A veritable feast of Nikau berries

A second quiet day at Kainga Tiaki. No patients to see, as One was admitted overnight and the other wouldn't come in. And I'm not going out. Did some reading instead.

An interesting meta-analysis of ketamine for treatment resistant depression. Although there is no clear explanation as to how ketamine might benefit those who have not responded to at least two trials of an antidepressant, the multinational group of authors waxed eloquently about the rate of response (at least 50% reduction in symptom scores) and the rate of remission (a score of less than 10 on a symptom rating scale). 

Combining the results from a number of small studies produced a response rate at one week of 38% with a remission rate of 25%. But we have known for at least 20 years that lithium added to antidepressants produces a response rate closer to 60% in such a group of patients with a remission rate of 45%. 

I will continue trying to convince others of the value of lithium.

Late afternoon walk was good. The extra took my eye. But after I had returned home, I saw a Kereru in one of the big Nikau out the back, feasting on the berries.