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Treatment-resistant depression (TRD) is one of the most debilitating conditions that does not respond to conventional pharmacotherapy. Ketamine is a recently used effective treatment option in depressive disorders with a novel mechanism of action. Still, studies estimating the improvement of depressive symptoms in TRD with multiple doses of ketamine are limited. Hence, we report 5 TRD cases that received six open-label intravenous (IV) infusions of ketamine. Five cases of TRD, diagnosed by a clinician defined as the persistence of significant depressive symptoms despite being treated with two different antidepressant regimens, each used for more than 6 weeks were evaluated to identify the need for ketamine infusion and were administered six open-label IV infusions of ketamine which were done at the rate of 0.5 mg/kg body weight, thrice weekly, on alternative days for 2 weeks, following standard protocol. The Montgomery–Åsberg Depression Rating Scale (MADRS) scores were administered by the clinician before the infusion and were repeated after 2 weeks post-infusion. The response was recorded and was seen as a more than 50% decrease in MADRS scores and our cases showed significant improvement clinically. Our low infusion rate and serial dosing trial with ketamine support the efficacy of this drug in TRD. Approximately 30% of patients with major depressive disorder are treatment-resistant. New treatment strategies are needed to address that portion of cases. Subanesthetic doses of IV ketamine have a rapid antidepressant effect in TRD, this signifies the potential of ketamine to be used in this regard.

Introduction: Exam anxiety is characterized by a combination of bodily symptoms, such as overarousal, tension, and somatic symptoms; mental symptoms, such as concern, dread, and fear of failing; and physical symptoms, similar to catastrophizing. According to recent research, test anxiety affects anywhere between 25% and 40% of students. Self-distraction, denial, substance use, behavioral disengagement, emotional support, venting, humor, acceptance, self-blame, religion, active coping, the use of instrumental support, positive reframing, and planning have all been claimed to be successful coping mechanisms. Aim and Objectives: This study aimed to assess the test anxiety levels and related coping strategies in medical students. Materials and Methods: A total of 106 medical students of a tertiary care teaching hospital were included between September 2022 and January 2023. The students who consented to participate in the study were asked to complete the self-administered questionnaire consisting of parts on sociodemographic profile, Westside Test Anxiety Scale, and Brief Coping Orientation to Problems Experienced Scale. Results: Males had 38.1%, 35.7%, and 26.7% of average, moderate, and high levels of test anxiety and females reported of 43.8%, 34.4%, and 21.9%, respectively. Conclusion: Academic factors are greater perceived cause of anxiety in medical students. Interventions must be developed and implemented to target particular stressors to reduce the burden and anxiety on students from the 1st year itself. Early screening and interventions of test anxiety among medical students were warranted.

Introduction: Cholesterol is considered a core component of the central nervous system, essential for cell membrane stability and the correct functioning of neurotransmitters. Cholesterol plays a vital role in the brain’s second messenger system related to the mechanism of action of antidepressant drugs and mood stabilizers. It may be involved in the etiology and pathogenesis of mood disorders. Aim: This study aims to explicate facts and views about the role of cholesterol levels in depressive disorder and suicidality. Materials and Methods: This was a cross-sectional comparative study where the patients were divided into two groups, i.e., subjects with first-episode major depressive disorder (MDD) with a recent suicide attempt and without suicide attempt. A detailed psychiatric interview, their sociodemographic characteristics, and clinical details were noted on a structured pro forma. MDD diagnosis in the patients was made using the Diagnostic and Statistical Manual of Mental Disorders V. Hamilton Depression Rating Scale was used on subjects to determine the patient’s level of depression. After the overnight fast, blood samples are collected between 6 am and 7 am. Total cholesterol (TC), triglyceride, high-density lipid levels, and low-density lipid levels were measured on the Cobas c311 machine. Results: In the current study, a positive correlation was noted in TC (r = 0.488) and low-density lipid (LDL) levels (r = 0.549) in subjects with depression and suicide attempts. Conclusion: The present study results add to the other studies that support an association between serum cholesterol with depression and suicide. Understanding the significance of lower cholesterol levels is central for future treatments of depressive disorder.