Ketamine, Transcranial Magnetic Stimulation, and Depression Specific Yoga and Mindfulness Based Cognitive Therapy in Management of Treatment Resistant Depression: Review and Some Data on Efficacy

Abstract

Depression affects about 121 million people worldwide and prevalence of major depressive disorder (MDD) in US adults is 6.4%. Treatment resistant depression (TRD) accounts for approximately 12–20% of all depression patients and costs $29–$48 billion annually. Ketamine and repetitive transcranial magnetic stimulation (rTMS) have useful roles in TRD, but their utility in long term is unknown. As per the latest literature, the interventions using Yoga and meditation including the mindfulness based cognitive therapy (MBCT) have been useful in treatment of depression and relapse prevention. We present a review of rTMS, ketamine, and MBCT and also report efficacy of a depression specific, innovative, and translational model of Yoga and mindfulness based cognitive therapy (DepS Y-MBCT), developed by the first author. DepS Y-MBCT as an adjunctive treatment successfully ameliorated TRD symptoms in 27/32 patients in an open label pilot trial in TRD patients. Considering the limitations of existing treatment options, including those of ketamine and rTMS when used as the sole modality of treatment, we suggest a “tiered approach for TRD” by combining ketamine and rTMS (alone or along with antidepressants) for rapid remission of acute depression symptoms and to use DepS Y-MBCT for maintaining remission and preventing relapse.

Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far

“…Effective treatment of depression is available in the form of drugs, psychotherapy, electroconvulsive therapy (ECT) and other non-invasive brain stimulation methods. However, prevalence of treatment resistance in depression is close to 20% and research scholars are looking for options to tackle this challenge 3 4…”

Combining Ketamine, Brain Stimulation (rTMS) and Mindfulness Therapy (TIMBER) for Opioid Addiction

“…Trauma memories lay at the core of the pathogenesis of PTSD. TIMBER therapy attempts to alter the expression of emotionally charged memories such as traumatic memories, and has been successfully tried in chronic PTSD alone or in combination with memory altering pharmacotherapy like ketamine infusion [ 5 , 7 ]. There are many similarities between the emotionally charged memories common in PTSD, and the emotionally charged memories associated with addiction.…”

“…There has been no study to date that has used a combination of both for OUD, and there are still many unanswered questions with respect to both. Trauma Interventions using Mindfulness Based Extinction and Reconsolidation of memories (TIMBER) attempts to alter the expression of emotionally charged memories such as traumatic memories, and has been successfully tried in chronic post-traumatic stress disorder (PTSD) alone, or in combination with memory-altering pharmacotherapy like ketamine infusion [5][6][7]. By a combination of extinction and re-consolidation of memory approaches, TIMBER works to not overflood and/or re-traumatize as is seen in other treatment approaches.…”

A Systematic Review of Mechanisms of Change in Body-Oriented Yoga in Major Depressive Disorders

“…However, yoga may be associated with a higher frequency of non-serious adverse events than psychological or educational interventions without any physical activity. Despite the limitations of the available evidence, the authors conclude that A Systematic Review of Mechanisms of Change in Body-Oriented Yoga in Major Depressive Disorders yoga presents a generally safe intervention [6], follows a clear biological rationale in altering the stress diathesis model that may influence the onset and relapse of MDD and has utility as a self-management technique that empowers the person as a whole rather than (narrowly) affecting just symptomatology [2,5,[7][8][9][10][11][12][13]. Regarding research trends, the number of publications on yoga since 2000 has continually increased significantly.…”