The 2010s were an active time for the psychiatric world. Probably the biggest story of the decade came in 2013, with the release of DSM-5 — the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A number of diagnostic categories were shuffled relative to the previous edition, but the most controversial change might be the elimination of the diagnosis of Asperger’s Disorder, which was subsumed under the broader category of “Autism Spectrum Disorder.”
Part of the motivation behind this move was a desire to no longer honor Dr. Hans Asperger, an Austrian pediatrician and eugenicist responsible for selecting thousands of “mentally defective” children in the Third Reich for execution, so they would not become burdens to the state or go on to reproduce and “poison” the gene pool. Asperger spared those who were impaired but deemed “salvageable,” leading them to be labeled “Asperger’s children.” Not the best legacy!
Although officially approved for the treatment of depression in 2008, TMS (transcranial magnetic stimulation) did not become widely available until after 2010. It remains very costly and requires a tremendous time commitment on the part of the patient receiving it, but it’s less invasive and has fewer side effects than older non-pharmaceutical treatments like ECT (electroconvulsive therapy).
Just this last year, in 2019, the FDA approved Spravato, an inhaled form of esketamine — the left-handed isomer of ketamine — as a treatment for refractory (treatment-resistant) depression. Ketamine has been around since 1970, but until recently was used legally only as a veterinary tranquilizer (principally for horses undergoing surgery). Humans began using ketamine illegally in the 1970s after discovering it caused vivid hallucinations when injected, and on the street it became known as “Special K.”
But in the last few years, academic medical centers began experimenting with low-dose infusions of ketamine for refractory depression, with rapid but short-lived benefit. The inhalation version promises easier administration with fewer side effects — but still requires careful post-administration monitoring of blood pressure, and for episodes of depersonalization/derealization.