Major Depressive Disorder: Understanding the Significance of Residual Symptoms and Balancing Efficacy with Tolerability

Balancing Competing Needs: A Meta-Ethnography of Being a Partner to an Individual With a Mood Disorder

BACKGROUND

More than 20% of individuals experience a mood disorder in their lifetime. Qualitative studies have explored the experience of being a partner to an individual with a mood disorder, but these studies remain isolated pieces of a larger puzzle.

AIMS

In this metasynthesis, I aimed to integrate current qualitative research to describe the experience of being a partner to an individual with a mood disorder.

METHOD

A systematic search was conducted to identify qualitative research. Noblit and Hare's meta-ethnography was used to translate key metaphors from individual studies into a single set of metaphors to describe the experience.

RESULTS

Results indicated that these partners are disenfranchised caregivers balancing their own needs with partners' perceived and reported needs to strive for a stasis of guarded stability.

CONCLUSIONS

Future research must explore ways to support these partners and include them in the health care team.

Treatment-Resistant Major Depression: Rationale for NMDA Receptors as Targets and Nitrous Oxide as Therapy

Major depressive disorder (MDD) remains a huge personal and societal encumbrance. Particularly burdensome is a virulent subtype of MDD, treatment resistant major depression (TMRD), which afflicts 15-30% of MDD patients. There has been recent interest in N-methyl-d-aspartate receptors (NMDARs) as targets for treatment of MDD and perhaps TMRD. To date, most pre-clinical and clinical studies have focused on ketamine, although psychotomimetic and other side effects may limit ketamine's utility. These considerations prompted a recent promising pilot clinical trial of nitrous oxide, an NMDAR antagonist that acts through a mechanism distinct from that of ketamine, in patients with severe TRMD. In this paper, we review the clinical picture of TRMD as a subtype of MDD, the evolution of ketamine as a fast-acting antidepressant, and clinical and basic science studies supporting the possible use of nitrous oxide as a rapid antidepressant.