry populations are changing accordingly. This article reviews the existing and anticipated criminogenic needs of previously incarcerated individuals as they transition to the community during a pandemic. It also provides recommended adaptations to reentry services in order to promote successful reentry during the COVID-19 pandemic.

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