A common antidepressant has been subject to a recall, necessitating immediate review of current prescriptions and patient monitoring for potential substitution.
A meta-analysis demonstrates that 5-HT3R antagonists, including setrons and vortioxetine, significantly improve negative symptoms and cognitive impairment in schizophrenia, supporting their potential as adjunctive treatments.
This article proposes integrating chronotherapeutic strategies into lithium treatment for bipolar disorder by aligning dosing with individual circadian rhythms to potentially improve efficacy and reduce toxicity.
A meta-analysis indicates that magnetic seizure therapy offers comparable efficacy to electroconvulsive therapy for major depressive disorder with significantly better cognitive safety and tolerability profiles.
A single dose of psilocybin is associated with rapid relief from depressive symptoms, highlighting its potential as a novel pharmacotherapy for depression.
Clinical Pearls
Bite-sized clinical takeaways from today's literature (sources from Jun 16 – Jun 17)
- Remember that antipsychotics remain the standard of care for agitation in Alzheimer's disease and are not FDA-approved for this indication; use with caution due to black box warnings.
- Immediately audit your active prescriptions for any antidepressants subject to recent recalls and proactively monitor patients for withdrawal symptoms or therapeutic failure while arranging substitutions.
- When addressing apparent treatment resistance, consider switching from oral to long-acting injectable antipsychotics to rule out non-adherence before labeling the case as truly resistant.
- Spironolactone shows promise as an adjunctive NRG1-ERBB4 antagonist for schizophrenia negative symptoms, but current evidence is mixed regarding working memory benefits; consider it only within clinical trials or off-label with careful monitoring.
- Consider adding a 5-HT3R antagonist (such as ondansetron) to the regimen of patients with schizophrenia who have persistent negative symptoms and cognitive impairment, given meta-analytic support for this adjunctive strategy.
- For bipolar patients on lithium, consider chronotherapeutic dosing aligned with individual circadian rhythms to potentially enhance efficacy and minimize toxicity risks.
- Monitor sleep architecture in treatment-resistant depression patients receiving ketamine; an increase in early NREM slow wave activity may serve as a biomarker for positive antidepressant response.
- When ECT is contraindicated or poorly tolerated due to cognitive side effects, discuss magnetic seizure therapy (MST) as a viable alternative with comparable efficacy but a superior cognitive safety profile.
- In cases of delusional infestation, prioritize pragmatic engagement and safety monitoring over immediate high-dose antipsychotics, utilizing agents like pimozide or risperidone only after establishing therapeutic alliance.
- While psilocybin shows rapid antidepressant effects in trials, it remains investigational; do not prescribe outside of approved clinical trial protocols or specialized regulated settings.
Policy & Regulation 1
The FDA has approved a new medication specifically for the treatment of agitation associated with dementia due to Alzheimer disease.
Clinical Pearl 1
A proof-of-concept trial found that spironolactone did not significantly improve working memory in schizophrenia compared to placebo, though post-hoc analyses suggest potential benefit warranting further study.
Diagnosis & Treatment 1
This article reviews the use of antipsychotics like pimozide and risperidone for delusional infestation, emphasizing pragmatic engagement strategies and safety monitoring in a psychodermatology context.
Mechanism of Action 1
Ketamine increases early NREM slow wave activity in treatment-resistant depression patients, particularly responders, suggesting this sleep modulation is linked to its antidepressant efficacy.
Drug Development 3
USC has secured funding to initiate its first clinical trial evaluating psilocybin for mental health conditions, marking a step in the ongoing research into psychedelic pharmacotherapy.
A randomized controlled trial published in Nature demonstrates that spironolactone, repurposed to antagonize the NRG1-ERBB4 signaling pathway, is a viable treatment for schizophrenia.
Monash University has launched Australia's first randomized clinical trial to evaluate psilocybin-assisted therapy for persistent post-concussion symptoms, targeting neuroinflammation and neural plasticity.
Podcast Summary 1
This podcast episode outlines the American Society of Clinical Psychopharmacology's consensus framework on deprescribing psychotropics, offering practical guidance on managing polypharmacy, addressing pseudotreatment resistance via long-acting injectables, and navigating the psychological aspects of medication discontinuation.