MentalHealthDaily

Esketamine Failed Cost-Effectiveness vs. Cheaper TRD Options at $50K/QALY

by GLOOM

Photoreal illustration of a depression-treatment decision with cost and outcome imagery, conveying healthcare-economic decision-making.

Intranasal esketamine — FDA-approved for treatment-resistant depression in 2019 — failed cost-effectiveness benchmarks against four cheaper third-line options in a 2026 Hong Kong modeling study, with incremental cost-effectiveness ratios (ICERs) of US$134,127 to US$312,750 per quality-adjusted life-year (QALY) at a US$50,000/QALY willingness-to-pay (WTP) threshold.1 Combination antidepressant therapy was the most cost-effective strategy modeled. Research Highlights …

SSRI Pharmacogenomic Testing: CYP2D6, CYP2C19, Remission

by GLOOM

A 2026 methylome-wide association study by Shen et al. found 48 CpG methylation sites tied to the quadratic CYP2C19 metabolizer-status term in 18,396 Generation Scotland participants, with 19 sites showing non-linear patterns and targeted replication in 1,238 older adults.1 That supports CYP2C19 as real biology beneath SSRI pharmacogenomics, but it does not prove universal antidepressant …

Post-Stroke Depression Tracks Serotonin-Acetylcholine Damage

by GLOOM

Photoreal illustration of stroke lesion with overlapping neurotransmitter network damage, conveying mechanism of post-stroke depression.

A 2026 two-cohort connectome study found that post-stroke depressive symptoms tracked damage to networks weighted by the serotonin transporter and vesicular acetylcholine transporter: 5-HTT damage predicted depression in Leipzig (OR 2.4, 95% CI 1.15–5.02) and Oxford (OR 2.05, 95% CI 1.03–4.09), while VAChT damage also replicated across both cohorts.1 The dopamine part of the original …

Esketamine Can Trigger Trauma Re-Experiencing in PTSD

by GLOOM

Photoreal illustration of a patient receiving nasal spray with overlay of trauma memory imagery, conveying esketamine + PTSD interaction.

A 2026 retrospective case series of 22 adults with treatment-resistant depression and comorbid PTSD found that trauma re-experiencing during intranasal esketamine disappeared over later sessions in 72.7% of patients, while 27.3% stopped esketamine because the flashbacks persisted.1 Research Highlights Flashbacks usually faded, but not always: In 16 of 22 patients (72.7%), esketamine-related trauma re-experiencing disappeared …

IV Clomipramine Shows No Clear Edge in Depression or OCD

by GLOOM

Photoreal illustration of an IV infusion bag and capsule with brain imagery, conveying parenteral vs oral antidepressant pharmacokinetics.

Parenteral clomipramine has a strong clinical myth around it: bypass the gut, raise parent-drug exposure quickly, and maybe accelerate rescue in severe depression or OCD. A 2026 systematic review found the route advantage was not clearly proven: in depression, 5 RCTs without high risk of bias did not show clear IV or IM superiority over …

Antidepressant Use in Pakistan (2026): SSRI Prescribing Patterns and Patient-Reported Side Effects

by GLOOM

Photoreal illustration of a pharmacist counseling patient on antidepressant medication, conveying global pharmacovigilance.

Most antidepressant pharmacovigilance data come from high-income countries, leaving prescribing patterns and adverse-effect profiles in low- and middle-income countries underdocumented. A 2026 cross-sectional study by Riaz and colleagues describes antidepressant use in Pakistan, with patient-reported adverse effects mapped against prescription patterns.1 Research Highlights Antidepressant use in low- and middle-income countries (LMICs) has grown substantially but …

tVNS Alters Effort and Reward Decisions in Severe Depression

by GLOOM

Photoreal illustration of an ear-clip vagus nerve stimulation electrode, with neural pathway motifs representing reward-effort circuits.

An ear-clip that modulates mood by stimulating the vagus nerve has obvious appeal — but the evidence base for non-invasive tVNS in depression has been mixed for a decade. A 2026 cross-over RCT by Forbes et al. sharpens what specifically tVNS does well.1 Research Highlights Transcutaneous vagus nerve stimulation (tVNS) is a non-invasive ear-electrode version …