This newsletter includes information about cariprazine as an adjunctive treatment for major depressive disorder.
We also share practical tips for treating generalized anxiety disorder, key points from a presentation on antipsychotic switching, and our practical research summaries (Quick Takes).
Cariprazine as an Adjunctive Treatment for Major Depressive Disorder
On February 22, 2022, a supplemental New Drug Application (sNDA) was submitted to the FDA for the approval of cariprazine as an adjunctive treatment for major depressive disorder (MDD) in patients who are already receiving an antidepressant.
- For what is cariprazine already approved?
- In 2015, it was approved to treat schizophrenia and manic/mixed bipolar episodes in adults.
- In 2019, it was approved to treat depressive episodes in adults with bipolar I disorder.
- What do we know about its efficacy as an adjunctive treatment for major depressive disorder?
- A phase 3 study from 2016 showed a significantly greater reduction in MADRS total score at Week 8 with adjunctive cariprazine at doses of 2 mg/day–4.5 mg/day but not with doses of 1 mg/day–2 mg/day. You can learn more here.
- In another phase 3 study, MADRS total score improved, but results were not significant.
- In a recent phase 3 study, patients treated with cariprazine 1.5 mg/day showed a clinically and statistically significant change in MADRS total score from baseline to Week 6.
- What do we know about its tolerability in patients with MDD?
- The most common adverse effects are akathisia, headache, insomnia, and nausea.
- There are no clinically relevant changes in metabolic parameters; mean weight gain is similar to risperidone and aripiprazole.
- How might it be different from using other atypical antipsychotics for inadequate response to antidepressants?
- Cariprazine has not been included in network meta-analyses to evaluate whether there are differences in efficacy with other atypical antipsychotics.
- One of the main advantages would be a minor effect on the metabolic profile and weight gain and fewer extrapyramidal side effects than other antipsychotics.
- It offers good tolerability and could be a drug of choice in long-term management of MDD.
The manufacturer published a press release in February 2022. Learn more.
GAD Psychopharmacology Algorithm, With David Osser, M.D.
In this interview, Dr. David Osser discusses an evidence-based treatment algorithm for treating generalized anxiety disorder (GAD). He also explores the psychopharmacologic agents commonly used for the treatment of GAD as well as common clinical concerns.
Interview highlights include the following:
- In DSM-5, GAD is diagnosed using the cardinal symptom of chronic worrying.
- Although SSRIs are first-line medications for the treatment of GAD, prescribers should avoid going over the maximum dose recommendations for these agents.
- For patients with GAD and a comorbid bipolar disorder, quetiapine is a reasonable agent to use.
Learn more and earn 0.5 CME credits here.
Antipsychotic Switching: The Intersection of Art and Science
In this video lecture, Dr. Brian Miller discusses the clinical indications and relative contraindications to antipsychotic switching. He reviews different strategies for antipsychotic switching, including a thorough explanation of how to switch between different formulations. Finally, he addresses special considerations for switching to clozapine.
Types of Antipsychotic Switching: Between PO Agents and From PO to LAI
- Expert consensus guidelines on antipsychotic dose equivalents can guide the switch.
- When switching to an LAI, establish tolerability with the PO antipsychotic first.
- A period of PO antipsychotic supplementation is required after the first injection.
Learn more and earn 1.0 CME credit here.
Quick Takes: Informing Your Practice
Treatment Implications of Sleep-Related Problems in Pediatric Anxiety Disorders
- Anxiety and sleep-related problems in children and adolescents exacerbate one another. Treatment of one can help the other, but targeting sleep may be underutilized. Learn more.
Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major Depression or Bipolar Disorder
- In this study of veterans with a prior suicide attempt, lithium was not better than a placebo for lowering subsequent suicide (attempts or completions) over 1 year of observation. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
Listen to Our Podcast: Psychopharm Updates
Don’t miss out on the latest updates in psychopharmacology! Each episode of our podcast showcases one of our products on a regular basis: Video lectures, Quick Takes, and Expert Consultations. We update our feed every 5 days.
References
- Durgam, S., Earley, W., Guo, H., Li, D., Németh, G., Laszlovszky, I., Fava, M., & Montgomery, S. A. (2016). Efficacy and safety of adjunctive Cariprazine in inadequate responders to antidepressants. The Journal of Clinical Psychiatry, 77(03), 371-378.
- AbbVie. (2022, February 22). AbbVie’s Cariprazine (VRAYLAR®) met primary endpoint in phase 3 study as an adjunctive treatment for major depressive disorder. News Center | AbbVie News Center. https://news.abbvie.com/news/press-releases/abbvies-cariprazine-vraylar-met-primary-endpoint-in-phase-3-study-as-an-adjunctive-treatment-for-major-depressive-disorder.htm#:~:text=%22When%20added%20to%20ongoing%20antidepressant,compared%20to%20placebo%20in%20two
