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The Future of Major Depressive Disorder Treatments




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.

Advances in Evidence-Based Treatment

Drug therapy has come a long way in recent years. We’ve improved the scope and focus of drug therapy by developing more selective or specialized antidepressants and combining them in new ways, with fewer side effects.

Drug therapy today may include newer medications like citalopram (Celexa) and escitalopram (Lexapro) as well as existing medications like fluoxetine (Prozac) and sertraline (Zoloft). 

It tends to work best when combined with psychotherapy, as supported by ample evidence. We now know the most effective and efficient types of therapy appear to be cognitive-behavioral and psychodynamic therapy.

For people whose depression is resistant to psychotherapy and drug therapy, doctors may use electroconvulsive therapy (ECT). Today’s version of ECT is much more specific, with lower side effects. It’s usually reserved for people who have severe, drug-resistant depression with bipolar characteristics.

Newer Treatments

Many new therapies have been introduced that have led to major improvement for patients.


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. Many patients have longstanding relief, and in some cases, recover.

Ketamine therapy may involve as little as a single dose. Or it could be multiple doses over a short period of time. But it must be done under medical supervision. While it’s usually outpatient therapy, proper dosing and support of a patient using ketamine is critical.

It’s not the first drug of choice because it has fairly profound effects on the brain and has to be used with caution. Right now it’s used for severe treatment-resistant depression. But there’s an ongoing discussion that people with severe depression may do well using it earlier in treatment.

I think you’ll see an increased use of ketamine in the future, particularly for those who don’t get help from other treatments.


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.

Psychedelics are still viewed with relative stigma and they’re a controlled substance. It’s necessary to find the right microdose and schedule for the best effect. Not all clinicians are skilled, comfortable, or willing to provide psychedelic drugs.

Another drawback is that people may try to self-medicate, which is very difficult. This is a very specific method that requires clinical skill.

More research is needed. We need medicine-based evidence for the use and value of psychedelics in treating certain types of depression.

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.

There’s very promising research that repetitive TMS can be very effective in treating certain forms of treatment-resistant depression. It’s very easy to do, can be tailored to each patient’s needs, and often has a rapid and durable response. It can be used by itself or combined with psychotherapy or drug treatment.

But while the effects of TMS are robust, they may taper over time. It may require multiple sessions, and you have to find a clinician who’s trained and skilled to administer TMS.

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.

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.


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The Truth About Whole-Body Scans




Take a drive around certain neighborhoods in Los Angeles and you may spot as many signs advertising body scans as burger joints. Or maybe you’ve seen the ads on TV or the internet: “Protect your health! Get a body scan now!” 

Are whole-body CT scans really able to do that – and what are the risks? And are DEXA scans a good way to check on your body composition?

While technologies vary, most of these high-tech checkups use computed tomography (CT) scans to examine your entire body or specific parts, such as the heart and lungs, to try to catch dangerous diseases in earlier, more curable stages.

During the 15- or 20-minute scan, you lie inside a doughnut-shaped machine as an imaging device rotates around you, transmitting radiation. The technique combines multiple X-ray images and, with the aid of a computer, produces cross-sectional views of your body. By examining the views, a doctor can look for early signs of abnormalities.

The scans aren’t cheap – whole-body scans run anywhere from $500 to $1,000 per scan and usually aren’t reimbursed by insurance. And the question of how helpful these scans really are is a matter of debate among medical experts.

Advocates promote scans as a smart part of a routine physical exam. But if you’re healthy, with no worrisome symptoms, a scan is usually not warranted, says Arl Van Moore, MD, a radiologist and clinical assistant professor of radiology at Duke University Medical Center in Durham, NC, who is also a spokesman for the American College of Radiology (ACR).

According to the ACR’s official position, there’s not enough evidence to recommend scans for those with no symptoms or family history suggesting disease. But Van Moore sees a possible exception. “There may be a benefit to people at high risk of lung cancers, such as current smokers or those with a long history of smoking,” he says. 

For healthy people, the scans may cause undue worry – for instance, by finding something that turns out to be benign. Plus, the amount of radiation exposure, especially with frequent scans, is another concern. If scans are done too often, the radiation exposure may actually increase the number of cancer cases over the long term, according to a 2004 report in the journal Radiology.

The American College of Preventive Medicine says that whole-body scans “aren’t very good at finding cancer in people without symptoms” and that the radiation you get from these scans can increase your risk of cancer.

Before scheduling a body scan, talk to your doctor about your overall health risks and how a scan may or may not help you. In particular, ask yourself:

  • What’s your history? Do you have a personal or family history of lung disease, heart disease, or specific cancers?
  • Did you inhale? Are you a longtime smoker?
  • If so, how long? Even if you’ve quit smoking, for how many years were you an active smoker?


This is a different type of scan, called DEXA (dual energy X-ray absorptiometry). You might have heard of DEXA scans to check on bone density to see if you have osteoporosis or osteopenia. It uses low-level X-rays to check on your body composition, like how much body fat you have and where it is in your body. 

There are various ways to measure your body fat. Experts have told WebMD in the past that DEXA scanning is a “very good technique” and “one of the most accurate methods out there.” And researchers have called it the “gold standard” for checking on body composition – specifically, for bone, fat, and muscle. But it’s not covered by insurance, unless you’re getting a DEXA scan to screen for bone density. The cost of a DEXA scan varies, starting around $75 in some cases.


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5 Family and Community Engagement Strategies to Improve Student Outcomes




Strong school-family-community partnerships bring exceptional value to children’s education. A recent book by Karen L. Mapp, a senior lecturer at the Harvard Graduate School of Education, and four other co-collaborators synthesizes the available research to explain who benefits from these partnerships and the many advantages of family and community engagement.

Everyone Wins! The Evidence for Family-School Partnerships & Implications for Practice (Scholastic, 2022) cites various research to demonstrate how family-community-school partnerships benefit all stakeholder groups when they’re approached effectively:

  • Students have higher grades, better attendance, deeper engagement in school, greater self-esteem, and higher rates of graduation and college attainment.
  • Educators enjoy better job satisfaction, better success motivating students from different backgrounds, more family support, and an improved mindset about students and their families.
  • Families have stronger relationships with their children and better rapport with educators. They can navigate school policies and advocate for their children more effectively.
  • Schools enjoy a better climate, more support from their community, and improved staff morale—leading to better teacher retention.
  • School districts and communities become better places to live and raise children. They experience fewer disciplinary problems, greater participation in afterschool programs, and more family and student involvement in decision-making.
community members talking and hugging in matching green volunteer t-shirts in front of an outdoor mural

What elements make school-family-community partnerships particularly effective? Here are five tips for how school systems can successfully promote family and community engagement in education and drive better student outcomes.

1. Successful Family Engagement Requires Intentional Leadership

Engaging with families has to be a core activity and not just an afterthought. It requires a total commitment by school and district leaders, and this commitment must include investing in the tools and training needed to help educators effectively engage with families from all backgrounds. It must be a real and intentional focus, and as Mapp says: “It’s real when I see it on your budget sheets.”

2. Teachers and Administrators Must Communicate Clearly and Consistently

To encourage family involvement in their children’s education, educators must interact with families frequently—and in many ways. For instance, teachers and administrators might engage with families in person during school drop-off and pick-up periods, set up a Family Information Board in the school’s lobby, write and distribute regular newsletters or blog posts, and/or send emails or text messages to parents.

Communicating effectively is one of the National PTA’s “National Standards for Family-School Partnerships,” which guides how schools and families should work together to support student success. Teachers and administrators should learn about and meet families’ preferred methods of communication, and families should be able to share and receive information in culturally and linguistically relevant ways.

3. Develop Healthy, Positive Relationships Based on Mutual Trust and Respect

Interactions between educators and families should be positive and reciprocal, with families feeling valued and supported. Educators can establish trust and encourage healthy, two-way communications with families by sharing information about their children’s positive behaviors and accomplishments and which skills may need work. Listen to all parents and provide opportunities for shared decision-making.

4. Be Mindful of Diversity, Equity, and Inclusion

Welcoming all families and fostering a sense of belonging is another National PTA standard. When families engage with your school, do they feel respected, understood, and connected to the school community?

To ensure equity and inclusion, learn about the families you serve and their unique needs and challenges. Use culturally responsive engagement practices. Create opportunities for connection, especially with historically marginalized families and students. Learn about and seek to remove barriers for families to participate fully in their children’s education.

5. Help Families Support and Extend the Learning at Home

Students learn more effectively when they have opportunities at home to practice, reinforce, or extend the skills and lessons they’ve learned in school. Educators can facilitate this process by giving families specific ideas for expanding their children’s learning at home, such as by incorporating core math and literacy concepts into everyday routines.

Schools can also make instructional resources such as take-home packs, activity sets, and other materials available to families to support their children’s education.

How School Specialty® Can Help

School Specialty has more than six decades of experience in providing tools, resources, and strategies that promote successful education both in school and at home. We offer arts and crafts, early childhood, ELA, math, science, STEM/STEAM, physical education, special needs, and social emotional learning resources for families, as well as games, puzzles, and general supplies.

How do you promote family engagement in your classroom and community? Let us know in the comments!


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Preteens and skincare: What parents should know – CHOC





Published on: April 16, 2024
Last updated: April 9, 2024

Should teens and preteens be using so many skincare products with fancy ingredients? A pediatric dermatologist answers parents’ questions.



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