A systematic review of ten studies examined whether mindfulness-based interventions improve autonomic nervous system function in people with medical conditions. Only oncology met the criteria for “possibly effective” based on clinical practice guidelines. Cardiac and chronic pain conditions showed some evidence of benefit in individual studies, but the overall level of evidence was insufficient to recommend MBIs for those groups. The review followed PRISMA protocols and used objective pre/post measures of autonomic function.
Esketamine, approved by the FDA in early 2019 for treatment resistant depression, works by blocking NMDA receptors and improving symptoms rapidly through glutamatergic activation. Widespread use is limited by concerns about durability of response, especially during maintenance. Since esketamine must be taken with an oral antidepressant, choosing the right combination may improve outcomes. Because many patients with major depressive disorder and treatment resistant depression have dysfunction in dopaminergic pathways, adding a prodopaminergic agent like bupropion could enhance and prolong response. Anecdotal evidence and mechanistic rationale support this approach, and the oral combination of dextromethorphan and bupropion (AXS-05) has shown promise in clinical trials. This paper argues that dopaminergic enhancement may boost esketamine's efficacy and durability, encouraging further research.