Considering the ample evidence of involvement of the glutamate system in the pathophysiology of depression, pre-clinical and clinical studies have been conducted to assess the antidepressant efficacy of glutamate inhibition, and glutamate receptor modulators in particular. This review focuses on the use of glutamate receptor modulators in unipolar depression.

There is emerging evidence that glutamatergic system dysfunction might play an important role in the pathophysiology of bipolar depression. This review focuses on the use of glutamate receptor modulators for depression in bipolar disorder.

Glutamate receptor modulators, including ketamine, are possible candidates for new antidepressants with a novel mode of action. The pair of reviews discussed in this month's Round the Corner considered their use in treating unipolar major depression and bipolar depression. Promising results were seen for ketamine, but further studies are needed, in particular to investigate whether the benefits are sustained or can be extended by repeated or adjunctive treatment, whether ketamine is effective in treatment resistance, whether other modes of administration are as effective as the intravenous route and the long-term adverse effects of use.

Ketamine, a synthetic derivative of phencyclidine, is a commonly misused party drug that is restricted in high-income countries because of its addictive potential. Ketamine is also used as an anaesthetic in human and veterinary medicine. In the 1990s, research using ketamine to study the pathophysiology of schizophrenia was terminated owing to ethical concerns. Recently, controversy surrounding the drug has returned, as researchers have demonstrated that intravenous ketamine infusion has a rapid antidepressant effect and have therefore proposed ketamine as a novel antidepressant. This article debates the question of ketamine as an antidepressant, considering the drug's addictive potential, ethical concerns about prescribing a hallucinogen, the evidence base and motives behind ketamine trials.

This article explores the philosophical concept of akrasia, also known as weakness of will, and demonstrates its relevance to clinical practice. In particular, it challenges an implicit notion of control over one's actions that might impede recovery from substance misuse. Reflecting on three fictional case vignettes, we show how philosophical work on akrasia helps avoid this potentially harmful notion of control by supporting a holistic engagement with people for whom substance misuse is a problem. We argue that such engagement enhances their prospects of recovery by focusing on agency over time, as opposed to individual lapses.

Misuse of drugs such as opium, cocaine and cannabis was common around the world before the First World War and it provided a valuable market for the colonial powers. There seems to have been a brief period of sobriety between the two World Wars, along with widespread criminalisation of drug dealing and use, followed by an explosion of the illicit drug market and the hugely expensive US-led ‘war on drugs'. The cost and impracticality of drug criminalisation, together with changes in Western public opinion, mean that cannabis legalisation has very recently been accepted in some countries and drug prohibition is being dismantled.

This article is a practical guide for psychiatrists who want to apply basic and straightforward statistics in their research. It describes ways of summarising data and provides an overview of statistical tests for comparing patients' characteristics. Measures of association such as correlation and regression are also explained, along with principal components analysis, a method for reducing the dimensionality of data. Explanations are clarified using data from the published studies.

This brief article gives key demographic, socio-economic and health information for the Argentine Republic, with special emphasis in the field of psychiatry and mental health. It also informs about the country's mental health legislation and ongoing epidemiological research projects. It points out deficiencies and obstacles encountered in meeting the population's healthcare needs, and suggests developments to improve this situation.

The health and social care landscape in the UK is changing, and there is now, more than ever, a real need for doctors to embrace leadership and management. Evidence shows that medical leadership is associated with better outcomes for patients. Psychiatrists are particularly well suited to such roles, given the interpersonal skills and self-awareness that they develop in their training. In this article, we examine the role of the psychiatrist in leading at a patient, team and organisational level and the impact this has. We also discuss different leadership and management styles.

Continued learning is essential to doctors' safe and effective practice throughout their careers. To improve the care they provide, they need not only to acquire new knowledge and skills but also to consider how their current practice compares and what they need to change. Such reflection is not usually automatic; time, and often help from peers, is needed to make it effective; formalised, this is continuing professional development (CPD). Revised guidance from the Royal College of Psychiatrists emphasises the importance of linking learning to improved practice through reflection and promotes the CPD peer group's role in supporting psychiatrists to do this.

Psychiatric expert witnesses instructed to undertake assessments of defendants charged with murder should be familiar with the partial defences of diminished responsibility and loss of control. The Coroners and Justice Act 2009 enacted major amendments to the partial defence of diminished responsibility and introduced a new defence of loss of control to replace the provocation partial defence. In this article, the changes to the law are described with particular focus on the implications for the psychiatric assessment.