HHS Secretary RFK Jr. announced initiatives to reduce SSRI prescribing and promote non-pharmacological interventions for depression and anxiety, representing a significant policy shift in psychiatric treatment guidelines.
A case report highlights a rare, dose-independent pulmonary embolism with a false-negative D-dimer in a patient taking clozapine, reinforcing the need for high clinical suspicion of thromboembolism in patients on this antipsychotic despite low-risk scoring.
Research demonstrates that increased serotonin reduces 'belief stickiness,' a cognitive inflexibility trait associated with obsessions, providing a mechanistic rationale for serotonergic treatments in OCD.
This real-world retrospective study reports 8-week continuation rates and discontinuation reasons for brexpiprazole in inpatients with schizophrenia, highlighting akathisia and insufficient efficacy as primary drivers for stopping treatment.
The FDA's initiation of a rolling review for COMP360 psilocybin therapy for depression represents a significant regulatory milestone for this novel psychedelic treatment, potentially impacting future approval timelines for COMPASS Pathways.
Clinical Pearls
Bite-sized clinical takeaways from today's literature (sources from Mar 25 – May 05)
- Consider prescribing Axsome's new non-antipsychotic agent for agitation in Alzheimer's dementia when antipsychotics are contraindicated or poorly tolerated.
- Use adjunctive CBT following esketamine administration to mitigate the high risk of suicide relapse upon discontinuation of acute therapy.
- Rely on lumateperone as a high-efficacy adjunctive option for major depressive disorder when comparative data favors its profile.
- Monitor closely for akathisia and insufficient efficacy, as these are the primary drivers of brexpiprazole discontinuation in inpatient schizophrenia populations.
- Maintain a high index of suspicion for pulmonary embolism in patients on clozapine, even if D-dimer results are falsely negative and standard risk scores are low.
- Apply the ASCP Delphi consensus guidelines to structure the tapering and discontinuation of psychotropic medications for mood disorders.
- Utilize lorazepam as an effective intervention for resolving catatonia and psychosis in complex neuropsychiatric presentations such as Parkinson's disease with acromegaly.
- Leverage the serotonin-mediated reduction of 'belief stickiness' to explain and anticipate the efficacy of serotonergic agents in treating obsessive-compulsive disorder.
- Incorporate SSRIs and SNRIs as cornerstone pharmacological interventions for poststroke anxiety and depression to support functional recovery.
- Consider the potential off-label benefit of GLP-1 agonists for reducing psychiatric hospitalizations and sick days in patients with comorbid depression and anxiety.
Policy & Regulation 2
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.
Clinical Pearl 4
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 clinical trial is recruiting participants to evaluate the efficacy of group psychotherapy combined with psilocybin for the treatment of major depressive disorder.
A clinical trial is recruiting to evaluate behavioral psychedelic integration coaching as an adjunct to ketamine therapy for treatment-resistant depression.
A clinical trial is evaluating the efficacy of ketamine-assisted psychotherapy for reducing PTSD and trauma-related morbidity in patients with burn injuries.
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.
Journal Article 1
Drug Development 3
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.
A clinical trial is recruiting healthcare clinicians with loss of meaning and depression symptoms to evaluate group retreat psilocybin therapy, representing ongoing research into novel psychotropic treatments for occupational burnout and depressive symptoms.
A clinical trial is recruiting to evaluate the efficacy and safety of roluperidone for negative symptoms of schizophrenia compared to standard antipsychotics and placebo.
Diagnosis & Treatment 3
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 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.