The novel psychedelic compound 25C-NBF demonstrates rapid antidepressant effects in preclinical models without the addictive properties typically associated with classic psychedelics, suggesting a potential new avenue for treating depression.
This case-based discussion explores the clinical strategy of using dual antipsychotics to manage risperidone-induced hyperprolactinemia, offering a practical prescribing alternative for psychiatrists.
A study suggests psilocybin may cause temporary structural changes in the brain, contributing to the mechanistic understanding of this psychedelic substance's potential psychiatric applications.
Phase 2 clinical trial results for a next-generation formulation of the atypical antipsychotic amisulpride show promising efficacy for schizophrenia.
President Trump's executive order accelerates psychedelic drug development and approval through FDA priority vouchers, DEA scheduling reforms, and ARPA-H funding, raising questions about clinical readiness.
Clinical Pearls
Bite-sized clinical takeaways from today's literature (sources from May 04 – May 06)
- Consider prescribing Auvelity for agitation in Alzheimer's disease as a non-antipsychotic alternative to avoid extrapyramidal side effects and metabolic risks associated with typical antipsychotics.
- Monitor brexpiprazole-treated inpatients closely for akathisia and insufficient efficacy, as these are the primary drivers of treatment discontinuation.
- Maintain a high index of suspicion for pulmonary embolism in patients on clozapine even if D-dimer levels are falsely negative, as thromboembolic events can occur dose-independently.
- Utilize lumateperone as a highly effective adjunctive option for major depressive disorder based on recent network meta-analysis rankings.
- Address risperidone-induced hyperprolactinemia by considering the strategic addition of a second antipsychotic rather than immediate discontinuation of the offending agent.
- Recognize that increased serotonergic activity reduces 'belief stickiness,' providing a mechanistic rationale for prioritizing serotonergic treatments in patients with rigid obsessions in OCD.
- Be aware that emerging FDA rolling reviews for psilocybin therapy may soon alter the regulatory landscape and availability of psychedelic-assisted treatments for depression.
- Evaluate the potential for novel psychedelic compounds like 25C-NBF in treatment-resistant depression, particularly given preclinical evidence of rapid antidepressant effects without classic addictive properties.
- Consider the clinical implications of policy shifts aimed at reducing SSRI prescribing, ensuring that deprescribing decisions are evidence-based and do not compromise patient stability.
- Monitor for signs of treatment resistance or adverse effects when initiating next-generation amisulpride formulations, noting ongoing phase 2 data supporting its efficacy in schizophrenia.
Drug Development 3
Coreterra Therapeutics has secured patents for new agents targeting schizophrenia, indicating ongoing drug development efforts in this therapeutic area.
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.
Clinical Pearl 4
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.
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 4
Research into psilocybin-induced brain changes provides mechanistic insight into its therapeutic effects, relevant to the pharmacological understanding of psychedelics in psychiatry.
A single dose of psilocybin induces lasting brain changes detectable 50 days later, providing mechanistic insight into the neurobiology of psychedelic therapy.
This article reports on the neurobiological effects of psilocybin in humans, providing mechanistic insights into how this psychedelic compound alters brain function, which is relevant to the pharmacodynamics of emerging psychedelic therapies.
A single dose of psilocybin induces lasting brain changes, highlighting its potential mechanism of action for psychiatric treatment.
Policy & Regulation 4
Robert F. Kennedy Jr. has initiated a campaign to encourage the deprescribing of antidepressants, representing a significant policy and regulatory shift in psychiatric prescribing practices.
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 study identifies international supply chain disruptions as the cause of the 2022-2023 ADHD medication shortage in the US.
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.
Journal Article 2
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.