Jul 27, 2016

In the August 2016 issue of the Australasian Psychiatry podcast, Dr Andrew Amos speaks with Professor Gordon Parker about his article on the clinical management of patients who are ultra-rapid metabolisers of antidepressant medications. Professor Parker starts with the premise that much of the heterogeneity of response to antidepressant medication is due to the poor reliability of diagnosis, and proposes that antidepressant medication is particularly indicated for patients with melancholic forms of depression. Professor Parker suggests we should be sensitive to the possibility of ultra-rapid metabolism in patients with melancholic depression who report no clinical benefit and no side effects of medication at higher doses, including in young patients experiencing their first episode. He describes his approach, which includes the use of tricyclic antidepressants both because of the existence of serum level assays, and for their greater efficacy in some patients with depression. Finally, Professor Parker discusses the use of stimulant medications and ketamine in patients with treatment-resistant depression, and issues a challenge to the profession to improve the evidence base for treatment-resistant depression and ultra-rapid metabolisers in particular.In the August 2016 issue of the Australasian Psychiatry podcast, Dr Andrew Amos speaks with Professor Gordon Parker about his article on the clinical management of patients who are ultra-rapid metabolisers of antidepressant medications. Professor Parker starts with the premise that much of the heterogeneity of response to antidepressant medication is due to the poor reliability of diagnosis, and proposes that antidepressant medication is particularly indicated for patients with melancholic forms of depression. Professor Parker suggests we should be sensitive to the possibility of ultra-rapid metabolism in patients with melancholic depression who report no clinical benefit and no side effects of medication at higher doses, including in young patients experiencing their first episode. He describes his approach, which includes the use of tricyclic antidepressants both because of the existence of serum level assays, and for their greater efficacy in some patients with depression. Finally, Professor Parker discusses the use of stimulant medications and ketamine in patients with treatment-resistant depression, and issues a challenge to the profession to improve the evidence base for treatment-resistant depression and ultra-rapid metabolisers in particular.