Novel Medications Carlat Reports

Research Update

Gabapentin Enacarbil XR Efficacy Less Than Expected for AUD

From The Carlat Addiction Treatment Report, Legal Issues in Addiction Medicine

Review of: Falk DE et al, Alcohol Clin Exp Res 2019;43(1):158–169 Gabapentin enacarbil extended-release (GE-XR) (Horizant) is an extended-release version of gabapentin. GE-XR is a prodrug, meaning that once ingested it is metabolized into gabapentin. It is currently approved for treatment of postherpetic neuralgia and restless legs syndrome. It di

Expert Q&A

Getting Uncomfortable with Esketamine

From The Carlat Psychiatry Report, Esketamine

Esketamine (Spravato) was approved for treatment-resistant depression in 2019. In this interview, Dr. Williams (who has no relationship with Janssen Pharmaceuticals, Inc) addresses some lingering doubts that have been raised about the medicine. TCPR: Where does esketamine fit in the list of interventional therapies for depression, like repetitive tra

Research Update

Psilocybin vs Escitalopram for Depression

From The Carlat Psychiatry Report, Overdiagnosis

REVIEW OF: Carhart-Harris R et al, New Engl J Med 2021;384(15):1402–1411 STUDY TYPE: Randomized controlled trial Psilocybin is, among other things, a serotonin 2A agonist responsible for the psychedelic properties of magic mushrooms. Back in 1960, Sandoz (now Novartis) began marketing psilocybin to enhance the effects of psychotherapy, but produ

Clinical Update

Silexan: A Novel Anxiolytic

From The Carlat Psychiatry Report, Traumatic Brain Injury

Patients with generalized anxiety disorder (GAD) often look to medications for help, but GAD is one of the disorders where medications are likely to disappoint. Effect sizes tend to fall in the small range (0.2–0.3) with meds for GAD, including SSRIs, SNRIs, buspirone, and pregabalin (Lyrica). Only the benzodiazepines have an effect in GAD that’s bi

Clinical Update

The Modafinils in Bipolar Depression

From The Carlat Psychiatry Report, Borderline Personality Disorder

Your patient has recovered enough from bipolar depression to leave the hospital, but not enough to return to work. He is inactive, he can’t concentrate, and it takes him 4 hours to wake up in the morning. What can you add to his regimen of lithium, lamotrigine, and lurasidone? Modafinil (Provigil) and armodafinil (Nuvigil) are wakefulness-promoting

Clinical Update

Nuplazid: Novel Mechanism, Modest Benefits

From The Carlat Psychiatry Report, Psychopharmacology Algorithms

Psychosis can be a paralyzing dilemma for patients with Parkinson’s disease (PD). Most antipsychotics worsen the motor symptoms of PD, while the dopaminergic drugs that treat PD can worsen the psychosis. Psychosis afflicts up to 60% of patients with PD, and it is the leading cause of nursing home placement in these patients (Hacksell U et al, Neuroche

Research Update

Antipsychotics Fall Short in Delirium

From The Carlat Psychiatry Report, Psychopharmacology Algorithms

Review: Oh ES et al, Ann Intern Med 2019;171(7):474–484; Nikooie R et al, Ann Intern Med 2019;171(7):485–495 Study type: Systematic reviews of randomized controlled trials and prospective studies Delirium is common and costly. With an incidence rate approaching 50% in hospitalized older adults, the condition poses a burden that is anticipated

Research Update

Anti-Inflammatories as Antidepressants?

From The Carlat Psychiatry Report, Mental Health Apps

Topics: Antidepressants | Depression | Inflammation | Novel Medications | Treatment-Resistant Depression

Review of: Köhler-Forsberg O et al, Acta Psych Scand 2019;139(5):404–419 Study Type: Meta-analysis of randomized controlled trials Several lines of evidence suggest that chronic inflammation contributes to depression. For example, markers of inflammation tend to be elevated in depressed patients, and inflammatory syndromes elicit depressive sym

News of Note

A New Dopamine and Norepinephrine Reuptake Inhibitor for Excessive Sleepiness

From The Carlat Psychiatry Report, Side Effects Part I

Topics: Novel Medications | Pharmacology | Sleep Apnea | Sleep Disorders

Solriamfetol (Sunosi), a new dopamine and norepinephrine reuptake inhibitor (DNRI), has been approved by the FDA “to improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea.” The medication has never been studied in psychiatry, but is likely to have important psychiatric effects

Research Update

New Augmentation Strategies in OCD

From The Carlat Psychiatry Report, Side Effects Part I

Topics: Amphetamines | Novel Medications | OCD | Pharmacology

Review of: Naderi S, Psychiatry Clin Neurosci 2019;73(4):169–174 and Zheng H et al, Eur Neuropsychopharmacol 2019;29(3):397–404 Study types: Positive RCTs Serotonergic agents—both SSRIs and clomipramine—have historically been the cornerstone of pharmacotherapy for OCD. However, response rates are notoriously low, and few patients achieve full