Esketamine Gets FDA Approval

Topics: Depression | Depressive Disorder | Esketamine | Pharmacology | Treatment-Resistant Depression

On March 5, 2019, the FDA approved esketamine (Spravato) nasal spray as add-on therapy to traditional antidepressant medications for treatment-resistant depression (TRD). In this article, I will describe the events that led to esketamine’s development, review the data submitted to the FDA, and discuss what the future might hold for esketamine. Backgr

Risk Evaluation and Mitigation Strategy (REMS) Programs

Topics: Depression | Depressive Disorder | Esketamine | Pharmacology | Treatment-Resistant Depression

Certain psychiatric treatments require both the healthcare provider and patient to enroll in a Risk Evaluation and Mitigation Strategy (REMS) program before they are administered. Below are links to enroll: Brexanolone (Zulresso) http://www.zulressorems.com/ Buprenorphine-based therapies (Suboxone, Subutex) https://www.samhsa.gov/medication-assi

Brexanolone (Zulresso) for Postpartum Depression

Topics: Depression | Depressive Disorder | Pharmacology | Postpartum Depression | Pregnancy

On March 19, 2019, the FDA approved brexanolone (Zulresso), the first medication for postpartum depression (PPD). Delivered by intravenous injection, brexanolone is an analogue of the hormone allopregnanolone. Allopregnanolone levels fall abruptly after childbirth, which is thought to contribute to PPD by destabilizing GABAA receptors. We covered brexa

Lithium in Geriatric Depression

Topics: Depression | Depressive Disorder | Geriatric Psychiatry | Lithium | Psychopharmacology | Treatment-Resistant Depression

REVIEW OF: Buspavanich P et al, J ­Affect Disord 2019;251:136–140 TYPE OF STUDY: Prospective, non-randomized controlled trial Augmentation with lithium has long been established as an effective strategy for refractory depression, but how does it fare in geriatric patients? There is a dearth of evidence on lithium in the geriatric population, which

Does TMS Really Work in Depression?

Topics: Depressive Disorder | Free Articles | Research Update

Review of: Yesavage et al, JAMA Psychiatry 2018;75(9):884–893 Type of study: Randomized, sham-controlled trial Repetitive transcranial magnetic stimulation (rTMS) has been FDA-approved for treatment-resistant depression (TRD) since 2008. This non-invasive therapy uses an electromagnetic coil to stimulate electrical activity in the frontal cortex

Behavioral Strategies for Suicide Prevention

Topics: Depressive Disorder | Free Articles | Psychotherapy

What can you do—beyond prescribing medications—to help your patients who have suicidal ideation? There are many strategies that you can teach your patients, even in the context of brief psychopharm visits. In this article, I’ll describe eight behavioral strategies that your patients are likely to find helpful. They are adapted from cognitive behav

Antidepressant-Induced Suicidality: What It Is and What You Should Do

Topics: Child Psychiatry | Depressive Disorder | Practice Tools and Tips

Do antidepressants actually cause children to be suicidal? If so, how do we detect it, and what should we do about it? In this article, we’ll give you a brief review of the most recent findings on antidepressant-induced suicidality (AIS) in children and adolescents, and then move on to some practical tips for how to evaluate and prevent this problem.

Current Use of Antidepressant Medication in Children

Topics: Child Psychiatry | Depressive Disorder | Practice Tools and Tips

Editor’s note: The issue of emergent suicidal thinking has weighed on us since the 2004 black box warning—amplified by the re-analysis of the now infamous study 329, which found the emergence of previously under-reported suicidal thinking. How do we offer hope for effective use of medication while balancing the potential risks? Dr. Danella Hafeman h

Depression in Transition to Adulthood: A Case Study

Topics: Child Psychiatry | Depressive Disorder

Editor’s note: Recently, CCPR presented the following hypothetical case to leading child and adolescent development authority Calvin Colarusso, MD, for his advice on how to help a young man presenting with a possible major depressive disorder (MDD). The case: As he struggles to complete his senior college research project, a 23-year-old majoring in

CBT vs Pharmacotherapy for Childhood Anxiety

Topics: Depressive Disorder | Research Update

Review of: Wang Z et al, JAMA Pediatr 2017;171(11):1049–1056 Managing childhood anxiety can sometimes leave clinicians in a quandary. There is a paucity of evidence comparing different treatment approaches, and current guidelines on the subject are old and make inconsistent recommendations. To address this dilemma, researchers at the Mayo Clinic pe

Serotonin Syndrome Risks With Co-Prescription of Triptan Drugs and SSRIs or SNRIs

Topics: Depressive Disorder | Research Update

Review of: Orlova Y, JAMA Neurology 2018;E1–E7 In 2006, the FDA issued a warning that patients using either selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors (SSRIs or SNRIs) together with triptan antimigraine drugs might be at a heightened risk for serotonin syndrome. Their advisory was based on 27 case report

Treatment-Resistant Depression: Some Introductory Tips

Topics: Antidepressants | Bipolar Disorder | Depressive Disorder | Registered Articles

Treatment-resistant depression (TRD) has a fairly low barrier of entry. Failure of 2 full antidepressant trials—lasting 6 weeks at a minimally effective dose—is enough to qualify. In this month’s issue of TCPR, we’ll highlight pharmacologic advances that are underutilized and debunk a few that are unlikely to be effective for TRD. But first, we

Lithium: Practical Considerations for Children With Suicidal Thinking

Topics: Child Psychiatry | Depressive Disorder | Free Articles | Practice Tools and Tips | Psychopharmacology Tips

Billy, age 10, has periods of intense aggression alternating with moments of wanting to be dead, severe mood swings, poor sleep, and pervasive irritability. He has a family history of bipolar disorder. Other family members have responded well to lithium. Since they want to act assertively to help him, Billy’s family is open to medication trials and an

Efficacy and Safety of SSRIs and SNRIs for Child and Adolescent Psychiatric Disorders

Topics: Child Psychiatry | Depressive Disorder | Research Update

Review of: Locher C et al,  JAMA Psychiatry 2017;74(10):1011–1020 Since the 2004 FDA black-box warning on all antidepressants for pediatric use, controversy continues over the use of SSRIs and SNRIs in children and adolescents. Both classes of medication are still commonly used for pediatric depressive disorders, anxiety disorders, and obsessive-

A Cautionary Consensus on the Use of Ketamine for Depression

Topics: Antidepressants | Depressive Disorder | Research Update

Review of: Sanacora G et al, JAMA Psychiatry 2017;74(4):399–405. doi:10.1001/jamapsychiatry.2017.0080 Ketamine has become increasingly popular as an off-label medication for rapid onset treatment of refractory depression. Recently, the American Psychiatric Association convened a task force to review the data and come up with some recommendations. T

Treatment of First Episode Psychosis in College Students: It Takes a Team

Topics: Antipsychotics | Child Psychiatry | Depressive Disorder

You are a psychiatrist working in a college student healthcare center when Anna, a junior, comes to your office escorted by her resident advisor. Anna describes feeling severely depressed. Sleeping excessively, she has missed most of her classes over the last two weeks. For the past week, she has heard voices telling her she is worthless and will never

Evaluating Psychosis in Children

Topics: Antipsychotics | Child Psychiatry | Depressive Disorder

CCPR: First of all, how common is psychosis in children? Dr. Cepeda: It depends on what population you are talking about. It is quite uncommon among all kids who show up at a primary care provider’s office. But in a child psychiatric practice, about 3%–5% of children have psychosis, and among children needing hospitalization, the rates are much

Take The CME Post-Test for Psychosis in Children and Adolescents, CCPR, August 2017

Topics: Antipsychotics | Child Psychiatry | Depressive Disorder

The post-test for this issue is available for one year after the publication date to subscribers only (December 31, 2017). By successfully completing the test you will be awarded a certificate for 1 CME credit. Click here to take your CME test. Note: All of the CME tests are available in the “My Account” section of the site when you are logged

Beginning Antidepressant Treatment: A Recommended Approach

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips

How do you start a new patient on antidepressant treatment? We do this countless times in our practices, and reviewing the topic may feel a bit like returning to residency. However, it’s important to revisit our standard operating procedures from time to time to ensure we’re thinking carefully about our decisions during our busy days. If we turn

When First-Line Depression Treatments Don’t Cut It: Newer Antidepressants and Sometimes, Antipsychotics

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips | Registered Articles

TCPR: It’s been about 10 years since we last talked with you about the practical use of antidepressants with so many drugs to choose from. Over the last few years, three new antidepressants have come out: vilazodone (Viibryd), vortioxetine (Trintellix), and levomilnacipran (Fetzima). My sense is that an awful lot of clinicians still haven’t changed