Welcome back, Innovations Readers! Last month Dr. Henry A. Nasrallah, Chair of the 22nd Annual Psychopharmacology Update, shared that there is “a surge of new innovative medications based on novel mechanisms of action to be discussed,” and went on to list them. For this month, we decided to run that list by our foremost thought leaders in psychiatry and addiction medicine who are faculty at the upcoming Psychopharmacology Update.  and get their immediate thoughts.

“This list contains things so new that nobody except an investigator in the actual trials can knowledgeably speak to how meaningful any of these interventions is,” commented Dr. Joseph Goldberg. “You may wind up with a lot of anticipatory glee but no scientific substance…” I think we ended up with some of both, with insightful thoughts from a variety of psychiatry clinician backgrounds. Read on for some candid insights into new and in-development treatments. 

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This month’s Psych Resource section will keep you updated with articles from Clinical Psychiatry News, Current Psychiatry, MDedge Psychiatry, New England Journal of Medicine, and JAMA Psychiatry—check them out below. 

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Last month we featured an interview with Dr. Henry A. Nasrallah, Chair of the 22nd Annual Psychopharmacology Update, discussing various topics. If you missed it, you can catch it here.

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A huge thank you to our faculty for giving their time this month. Please contact me at colleen@cmhadvisors.com with any comments and/or suggestions, and thanks for reading! —Colleen Hutchinson

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Don’t miss!— Psychopharmacology Update (22nd Annual)

Friday/Saturday October 27-28, 2023; Hyatt Regency, Cincinnati, Ohio 

• Full-day, 3-part Masterclass focusing on Psychopharmacology. I: Brave New Psychopharmacology; II: Judicious Psychopharmacology; III: Creative Psychopharmacology; IV: Strategic Psychopharmacology; V: Harm-Avoidance Psychopharmacology.
• Workshops on Psychedelics, Addiction and Cannabis on Friday, October 27, 2023

Register here

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The Dish on New Treatments! Faculty of the 22nd Annual Psychopharmacology Update Opine

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KAR-XT and emraclidine—two antipsychotics that do not block dopamine receptors.

Dr. Leslie Citrome: Innovative and groundbreaking treatments for schizophrenia

Dr. Joseph F. Goldberg: Fun mechanism. We'll see if they really do anything

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Glutamatergic rapid-acting antidepressants (dextromethorphan).

Dr. Sidney Zisook: More should be coming

Dr. Citrome: Useful adjunct

Dr. Goldberg: another something to try.  Fun mechanism to explain.

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Cannabis—do the positives outweigh the negatives?

Dr. Edwin Salsitz: Probably not.

Dr. Citrome: Too many negatives

Dr. Zisook: Remains an interesting question

Dr. Goldberg:  Neurotoxin.  What positives??

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Zuranolone—oral medication for post-partum depression (via GABA-A receptors).

Dr. Citrome: Increasing awareness of PPD

Dr. Zisook: Important first step – next, for MDD?

Dr. Goldberg:  Killed by the FDA for MDD. Likely won't see much use.

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Muscarinic receptor agonism as a treatment for schizophrenia.

Dr. Citrome: Innovative and groundbreaking treatments for schizophrenia

Dr. Goldberg: Fun mechanism. We'll see if they really do anything

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Dexmedetomidine—a sublingual alpha 2 adrenergic agonist medication for agitation.

Dr. Citrome: Can avoid injections

Dr. Goldberg: Expensive guanfacine.

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Bupropion or theta burst transcranial magnetic stimulation.

Dr. Goldberg: Bupropion: old drug, not much to say.  Theta burst: promising initial study, crazy expensive off label

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Use of ketamine and ECT in treatment resistant depression.

Dr. Zisook: Wish we had better data on how these fit in life-long management

Dr. Goldberg: The 2 best known treatments

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Psilocybin/psychedelics for treatment resistant depression, mood disorders, anxiety and PTSD.

Dr. Zisook: A new and exciting frontier

Dr. Goldberg: Everybody wants to try it regardless of efficacy data

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Esmethadone for major depression.

Dr. Goldberg: Too soon to tell. Will be uphill FDA approval.

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Asenapine transdermal antipsychotic.

Dr. Citrome: First and only antipsychotic patch available in the US

Dr. Goldberg: Who cares? Weak drug.

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Xylazine—solution or problem (ie, wounds and ulcerations associated with its use).

Dr. Salsitz: Definitely a problem

Dr. Goldberg: Toxin.

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Serotonin 5HT2-A for negative symptoms of schizophrenia (studies in progress with pimavanserin and roluperidone).

Dr. Citrome: Great, if it works

Dr. Goldberg: Good idea, weak data so far.

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Glycine transport inhibitor for cognitive deficits in schizophrenia.

Dr. Citrome: Great, if it works

Dr. Goldberg: Good luck.

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New illicit drug classes (eg, nitazenes) on the horizon.

Dr. Goldberg:  New plague.

Dr. Salsitz: Ready or not, here come the nitazenes.

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Fentanyl’s role in decreasing effectiveness of medications, and making treatment options more challenging, for opioid use disorders (OUD).

Dr. Salsitz: Fentanyl has thrown a monkey wrench into treatment of OUD 

Dr. Goldberg: Plague.

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Psychiatry Resource Section

New England Journal of Medicine Editorial: Loosening the Shackles of Depression

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JAMA Psychiatry Original Investigation: Antidepressant Use and Risk of Manic Episodes in Children and Adolescents With Unipolar Depression

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Medscape Medical News Article: Psychedelic Therapy Tied to Reduced Depression, Anxiety

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Medscape Medical News Article: Common Meds Link to Sudden Cardiac Arrest in Type 2 Diabetes

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APA Learning Center October Free Members Course: Neurobiology and Treatment of Post-Traumatic Stress Disorder —CME: 1.5, COP: 1.5

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Clinical Psychiatry News: LSD use triples among young adults with depression

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Clinical Psychiatry News: Smart bracelet may predict mood changes in bipolar disorder