This bulletin covers multiple psychedelic clinical updates, including Helus's Phase 2a results, Atai Life Sciences' safety data for R-MDMA in social anxiety disorder and Phase 3 design for 5-MeO-DMT in treatment-resistant depression, and a published study on psilocybin for smoking cessation.
This retrospective study reports on the utilization and positivity rates of Alzheimer's biomarkers in a memory clinic, reflecting increased testing driven by the approval of amyloid-targeting treatments.
A randomized trial investigates whether adjunctive CBT following esketamine improves relapse prevention in patients with major depressive disorder and suicidal ideation, addressing the high risk of suicide after discontinuation of acute esketamine therapy.
A large retrospective study suggests GLP-1 agonists like semaglutide are associated with reduced psychiatric hospitalizations and sick days, indicating a potential off-label benefit for depression and anxiety symptoms.
This review outlines the management of poststroke anxiety and depression, highlighting SSRIs and SNRIs as cornerstone pharmacological interventions alongside nonpharmacological strategies to improve functional recovery.
Clinical Pearls
Bite-sized clinical takeaways from today's literature (sources from Aug 22 – May 04)
- Prescribe non-antipsychotic options like Axsome's approved agent for agitation in Alzheimer's disease to avoid the metabolic and extrapyramidal risks associated with traditional antipsychotics.
- Consider alternative pharmacotherapy strategies for bipolar patients who have failed lithium, as large-scale data now supports specific alternative regimens for this non-responsive population.
- Utilize the ASCP Delphi consensus guidelines to structure the tapering and discontinuation of psychotropic medications for mood disorders, ensuring a systematic approach to deprescribing.
- Counsel patients on the potential off-label psychiatric benefits of GLP-1 agonists like semaglutide, noting associations with reduced psychiatric hospitalizations and sick days.
- Use lorazepam as a diagnostic and therapeutic trial for catatonia in complex neuropsychiatric presentations, such as in Parkinson's disease patients with acromegaly.
- Prioritize SSRIs and SNRIs as cornerstone pharmacological interventions for poststroke anxiety and depression to support functional recovery alongside nonpharmacological strategies.
- Exercise caution when prescribing multiple non-opioid psychotropics during pregnancy, as co-exposures are associated with specific short-term neonatal outcomes that require careful risk-benefit analysis.
- Recognize that escitalopram may improve cognitive flexibility in OCD by reducing 'belief stickiness' via serotonin-mediated mechanisms, reinforcing its role in treating rigid thought patterns.
- Implement adjunctive CBT following esketamine treatment to mitigate the high risk of suicide relapse that often occurs after the discontinuation of acute esketamine therapy.
Diagnosis & Treatment 2
A large-scale study identifies favorable treatment strategies for bipolar disorder patients who do not respond to lithium, offering clinical guidance for alternative pharmacotherapy.
This study examines the association between the number of non-opioid psychotropic medications and co-exposures during pregnancy and short-term neonatal outcomes, providing data relevant to prescribing psychotropics in pregnancy.
Clinical Pearl 1
This case report illustrates that lorazepam can effectively resolve catatonia and psychosis in a Parkinson's disease patient with acromegaly, supporting its use in complex neuropsychiatric presentations.
Mechanism of Action 1
A computational and clinical study demonstrates that escitalopram reduces 'belief stickiness' via serotonin-mediated cognitive flexibility, offering a mechanistic explanation for its efficacy in obsessive-compulsive disorder.
Policy & Regulation 3
The FDA has approved the first non-antipsychotic medication for treating agitation associated with Alzheimer's disease, marking a significant shift in pharmacological management for this behavioral symptom.
The FDA has approved Axsome's first non-antipsychotic drug for treating agitation associated with Alzheimer's dementia, offering a new prescribing option for this challenging neuropsychiatric symptom.
ASCP published a Delphi expert consensus on the deprescribing of psychotropic medications for mood disorders, providing clinical guidance for tapering and discontinuing these agents.