Closing Thoughts on the Treatment of MDD

Roger S. McIntyre, MD, FRCPC: You know, it's interesting. We're only scratching the surface here and there's so many parts we haven't got into. But, you know, it's interesting. I was thinking about our conversation is that it's history, it's the present, and it's the future. It's history in the sense—I made reference to this at the top—that psychiatry has always had an appetite for finding a treatment that works very rapidly. That's obviously acceptable and is pragmatic. And I mean, I mentioned this historical example of sleep deprivation, which I think is really interesting, but obviously, it's not very pragmatic and not acceptable. But the appetite never disappeared. In the 1960s and 1970s, actually, with many younger people joining us—they wouldn't know this—but there was an appetite to increase antipsychotic dosing very high, very quickly, to get patients out of psychosis as soon as possible. And of course, the intention was noble but didn't quite work with again, with respect to pragmatic application of that and in acceptability. We've entered a new time. We have now dextromethorphan bupropion in combination. We have esketamine. Parenthetically, I know we have many people joining us who are experts in neurostimulation, [and] now what's called accelerated TMS or transcranial magnetic stimulation that works within a week. There's a whole new protocol around that, which is very exciting. And now we have an entirely new dropdown menu, so to speak, called the GABAergic ligands or treatments that have been developed, informed by the model of the disease of depression, working rapidly in people who clearly want their symptoms alleviated. So, the past has certainly always been with us. [In] the present, we now have some treatments that can do this for our patients and to look into the future. You know, it's always, was it Yogi Berra [who] said predictions are always difficult, especially when they involve the future. And, so, when it comes to predicting the future, I don't have any crystal ball. But here's what I really believe, Carmen. And I really believe [that] 5 to 10 years from now, we're going to look back. We're going to say, “Do you remember the days where we used to wait 4 to 6 weeks for drugs to work? What were we thinking at that time?” I think we're really now entered into a new overdue era where people with lived experience are getting what they deserve, and that is treatments that work rapidly, [that] are acceptable to them and they can take as needed in this situation. So, I think it's a very hopeful time for the field. I've been in the field now for 25 years without hyperbole. It's just so exciting. And thank you, Carmen, for this rich and informative discussion. And thanks to all of our audience for watching Patient Care Online presentation. If you enjoyed the program, please subscribe for our e-newsletters to receive upcoming programs and other great content right into your inbox.

Transcript is AI-generated and edited for clarity and readability.