Velandy Manohar, MD
Multi – Modal Treatment of Depressive disorders (velandymanoharmd.com) [Detailed report on website]
These are Key components of a potentially effective and safe treatment plan besides intermittent standalone Ketamine administration to restore persons experiencing significant Depression to the best level of function that is possible without significant side-effects and worsening of suicide risk or switch to symptoms of Manic episode after symptoms of depression appear to have been relieved. In Section V. Links in A and B offer reliable and beneficial reports on this real-life experience that can have serious implications in personal, professional, vocational, corporate roles of the person affected by the switch to feeling energized and enlivened suddenly after feeling down spirited and despondent for weeks and months. In short Ketamine treatment is NOT the end all and be all of effective Treatment of Major Depression.
It is disturbing and distressing to learn that we have heard only about the prescriptions for Ketamine that Mr. E. Musk appears to have accepted for management of the “episodes” debilitating 2851Depression in a seemingly unstructured manner without concomitant psychotherapy and overall health promotion efforts that is integrated with the use of Ketamine to ameliorate symptoms of depression rapidly albeit for short intervals. I believe this is most certainly to the long-term detriment for the functional capacity of the individuals, even Mr. Elon Musk to be solely dependent on the intermittent remissions induced by ketamine administration to get by from episode to another, instead of investing in achieving more enduring recovery from the Severe persistent Psychiatric Illness that seems to Mr Musk to be a form of disruptive and debilitating “Depression” that envelops him from the Blue from time to time? This would add value to the lives of people around him and accrue more stability and consistency in his own decisions and performance. Earlier I had posted a detailed comprehensive response to the reports of the use Ketamine as the sole intervention for managing episodes of Depression and personal use of Illicit drugs during the past few years without any report of the assessment process and coordinated multimodal treatment of Depression
There are 7 Sections in this revised document;
I. What are the Currently Prescribed Medications for Treatment of Depressive Disorders?
II. What is Transcranial Magnetic Stimulation and its place in the treatment of Depressive Disorders?
III. What are the 5 Types of Therapy for Major Depressive Disorder?
IV. What is Vagus Nerve Stimulation (VNS) for Depression?
V. What is the relationship of Antidepressant Treatment to Manic Switch of the mood and behavior of persons being treated for purported Depression?
VI. The Future of Major Depression Treatment
VII. The Pharmacogenomic [PGx] Testing in Major Depression
I. Currently prescribed Medications for treatment of Depressive disorders.
I. A.
Medications for Treatment of Depression - Psychiatric Disorders - Merck Manuals Professional Edition Very useful report on these subjects
• Antidepressants and Suicide Risk
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin Modulators (5-HT2 Blockers)
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
• Norepinephrine-Dopamine Reuptake Inhibitor
• Heterocyclic Antidepressants (HCAs)
• Monoamine Oxidase Inhibitors (MAOIs)
• Melatonergic Antidepressant
• Ketamine and Esketamine
• Choice and Administration of Antidepressants
I. B.
Antidepressants: What They Are, Uses, Side Effects & Types (clevelandclinic.org)
Antidepressants are prescription medications that help treat depression. Healthcare providers prescribe them to treat other conditions as well.
Antidepressants are one type of treatment for depression. While they can treat the symptoms of depression, they don’t always address its causes. This is why healthcare providers often recommend psychotherapy (talk therapy) in addition to depression medication.
There are several types (classes) of antidepressants, including:
• Selective serotonin reuptake inhibitors (SSRIs). These are the most common type of prescribed antidepressants.
• Serotonin/norepinephrine reuptake inhibitors (SNRIs).
• Tricyclic antidepressants (TCAs). TCAs are an older class of antidepressants often reserved for treatment-resistant depression and anxiety due to increased rates of side effects.
• Atypical antidepressants.
• Serotonin modulators.
• Monoamine oxidase inhibitors (MAOIs). These are the oldest antidepressants. Though highly effective, they’re often reserved for treatment-resistant depression and anxiety. This is because taking an MAIO requires dietary modifications to avoid hypertensive reactions caused by interactions with the amino acid tyramine, which is present in high levels in some foods.
• N-methyl-D-aspartate (NMDA) antagonists.
There are also several kinds of medications (and brands) within each class
What are the types of antidepressants?
There are several types (classes) of antidepressants, including:
• Selective serotonin reuptake inhibitors (SSRIs). These are the most common type of prescribed antidepressants.
• Serotonin/norepinephrine reuptake inhibitors (SNRIs).
• Tricyclic antidepressants (TCAs). TCAs are an older class of antidepressants often reserved for treatment-resistant depression and anxiety due to increased rates of side effects.
• Atypical antidepressants.
• Serotonin modulators.
• Monoamine oxidase inhibitors (MAOIs). These are the oldest antidepressants. Though highly effective, they’re often reserved for treatment-resistant depression and anxiety. This is because taking an MAIO requires dietary modifications to avoid hypertensive reactions caused by interactions with the amino acid tyramine, which is present in high levels in some foods.
• N-methyl-D-aspartate (NMDA) antagonists.
There are also several kinds of medications (and brands) within each class.
What are the possible complications of taking antidepressants?
Possible complications associated with antidepressants include:
• Risk of suicidal thoughts or behavior.
• Antidepressant discontinuation syndrome.
• Serotonin syndrome.
• Overdose.
SSRI medications are also associated with a modest increase in the risk of upper gastrointestinal bleeding. This risk is significantly elevated when you take an SSRI in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). Talk to your healthcare provider about this risk.
Suicidal thoughts or behavior
In some cases, children, teens and adults under the age of 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially when they first start them or when they take a different dose.
Overdose
The toxicity of antidepressants varies greatly. It’s important to talk to your healthcare provider or pharmacist about the risk of overdose. Always take your medication as prescribed and store your medications safely away from children and pets.
I.C.
Therapy vs. medication: Comparing treatments for depression in heart disease patients (msn.com)
New research by investigators from the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai shows that behavioral activation therapy is as effective as antidepressant medications in treating symptoms of depression in patients with heart failure.
Heart failure affects nearly 6 million adults in the United States, and approximately 50% of heart failure patients experience symptoms of depression along with their condition. Past studies show patients with heart failure and depression have lower cardiac function, more emergency department visits and hospital admissions, higher caregiver burden, and poorer quality of life compared with patients with heart failure who are not depressed.
The most important finding here is that patients experiencing depression have a choice in terms of their treatment between therapy or medications," said Waguih W. IsHak, MD, vice chair of Education and Research in the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai and first author of the study. "Patients who prefer not to be on medication can do behavioral activation therapy with similar results."
The study, which was published in JAMA Network Open, followed more than 400 patients over the course of a year. Half of the study participants received antidepressant medication management to treat depression symptoms while the other half participated in behavioral activation psychotherapy, an evidence-based treatment for depression that promotes engagement in activities a patient finds enjoyable.
Investigators say there was no statistically significant difference between the effectiveness of the two methods, with each patient group experiencing a more than 50% reduction in the severity of depressive symptoms.
I. D.
Depression’s new directions - Mayo Clinic Press
Depression is often misunderstood as temporary feelings of distress or sadness. Phrases such as “I’m feeling stressed” or “I’m having a rough week” — while not to be dismissed — are not typical descriptions of how depression feels.
Instead, those who have depression describe a feeling of darkness and hopelessness, like being at the bottom of a well and seeing no way out. Those feelings can quickly escalate and affect your ability to work, hold relationships and even stay alive.
But depression can be difficult to treat because it involves complex workings of the brain. What’s effective for one person may not work for another. In recent years, researchers have tested a number of new treatments that show promise for improving depression when other treatments aren’t working.
Currently, two classes of drugs — selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) — are typically recommended as a first treatment for depression in adults. They are often paired with cognitive behavioral therapy, a form of therapy in which people learn skills to manage symptoms of depression.
Some people don’t see much relief after taking these drugs. As many as one-third to one-half of people with severe depression — also called major depressive disorder — don’t get relief from SSRIs or SNRIs. If they do not see symptom improvements after trying two different medications over several weeks, they’re considered to have treatment-resistant depression.
Time
The drugs don’t reach full effectiveness until a month or longer after taking the first dose. That means people having a psychological crisis have to find other ways to manage until the drugs start working.
Side effects
Antidepressants can cause side effects including nausea, headaches and sleep problems. In the long term, sexual dysfunction, including loss of libido, is fairly common.
Newer approaches, faster results
Treatments that aim to improve upon those drug shortcomings have been recently approved. The most promising new antidepressant treatments come from a class of drugs called N-methyl-d-aspartate (NMDA) receptor antagonists. The effect they have in the brain is different from that of other antidepressants.
For instance, SSRIs work by increasing the availability of serotonin — a neurotransmitter connected to mood. Drugs in the NMDA class, on the other hand, act on a pathway in the brain that affects glutamate. Glutamate is a neurotransmitter important for processing information. People with depression often don’t have as many connections, called synapses, between brain cells, which may contribute to an increase in depression symptoms. These drugs create more of those connections, which may ease symptoms
Here’s a look at two newer options.
Esketamine.
Ketamine is the option that Mr. Elon Musk reportedly uses to manage mood disorder that descends on him. However, Ketamine treatment is NOT the end all and be all of effective Treatment of Major Depression.
Esketamine (Spravato) is a fast-acting antidepressant that was approved by the Food and Drug Administration (FDA) in 2019 for people with treatment-resistant depression. It’s given as a nasal spray, so it enters the bloodstream and reaches the brain much faster than an oral medication does. That swift delivery can ease depression symptoms within several hours, and many people report significant relief within one day. However, that effect appears to wear off rather quickly, with some studies showing a dose loses effectiveness within a week. The drug is to be taken in conjunction with an oral antidepressant.
Another drawback to Esketamine is that, at this time, it can only be given in a clinical setting under the supervision of a healthcare professional. That’s primarily because of potential side effects, including prolonged sedation and distortion of perceptions such as time and space. Also, research is still needed to determine how long a person can take Esketamine safely.
Right now, standard dosing involves taking the medication twice a week for about four weeks, then switching to once a week for another four weeks, and then tapering further as the care team recommends.
Esketamine’s long-term effectiveness is not clear, and long-term side effects are not yet well understood. Potential short-term side effects include blurred vision, dizziness, drowsiness, nausea, vomiting and higher blood pressure.
Dextromethorphan-Bupropion
The combination drug Dextromethorphan-Bupropion (Auvelity) was approved by the FDA for major depressive disorder in 2022. Dextromethorphan is a common cough suppressant with some effectiveness against depression, while Bupropion is a common antidepressant. It’s a tablet taken twice a day. Like Esketamine, Dextromethorphan-Bupropion reduces symptoms of depression quickly, within 1 to 2 weeks, and reaches maximum effectiveness in 4 to 6 weeks. Unlike Esketamine, the prescription drug can be taken at home, without direct supervision from a medical professional.
In clinical trials, the most common side effects of the drug included dizziness, nausea, diarrhea, headache, drowsiness and dry mouth. About 2 in 3 people reported side effects, which is about the same as for SSRIs and SNRIs.
Nondrug treatment options
A procedure called repetitive transcranial magnetic stimulation (rTMS) was approved by the FDA in 2008 to treat depression. It was later approved to treat headache- related pain and, in 2018, obsessive- compulsive disorder (OCD). Treatment is typically delivered in rapid bursts during 30-minute sessions, often over the course of several weeks.
The benefits of rTMS for depression do not appear to be as strong as those of some other therapies. However, rTMS does ease symptoms to some extent. Some studies have suggested that the benefit lasts at least a year in about half of the people who receive it.
This therapy causes few or no serious side effects in most people. It’s also seen as a promising treatment for older adults, who are more likely to be taking medications that can interact with antidepressants.
II.
What is Transcranial Magnetic Stimulation and its place in the treatment of Depressive Disorders?
What Is Transcranial Magnetic Stimulation & Can It Help With Depression? Here's What We Know (msn.com)
Story by Yvonne Glasgow
• 8mo • 11 min read
Major depression is a mental health disorder that affects adults, young adults, and even children and teenagers. According to KFF, at least one-third of the adult population in the United States may live with some form of depression and/or anxiety, with those falling between the ages of 18-24 affected at a rate of about 50%. The American Psychiatric Association lists some of the symptoms of depression as feeling down, experiencing decreased interest in things you previously took pleasure in, thinking the world would be a better place without you, excessive worrying, and even feeling more tired than usual. Andrew Leuchter, MD, explained via UCLA Health that "We've come to understand that depression is a disease state of the brain network – wrong connections being formed in the brain."
Standard treatments for depression include medications, talk therapy, and possible hospitalization, but for those whose condition doesn't respond well to these approaches, alternative modalities may be worth exploring. Doctors and scientists have been looking for new ways to help such treatment-resistant patients. From acupuncture to exercise and yoga, all sorts of other options exist (via Cleveland Clinic), and one of the newest varieties being talked about right now is transcranial magnetic stimulation (TMS). However, it's important to fully understand TMS before making a decision about whether it's the solution you've been looking for. This link provides comprehensive information.
III.
5 Types of Therapy for Major Depressive Disorder | MyDepressionTeam
5 Types of Therapy for Major Depressive Disorder
Medically reviewed by Paul Ballas, D.O.
Written by Emily Wagner, M.S.
Psychotherapy (talk therapy) is one of the most common treatments for major depressive disorder (MDD), also known as clinical depression or severe depression. It’s often used in a treatment plan in combination with medication. During talk therapy, you meet with a trained mental health professional — such as a psychiatrist, psychologist, or licensed therapist — to talk about your MDD and how it affects your life.
Depending on your case, your therapist may choose a specific type of psychotherapy to help you work through your past, learn new coping skills, and live the fullest life possible. Mental health professionals commonly use five types of psychotherapy to treat MDD. Each type focuses on different approaches and skill sets for living with depression.
In addition to different types of talk therapy, there are different formats:
• Individual therapy — Sessions involve only you and a therapist.
• Group therapy — Sessions take place in a group setting with at least two individuals seeking treatment and a therapist.
• Family therapy — Aimed at building a support network, these sessions include family members and a therapist.
• Couples therapy — In this type of therapy, a partner or spouse participates to learn how to better understand depression and how they can support their partner.
MyDepressionTeam members sometimes discuss their experiences with different types of talk therapy — or seek advice from others. One asked, “Has anyone here tried dialectical behavior therapy or cognitive behavioral therapy? I have tried every medication on the market and transcranial magnetic stimulation, with no results. Any helpful suggestions out there? This link provides very helpful information on the different psychotherapeutic modalities.
IV.
Treatment-Resistant Depression: Treating With Vagus Nerve Stimulation (webmd.com)
What is Vagus Nerve Stimulation (VNS) for Depression?
Medically Reviewed by Smitha Bhandari, MD on October 03, 2022
Written by WebMD Editorial Contributors
Vagus nerve stimulation (VNS) is a surgical procedure that can be used to treat those with treatment-resistant depression. A pacemaker-like device, implanted in the body, is attached to a stimulating wire that is threaded along a nerve called the Vagus nerve. The Vagus nerve travels up the neck to the brain, where it connects to areas believed to be involved in regulating mood. Once implanted, this device delivers regular electrical impulses to the Vagus nerve.
How Vagus Nerve Stimulation Works
During surgery for VNS, your surgeon will implant a small battery-powered device -- about the size of a silver dollar -- in your chest. It works like a pacemaker. Another incision is made on the left side of the neck and a thin wire (placed just under the skin) runs from the device to the large Vagus nerve in your neck. The device sends out pulses of electricity into the nerve, which transmits them to the brain.
For reasons that doctors don't completely understand, these electrical impulses transmitted via the Vagus nerve to the brain can relieve the symptoms of depression. The impulses may affect the way nerve cell circuits transmit signals in areas of the brain that affect mood. However, it usually takes several months before you feel the effects.
Whenever it's necessary, your doctor can change the settings on the device (essentially changing the dose) in the office with a programming wand. Usually, the device is set to go off at regular intervals. You can also turn it off using a special magnet.
Research into the effects of VNS on people with treatment-resistant depression has generally been positive. A study in Biological Psychiatry in 2005 compared 124 people that received usual treatment to 205 people that received usual treatment plus VNS. After one year of treatment, the combination treatment group showed more improvement than the usual treatment group. Significant improvement was seen in 27% of patients that received VNS vs. 13% that did not. VNS is not a rapid treatment for depression. Studies show that, on average, it may take up to 9 months for a treatment response to occur.
V.
A.
“Switching” of Mood From Depression to Mania With Antidepressants (psychiatrictimes.com)
“Switching” of Mood From Depression to Mania With Antidepressants
November 8, 2013
Ross J. Baldessarini, MD, PhD; Gianni L. Faedda, MD
B.
Antidepressant Treatment and Manic Switch in Bipolar I Disorder: A Clinical and Molecular Genetic Study - PMC (nih.gov)
Antidepressant Treatment and Manic Switch in Bipolar I Disorder: A Clinical and Molecular Genetic Study
Chih-Ken Chen,1,2,† Lawrence Shih-Hsin Wu,3,† Ming-Chyi Huang,4,5 Chian-Jue Kuo,4,5 and Andrew Tai-Ann Cheng3,6,*
Chia-Hsiang Chen, Academic Editor and Yu-Shu Huang, Academic Editor
VI.
A. The Future of Major Depressive Disorder Treatments (webmd.com)
The Future of Major Depression Treatment By James Giordano, PhD, as told to Kara Mayer Robinson
Over the last 20 years, we’ve seen major strides in the treatment options for major depressive disorder. We now understand that depression isn’t the same for everyone. The idea is to identify and diagnose what’s happening in a person’s neurochemistry so we can target our treatment in a way that works specifically for them.
1. Advances in Evidence-Based Treatment:
Newer Treatments
Many new therapies have been introduced that have led to major improvement for patients.
a. Ketamine
A newer therapy involves the drug ketamine, which has been used in the past as an anesthetic and has robust benefits. It’s a relatively new approach. It’s been around for about 5 years.
Ketamine therapy resets your brain node and network connectivity to reduce, if not abolish, many depressive signs and symptoms quite rapidly.
b. Psychedelics
There’s building evidence for the use of psychedelic drugs to treat major depression.
Drugs like psilocybin, commonly known as mushrooms, and LSD (lysergic acid diethylamide) can change the properties in your brain chemistry that are involved in Depression.
Microdoses or millidoses of these drugs can be very effective, either by themselves or when used with antidepressants. They can improve symptoms, behavior, and function. They tend to be fast-acting, but for some people the effects don’t last long.
c. Transcranial Magnetic Stimulation (TMS)
TMS, which involves passing a very weak magnetic current through your skull, is interesting. It works like a dimmer switch to change the electrical activity of your brain and reduce signs and symptoms of depression.
d. Deep Brain Stimulation (DBS)
Deep brain stimulation is a new, emerging treatment that involves implanting electrodes to target specific areas of the brain. It can be adjusted for each individual patient to most effectively control their symptoms and signs of depression.
DBS was first tried in 2005. Since then, the science has advanced considerably with the help of the BRAIN Initiative, an NIH program aimed at revolutionizing our understanding of the human brain. Now we have a better understanding of how to target the brain more precisely, which may lead to better results. More research will help even more.
DBS appears to reset the network activities of the brain. Over time, the brain activity involved in depression may be turned off, which means patients stay in remission. There’s evidence to suggest DBS has long-lasting effects.
An interesting effect we’ve seen with some patients is how significantly it changes their outlook. Some people appear more outgoing and ebullient, with a newfound vigor and even changing interests. It’s hard to tell if these changes are a side effect of DBS or if it’s the result of feeling the burden of depression lifted. It’s very interesting.
A downside of DBS is that it’s neurosurgery, so there’s the risk of infection and hemorrhage. It’s rare, but there’s also a risk of misplacement, or electrode drift.
Other cons include side effects and cost. Insurance companies don’t uniformly cover DBS. As the technology gets better, there will be a need for maintenance and upkeep that may be costly.
I believe DBS is the future. When it works, it really works.
2. Updates on ECT and DBS
2.a. ECT
How electroconvulsive therapy heals the brain − new insights into ECT, a stigmatized yet highly effective treatment for depression (msn.com)
i. Two types of electrical activity make up brain waves. The first, oscillations, are like the highly synchronized, melodic music you might hear in a symphony. The second, aperiodic activity, is more like the asynchronous noise you hear as musicians tune their instruments. These two types of activities coexist in the brain, together creating the electrical waves on EEG records.
ii. A long-standing theory of depression states that severely depressed patients have too few of a type of brain cell called inhibitory cells. These cells can turn other brain cells on and off, and maintaining the balance of these on and off states is critical for healthy brain function. This balance is particularly relevant for depression because the brain’s ability to turn cells off plays an important role in how it responds to stress, a function that, when not working properly, makes people particularly vulnerable to depression.
iii. Using a mathematical model of cell type-based electrical activity, I linked increases in aperiodic activity, like those seen in the ECT patients, to a huge change in the activity of these inhibitory cells. This change in aperiodic activity may be restoring the crucial on and off balance in the brain to a healthy level.
iv. …though our sample size is relatively small, our findings indicate that ECT and MST likely treat depression by resetting aperiodic activity and restoring the function of inhibitory brain cells. Further study can help destigmatize ECT and highlight new directions for the research and development of depression treatments. Listening to the nonmusical background noise of the brain could help solve other mysteries, like how the brain changes in aging and in illnesses like schizophrenia and epilepsy.
2.b. DBS and Biomarker to signal treatment response:
Depression recovery can be hard to measure − new research on deep brain stimulation shows how objective biomarkers could help make treatment more precise (theconversation.com)
Clinical depression is a debilitating condition that causes significant personal and societal suffering. It is one of the largest contributors to the overall disease burden of many countries. Despite the many approved treatments available, nearly 30% of the 8.9 million U.S. adults taking medications for clinical depression continue to have symptoms.
i. Deep brain stimulation can alleviate treatment-resistant depression for some patients.
ii. Depression recovery can be hard to measure − new research on deep brain stimulation shows how objective biomarkers could help make treatment more precise.
iii. Researchers have been working to find alternative options for those with treatment-resistant depression, and many decades of experiments have identified specific brain networks with abnormal electrical activity in those with depression. we monitored the brain activity of 10 patients receiving deep brain stimulation for severe treatment-resistant depression over six months.
iv. At the end of six months, 90% of the patients responded to the therapy – defined by a reduction of symptoms by at least a half – and 70% were in remission, meaning they no longer met the criteria for clinical depression.
v. Finding an objective biomarker that measures recovery in depression has the potential to improve treatment decisions. For example, one patient in our study had a relapse after several months of remission. Were a biomarker available at the time, the clinical team would have had warning that the patient was relapsing weeks before standard symptom surveys showed that anything was wrong. Such a tool could help clinicians intervene before a relapse becomes an emergency.
3. On the Horizon
The emerging technology is moving toward minimal or noninvasive DBS.
There’s cutting-edge technology involving nonsurgical implantation of electrodes. A program at DARPA, an agency that supports the BRAIN Initiative, is looking at small transmitters and stimulators that can be delivered into the bloodstream, inhaled, or even swallowed, then guided to the brain.
Other groups are looking at minimally invasive approaches that can be done in a doctor’s office. All it requires is a very small hole in your scalp, where doctors insert fluid electrodes, then guide them to the brain electromagnetically. When they get to the brain, they harden.
I believe this is the future. It may be ready in some form in 5-10 years.
VII.
A. Pharmacogenomics (PGx) for Depression: Genetic Analysis to Amplify Antidepressant Efficacy? (2023 Review) - MentalHealthDaily
This is a review of evidence to determine the effectiveness of pharmacogenomic (PGx) testing to improve clinical outcomes in major depressive disorder (MDD) undergoing pharmacotherapy. This was compared against the traditional method of treatment as usual (TAU). The focus was on determining whether PGx-guided care could significantly enhance the rates of remission and response in patients with moderate-to-severe MDD.
Currently, PGx testing in psychiatry is used in cases where patients have had poor responses or adverse reactions to standard treatments.
The potential for wider application hinges on further research to establish a robust evidence base, particularly addressing the limitations highlighted in the study, such as the need for more diverse and long-term data.
B. Pharmacogenomic testing for antidepressant treatment selection: lessons learned and roadmap forward | Neuropsychopharmacology (nature.com)
Pharmacogenomic testing for antidepressant treatment selection: lessons learned and roadmap forward.
Pharmacogenomic technology is a developing field with enthusiastic interest and broad application potential. Three large, controlled studies have been published exploring the benefit of pharmacogenomically guided antidepressant treatment selection. Though all three studies did not show significant benefit of using this technology, these studies laid the foundation for further research that should address the limitations of this previous research and currently available commercial platforms. Future research needs to include large scale pharmacogenomic trials with GWAS analytics across diverse groups with attention to cost-effectiveness models, particularly for cases of treatment resistance and polypharmacy. The application of results from these large scale pharmacogenomic trials must also include exploring optimal EHR user interface design.
Velandy Manohar, MD.,
Certified in Administrative Psychiatry, ABPN Certified in Adult Psychiatry, Previously ABPN certified in Addiction Psychiatry and Psychosomatic Medicine.
Distinguished Life Fellow, Am. Psychiatric Association, [APA]
Past Steering Committee and Founding member of Psychotherapy Caucus of the APA
Charter Member CT Multi-Cultural Health Partnership. Nancy Berger Member Award
Founding Member- Community Resilience Collaborative-Mx. County-CT Focused on Identifying and amelioration of near and if possible long-term consequences including Intergenerational transmission of the impact of Early Childhood Experiences
Member – Mx Community Coalition for Children -Mx. County, CT focusing on the significant impact of SDoH factors especially Housing, Food security, Health care access and affordability of medications for instance.
First Medical Director, Aware Recovery Care. [Retired Nov 22]
President- ARC- In-home Addiction treatment, [IHAT] PC. [Retired Nov 22]
In-Home Addiction Treatment Institute Impact Award - In recognition of your efforts to shift the Addiction Treatment paradigm – 2019
CT. Psychiatric Society: Roger Coleman Memorial Award for Exemplary devotion to patients and commitment to Quality of Care. 2010
CT. Psychiatric Society: Cornelius Boulehouwer, MD Award for service to the CT. Psychiatric Society: 2003
CT. Federation of Alcoholism and Drug Abuse Counselors Bestows Honorary Membership in Recognition of his many contributions to field of Alcoholism Treatment to Velandy Manohar, MD.,
In-Home Addiction Treatment Institute Impact Award - In recognition of your efforts to shift the Addiction Treatment paradigm – 2019
American Health Council- Best in Medicine-2018
CT. State Medical Society: Member: Quality of Care, Ethics, Disaster Preparedness Committees
Member- National Quality Assurance Committee- Aetna until 2023
CT. Medical Examining Board (CMEB- LICENSING AUTHORITY): Member 1995-2007. Participated in formulation of the Statement of the CMEB on the Use of Controlled Substances for the treatment of Pain in CT-2005
Chair- Community Engagement and Outreach Committee of the Community Advisory Council of the Office of Health Strategy-CT. Helped organize a very well attended live Facebook on Feb.10 6-8 PM- OHS- Consumer Advisory Council members presents. “Our Community Our Voices- Enhancing Medical, Behavioral Health and Housing Services for LGBTQ Youth”