In this issue, we discuss psychopharmacology news and recap our most useful key points from recent CME activities. We share recent information on lumateperone, key points from a presentation on unipolar depression, an expert interview on natural medications, and our research reviews (Quick Takes).
Lumateperone: A New Antipsychotic Approved for Schizophrenia
Lumateperone is a new antipsychotic approved by the FDA in December 2019. It will be available in U.S. pharmacies in March 2020.
- Approved indication:
- Schizophrenia
- Mechanism of action:
- Serotonin
- 5-HT2A antagonist
- Serotonin reuptake inhibitor
- Dopamine
- D2 presynaptic partial agonist
- D2 postsynaptic antagonist
- Glutamate
- D1 receptor-dependent modulator of glutamate
- Serotonin
- Common adverse reactions in clinical trials: Somnolence/sedation and dry mouth [1]
- Clinical comments:
- As of February 2020, we don’t know how lumateperone compares with other antipsychotics in terms of efficacy and adverse effects, such as weight gain, akathisia, and others.
- We will be monitoring the 2020 literature for comparison trials and new information.
Psychopharmacology Algorithms: Unipolar Depression
Dr. David Osser guides clinicians on the use of medications and somatic treatments in DSM-5 unipolar nonpsychotic major depression by using an algorithm.
The algorithm includes treatment for outpatients and inpatients; depression with comorbidities, different specifiers, and suicide or catatonia risk; and what to do in treatment-resistant cases or when treatments don’t seem to work.
You can earn 1.5 CME credits here: Psychopharmacology Algorithms: Unipolar Depression
Diagnosing Major Depressive Disorder With DSM-5
- Screen for medical comorbidities. Up to 10% of patients will have a purely medical cause of psychiatric symptoms that they self-identify as psychiatric and for which they seek mental health services. Learn more
Nonurgent Inpatients With Melancholic Depression: Antidepressants and Augmentation With Lithium, T3, or Citalopram
- The medication treatment of severe melancholic inpatients starts with venlafaxine, mirtazapine, or a tricyclic—but not an SSRI.
- These have more side effects than an SSRI, so clinicians need to be mindful of them.
- Augmentation, if necessary, can follow, and lithium or triiodothyronine (T3) are recommended by extrapolation from their positive results with tricyclic augmentation. However, this extrapolation may be considered speculative because direct studies do not exist. Learn more
Natural Medications in Psychiatry with Dr. David Mischoulon
In this interview with Dr. David Mischoulon, you will learn about the use of natural medications to treat psychiatric conditions. The quality control of these agents is explored, as well as the use of St. John’s wort, SAMe, Ginkgo Biloba, and others. The controversy on omega-3 fatty acids and cardiovascular health is discussed further as well as implications for mental health.
Interview Highlights
- St. John’s wort has a mild monoamine oxidation activity and should not be combined with other antidepressants.
- SAM-e has been shown to be effective for depression but not for OCD or anxiety symptoms.
- Valerian does not have a high risk for tolerance or dependency; it may be safer from this standpoint compared to benzodiazepines.
Learn more and earn 0.5 CME credits here: Natural Medications in Psychiatry with David Mischoulon M.D., Ph.D.
Quick Take: Informing Your Practice
Dr. James Phelps reviews the latest research on topics like pharmacogenomic testing in psychiatry and ketamine as well. Also covered is the literature on anticholinergic reduction in patients with dementia, childhood bipolar disorder, and augmentation with ondansetron in schizophrenia.
Ketamine Mechanism
- Ketamine’s antidepressant effects, previously thought to involve the NMDA receptor, may be produced through the opioid system (because blocking opiate receptors with naltrexone blocked the antidepressant effect). Learn more
Anticholinergic Reductions
- In patients with dementia, discontinuing medications with anticholinergic effects led to improvements in behavior and decreased caregiver stress–but only in patients with intermediate levels of dementia. Those with minimal or severe symptoms did not show statistical improvement. Learn more
Listen to or read the full volume, and earn 0.5 CME credits here: Quick Take Vol. 7
References
- Correll, C. U., Davis, R. E., Weingart, M., Saillard, J., O’Gorman, C., Kane, J. M., … & Vanover, K. E. (2020). Efficacy and safety of lumateperone for treatment of schizophrenia: a randomized clinical trial. JAMA Psychiatry.
