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Treatment-resistant Depression, Study notes of Psychiatry

acupuncture is safe and effective for treatment ... paroxetine in patients with major depressive disorder. Journal of. Psychiatric Research.

Typology: Study notes

2021/2022

Uploaded on 09/12/2022

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Scheduled presentations March 21, 2014 19-Mar-14
Order of Scheduled Presentations
TOPIC: Treatment-resistant Depression
Name
Notes
1.
John Neumaier, MD, PhD
No slides.
2.
Anna Borisovskaya, MD
No slides.
3.
Farrokh Farrokhi, MD
Vice President, WA State Association of Neurological Surgeons
4.
Mercy Yule, EAMP
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Scheduled presentations March 21, 2014

Order of Scheduled Presentations TOPIC 1.2.3.4. : Treatment-resistant Depression Name John Neumaier, MD, PhDAnna Borisovskaya, MDFarrokh Farrokhi, MDVice President, WA State Association of Neurological SurgeonsMercy Yule, EAMP Notes No slides.No slides.

Health Technology Assessment

Participant_disclosure Page 2 of 2

Disclosure Any unmarked topic will be considered a “Yes”If yes, list name of organizations that relationship(s) are with and for #6, describe other relationship: _________________________________________________________________________________ _________________________________________________________________________________ ________________________________________________________________________________________If yes to #7, provide name and funding Sources: _________________________________________________ _________________________________________________________________________________ 1.2.3.4.5.6. 7. Salary or payments such as consulting fees or honoraria in excess of $10,000.Equity interests such as stocks, stock options or other ownership interests.Status or position as an officer, board member, trustee, owner.Loan or intellectual property rights.Research funding.Any other relationship, including travel arrangements.Representation: if representing a person or organization, include the name andfunding sources (e.g. member dues, governmental/taxes, commercial productsor services, grants from industry or government). Potential Conflict Type Potential Conflict Type YesYes NoNo ________________________________________________________________________________________________________________________________________________________________________________If you believe that you do not have a conflict but are concerned that it may appear that you do, you may additional sheet I certify that I have read and understand this Conflict of Interest Form and that theinformation I have provided is true, complete, and correct as of this date. X For questions contact Department of Psychiatry but I am presenting my own professional opinions and am not representing thedepartment, hospital or University formally but am stating this for clarity sake. (^) Signature s explaining why you believe that you should not be excluded. : (^) Christine MastersHealth Technology AssessmentPO Box 42712Olympia, WA 98504-2712360-725-5126 Feb 20, 2014 Date I am a faculty member of the University of Washington John F Neumaier, MD, PhD Print Name^ xxxxxx x attach

Farrokh Farrokhi, M.D. March 21, 2014 WA ‐ Health Technology Clinical Committee 1

Treatment Resistant DepressionVice President - Washington State Association of Neurological SurgeonsDeep Brain Stimulation forRequest on behalf of WSANS/AANS/CNS to:Defer decision of DBS for TRDDue to insufficient evidencedNeurosurgery - Virginia Mason^ Comments onFarrokh Farrokhi, MDMarch 21, 2014 ƒ HTA Analysis: ƒ ƒ “The evidence was“DBS can result in serious complications.” ƒ ƒ ƒ “A single uncontrolled study evaluated certain responsepredictors.”“No controlled studies have been published.”“narrative review article provided an estimate that hemorrhagecan occur in up to 10% of patients (regardless of indication).” insufficient to allow conclusions.”

Farrokh Farrokhi, M.D. March 21, 2014 WA ‐ Health Technology Clinical Committee 3

Need individual tract maps to ensure full coverage of critical Simple Localization is not adequate even when done ideally^ Location of Active Contacts^ Standardized to AC-PCmean MNI space White matter bundles for each patient.^ One Source of Response Variability RespNon-R^ surgical precisionModeling (TAM)^ Voltage Field^ Butson & McIntyreBrain Stim 2008^ Overlap6m NR6m RN=6N=9^ mF10Probablistic TractographymF10mF10 ACCACCACC^ TAM-seednAcnAcnAc^ aTh^ athth^ L^ nAc^ nAcTh^ mFmF

Mercy Yule, EAMP March 21, 2014 WA‐ Health Technology Clinical Committee 1

Š Š Š Acupuncture has a record of safety with fewserious adverse events.Better research studies on acupuncture formany conditions are becoming available.Although more research is needed specificallyon the population with conditions that resistcurrent treatments, research shows thatacupuncture is safe and effective for treatmentof Major Depressive Disorder.^ Mercy Yule, EAMP

Mercy Yule, EAMP March 21, 2014 WA‐ Health Technology Clinical Committee 6

Š Š Š Š Š An RCT with 160 patients diagnosed withMDD assigned to one of three groups:Paroxetine aloneParoxetine combined with acupunctureParoxetine combined with electroacupunctureThis was a 6 week trial with a 4 week followup, using the Hamilton Depression RatingScale (HAMD-17), the Self-rating DepressionScale (SDS), and clinical evaluation (CGI-S).

Mercy Yule, EAMP March 21, 2014 WA‐ Health Technology Clinical Committee 9

Š Conclusion: “The antidepressanttreatment with fluoxetine showed ananti-inflammatory effect by reducingpro-inflammatory cytokines, while EAtreatment not only reduced pro-inflammatory cytokines but alsomodified Th2 cytokine synthesis andrestored the balance in the Th1/Th2ratio.”

  • Mercy Yule, EAMP March 21,
  • WA‐ Health Technology Clinical Committee
  • Mercy Yule, EAMP March 21,
  • WA‐ Health Technology Clinical Committee
  • Mercy Yule, EAMP March 21,
  • WA‐ Health Technology Clinical Š Conclusion: “ Acupuncture didimprove the course of depressionmore than pharmacologicaltreatment…” Committee
  • Mercy Yule, EAMP March 21,
  • WA‐ Health Technology Clinical Š Conclusion “Collectively, as mostantidepressant agents have broadside effects, acupuncture in manualand electrical stimulation modesprovides a safe and effectivetreatment in augmenting theantidepressant efficacy…” Committee
  • Mercy Yule, EAMP March 21,
  • WA‐ Health Technology Clinical Š Meta-analysis of 207 studies onacupuncture for depression; 133 were onMDD, 15 on PSD (Post-strokedepression).20 of the RCT’s on MDDwere considered high quality accordingto JADAD scale. Committee