Background No medication is currently approved for the treatment of cocaine dependence, but several preclinical and clinical reports suggest agonist-like medications, e.g. amphetamine analogues, may be a productive strategy for medication development. Objective This current proof-of-concept study sought to evaluate the safety, tolerability, and effectiveness of methamphetamine as a candidate treatment for cocaine dependence. Methods A randomized, double-blind, placebo-controlled study served to evaluate three treatment conditions in 82 cocaine-dependent individuals: (1) placebo (0 mg, 6×/day; n = 27), (2) immediate release (IR) methamphetamine (5 mg, 6×/day; n = 30), (3) sustained release (SR) methamphetamine (30 mg first pill, 1×/day; 0 mg 5×/day; n = 25). The study employed a sequential, two-phase design (i.e., 4 weeks of medication and counseling followed by 4 weeks of medication/counseling plus a contingency management procedure). Results Both preparation forms of methamphetamine were well tolerated, with similar retention to placebo (0 mg, 33%; 30 mg IR, 30%, 30 mg SR, 32%). Methamphetamine SR was associated with decreased sleep and increased weight loss. Medication adherence rates were high for the first dose of the day (95%), while adherence for subsequent capsules was lower. Those in the SR condition exhibited consistently lower rates of cocaine-positive urine samples (0 mg, 60%; 30 mg IR, 66%, 30 mg SR, 29%), p<0.0001, and reported the greatest reduction in craving for cocaine, p<0.05. Conclusions SR methamphetamine significantly reduced cocaine use and craving. Additional research is warranted to develop and evaluate agonist-like medications that may effectively treat cocaine dependence.

Antidepressant medications have an onset of action of several weeks and have moderate efficacy. Their mode of administration is oral (p.o.). Some clinicians wondered whether intravenous (i.v.) administration would speed onset of action and increase efficacy. In this article we review controlled studies on i.v. administration of antidepressants. These include clomipramine, citalopram, and other antidepressants. Overall these studies do not support increased efficacy of i.v. over p.o.administration but there are suggestions of a faster onset of action. In one study i.v. citalopram showed superior response rates over p.o. citalopram (79% vs. 63%) in severely depressed patients at 8 weeks.

Treatment-resistant depression (TRD) continues to challenge current therapeutic options, especially pharmacologic treatments often used as first-line management. Thus, multimodality treatments, including neurostimulation techniques, are sought for symptom improvement. Since the first use of electroconvulsive therapy (ECT), the field of neurostimulation has strived to find treatments that improve safety, efficacy, and the side-effect profile to provide relief for patients suffering from TRD. Development in neurostimulation is spurred by ongoing innovation in technology, but also by increasing awareness that TRD frequently requires multimodal approaches for optimal symptom relief. This article reviews the most recent advances in ECT, transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS) for use in TRD. ECT, TMS, and DBS are all researched in the treatment of depression, with ECT and TMS having approval from the US Food and Drug Administration, but differ widely in techniques, protocols, and patient selection parameters. ECT has the most data backing efficacy, but needs ancillary support (anesthesia, support staff) for implementation, and considerable stigma still represents an obstacle to widespread use. TMS and DBS, although less efficacious than ECT, are gaining popularity and as additional knowledge is acquired in regards to ideal use, circumstances may allow for them to become mainstream treatments for TRD in the next decade. [ Psychiatr Ann . 2016;46(4):240–246.]

No abstract

Obsessive-compulsive disorder (OCD) is a debilitating mental disorder characterized by obsessive thoughts that trigger compulsive actions. While OCD is associated with significant disability, there are currently no objective markers for screening, diagnosis, or tracking of treatment progression in OCD patients. This is especially troublesome given reliance on subjective measurements and patient-reported outcomes. Here, to advance existing assessment approaches, the authors propose the utilization of engineering tools to objectively track the physiological, kinetic, behavioral, and affective state of individuals with OCD to aid in their clinical management. The utilization of these tools to aid in human measurements is termed biobehavioral sensing. Although the data are preliminary, the authors believe that these blueprints may be implemented in the near future to aid in the screening, diagnosis, and management of OCD. Furthermore, these ideas may also be expanded to assist in the care of patients with other mental health disorders.