Treatments for major depression

Abstract

Steven Marwaha and colleagues1Marwaha S Palmer E Suppes T Cons E Young AH Upthegrove R Novel and emerging treatments for major depression.Lancet. 2022; 401: 141-153Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar wrote an intriguing Review about new treatments for major depression. My concern is with regard to figure 2 of the Review, which shows the location of the effects of new treatments for depression. The figure shows that psilocybin affected seven locations (two locations of the default mode network [DMN], three of the salience network [SN], and two of the executive network [EN]), whereas ketamine affected four locations (two of DMN, two of SN, and none of EN). Figure 2 might cause a misunderstanding, because there is no evidence that psilocybin is superior to ketamine. Moreover, figure 2 could not show the difference of connectivity between treatment-sensitive depression and treatment-resistant depression. Patients with treatment-sensitive depression have been reported to exhibit lower connectivity within EN, between EN and DMN, and between SN and DMN, compared with patients with treatment-resistant depression.2Rai S Griffiths KR Breukelaar IA et al.Common and differential neural mechanisms underlying mood disorders.Bipolar Disord. 2022; 24: 795-805Crossref PubMed Scopus (1) Google Scholar It is probable that treatment responses might depend on such connectivity as well as the location. Another concern is a lack of description of new psychotherapy for depression, although the authors focused on biological treatments. Metacognitive therapy is one of such new psychotherapies.3Terao T Kumari V Editorial: insights in psychological therapies: 2021.Front Psychiatry. 2022; 13890889Crossref Scopus (0) Google Scholar In addition, various new types of existential interventions are available for patients with depression in palliative care.4Terao T Satoh M The present state of existential interventions within palliative care.Front Psychiatry. 2021; 12811612Google Scholar I believe that both biological therapy and psychotherapy are necessary to improve patients’ depression and their wellbeing. Future studies are expected to investigate the compatibility between biological therapy and psychotherapy. As such, biological therapy cannot neglect psychotherapy. Therefore, we should consider connectivity in the brain and between therapies. I declare no competing interests. Treatments for major depression – Authors' replyAlain Braillon and colleagues outline several judgements about novel treatments for depression and argue that treatment-resistant depression does not have reliable research criteria. Although we are aware of the debate concerning multiple treatment-resistant depression1 definitions, their specificity, and precision, we used the widely accepted definition of not responding to at least two treatments that is consistent with approximately 50% of definitions that are used in the literature.2 We believe this was a pragmatic and reasonable choice, as the alternative is to not investigate therapy for people who have not responded to serial treatments before having an internationally agreed research criterion (clearly desirable). Full-Text PDF