Dr. Sriram Raghavendran, MD’s Post

Dextromethorphan successfully augmented SSRI #antidepressants in this new, small RCT (it's an ingredient in the rapid acting Auvelity, where it is paired with bupropion): https://lnkd.in/e3hzzE7M The patients had not failed the SSRI, so it's really an enhancement study. They confirmed dextromethorphan reached "therapeutic" levels (0.5–5.9 ng/ml). #psychiatry #pmhnp #depression

Aside from any CYP interactions, DM is considered serotonergic by itself. MOA could be multifold.

The FDA’s 14-1 vote to ease access to clozapine by removing the burdensome REMS registration requirement is a long-overdue decision and a huge win for patients with treatment-resistant schizophrenia. Clozapine has been widely recognized as the gold standard for managing treatment-resistant schizophrenia and holds potential for bipolar disorder if studies are expanded. The previous REMS restrictions created unnecessary barriers, preventing many patients in desperate need from accessing this life-changing medication. In contrast, European countries have managed to provide access to clozapine without imposing such stringent requirements, allowing more patients to benefit. It’s frustrating that these limitations persisted for so long in the U.S., delaying care for countless individuals. This regulatory shift finally aligns access in the U.S. more closely with global standards. The timing is interesting—it’s as if this change was rushed through before the incoming administration, which might not prioritize such reforms. Whatever the political dynamics, this decision is a step in the right direction for mental health care. Removing the REMS requirement opens the door to more equitable treatment and could inspire further research into clozapine’s broader applications, such as for bipolar disorder. It’s worth noting that we still face challenges, like addressing the variable quality and bioavailability of generic clozapine, which remains an issue. Generics need to meet the same standards as the original formulation to ensure consistent therapeutic outcomes. Moving forward, we should also focus on expanding research and education on clozapine’s potential, breaking the stigma surrounding its use, and ensuring it reaches all who need it.

Interesting read of risks vs benefits of REMS in use and accessibility of Clozapine.

Vortioxetine (Trintellix) has a linear dose-response, with 50% of the effects at 5 mg and 95% at 18mg/day, from new analysis of 16 trials in #depression: https://lnkd.in/eba-Urqt Most antidepressants do not have a linear dose-response curve. More updates in Carlat #Psychiatry News: https://lnkd.in/eQzQrUCs

Inflammation occurs in 30% of #depression, but do anti-inflammatory meds work better when it is present? So far most of the support for using antiinflammatories for this subtype comes from secondary analyses, often that parsed out otherwise negative trials, like this new one of celecoxib: https://lnkd.in/ehxQdrnw Time for a well designed study. More in Carlat #Psychiatry News https://lnkd.in/dv37nfQP

#Is_it_better_to_maintain_or_reduce? When treating a patient with a longstanding history of schizophrenia on long-term antipsychotic polypharmacy, you may hesitate to reduce the treatment but also consider minimizing it. The key question: is it better to maintain or reduce? A recent study sheds light on this by examining the effects of switching from antipsychotic polypharmacy (APP) to monotherapy (APM). Results showed that patients on long-term polypharmacy experienced significant reductions in movement disorders, metabolic issues, and certain side effects after switching to monotherapy. This offers valuable insight for optimizing treatment. Read more here :

Balancing Benefits and Risks of Ketamine Pills for Depression Using ketamine in pill form to treat severe depression shows promise but carries significant risks. Ketamine's potential for misuse is high, even if the pill form can't be crushed. Matthew Perry's death from ketamine underscores these dangers, highlighting the risks associated with ketamine, even under medical supervision. Despite its benefits for those with treatment-resistant depression, ketamine can cause serious side effects like high blood pressure, elevated heart rate, and dissociation. These side effects are less common with slow-release forms, but they still exist. Additionally, the potential for misuse remains a concern due to ketamine's street value and history as a party drug. For individuals with treatment-resistant depression, who often face a high risk of suicide and a poor quality of life, ketamine if proving to offer much-needed relief. However, the risks must be carefully managed. Strict prescription practices, thorough patient education, and continuous monitoring would be essential to ensure safety and effectiveness. While ketamine could be a breakthrough for many struggling with severe depression, its potential for misuse and serious side effects cannot be ignored. The balance between benefits and risks must guide any decision to prescribe ketamine for home use, as it appears this is the direction we are headed for treatment-resistant depression.

#Lithium reduced suicidality 49% in this new analysis of 13 randomized controlled trials (Caveat: Suicide was not the primary outcome in these studies): https://lnkd.in/eK6dg5qB Bottom Line: Don't avoid lithium to prevent suicidal overdose; the data suggests the opposite. NEW: Carlat #Psychiatry News, with in depth coverage of the daily studies posted on this feed: https://lnkd.in/es9s3KdU The April episode features #MDMA therapy, #lithium, #PTSD, #bipolar, #clozapine, #schizophrenia, #ECT, and a circadian therapy for #depression

Write for naloxone when patients are at risk for opioid #overdose New study found 72% filled it and 1 in 12 used this #opioid blocker to save a life: https://lnkd.in/eFGTGtdW More on naloxone: https://lnkd.in/eApdDHex #opioidcrisis #psychiatry #opioidepidemic #addiction