In this very special newsletter, we include information regarding vilaxozine, a recently approved medication for ADHD in children. We also share the clinical essentials of dopamine and depression, key points from a presentation on the use of psychotropics in patients with hepatic issues, and our practical research summaries (Quick Takes).
Vilaxozine (Qelbree): A Newly Approved ADHD Drug for Children
- What was vilaxozine approved for?
In April 2021, it was approved by the FDA for the treatment of attention-deficit/hyperactivity disorder (ADHD) in pediatric patients 6 to 17 years of age.
- What is vilaxozine?
Viloxazine is a second-generation antidepressant drug. It is an inhibitor of norepinephrine reuptake, but it may also enhance serotonin release from neuronal stores. Viloxazine was marketed for more than 2 decades as an antidepressant in Europe.
- What do we know about its efficacy?
In a recent study sponsored by the manufacturer, the authors found that vilaxozine reduced inattention and hyperactivity symptoms by about 50% vs placebo.
- What are its most common side effects?
Common adverse effects, which occurred in ≥5% of subjects, were somnolence, decreased appetite, fatigue, nausea, vomiting, insomnia, and irritability.
- Why is it different from existing medications?
“Unlike nearly all other ADHD medicines, vilaxozine is not a stimulant or a controlled substance, making it harder to abuse than older drugs. Experts say the drug may appeal to parents who don’t want to give their child stimulants.It also could be an option for kids who have substance abuse problems.”
The article was published in August 2020, and you can find it in Clinical Therapeutics. Learn more.
Dopamine and Depression: Clinical Considerations with Ken Gillman, M.D.
In this interview, Dr. Ken Gillman discusses the need to highlight anhedonia and anergia as core symptoms of biological depression. He emphasizes the clinical utility of MAOIs in treating patients with melancholic or biological depression and Parkinson’s disease and discusses the risks of adjunctive use of atypical antipsychotics for depression.
Interview highlights include the following:
- Anhedonia and anergia are core symptoms of biological depression, which may be underrecognized in DSM-5.
- Dopamine plays a key role in the neurochemical basis of melancholic depression.
- MAOIs, which enhance dopaminergic neurotransmission, may be useful in the treatment of melancholic biological depression and Parkinson’s disease.
Learn more and earn 0.5 CME credits here.
Use of Psychotropics in Patients With Hepatic Issues
In this presentation, Dr. Jonathan Meyer discusses whether it is safe to use psychotropics in patients with hepatic issues. He also guides clinicians on assessing liver function and the utility and interpretation of the Child-Pugh scale.
Rating Scales for Hepatic Dysfunction: Child-Pugh
- The Child-Pugh scale determines whether a patient needs a dose reduction or whether the medication can be given.
- The laboratory elements for Child-Pugh are bilirubin, serum albumin, and INR.
- AST and ALT are parameters of inflammation.
- There is no need to adjust the dose based on the Child-Pugh stage unless:
- The hepatic function has deteriorated.
- Side effects are present.
- Drug levels may be the best guide to decide an appropriate dose.
Learn more and earn 1.0 CME credits here.
Quick Takes: Informing Your Practice
Psychotherapy at a Distance
- COVID-19 has brought an abrupt transition to remote psychotherapy. The authors examine some obstacles to this work and make recommendations for handling them. Learn more.
New Somatic Treatments for Child and Adolescent Depression
- First-line treatments for child and adolescent depression are cognitive–behavioral therapy, interpersonal therapy, fluoxetine, and escitalopram. Here are data on options to consider if several first-line treatments are not effective: Pharmaceuticals; nutraceuticals; somatomotor techniques, like yoga; and neuromodulatory tools, like ECT and TMS. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
References
Nasser, A., Liranso, T., Adewole, T., Fry, N., Hull, J. T., Chowdhry, F., Busse, G. D., Cutler, A. J., Jones, N. J., Findling, R. L., & Schwabe, S. (2020). A phase III, randomized, placebo-controlled trial to assess the efficacy and safety of once-daily SPN-812 (Viloxazine extended-release) in the treatment of attention-deficit/hyperactivity disorder in school-age children. Clinical Therapeutics, 42(8), 1452-1466.
Johnson, L. A. (2021, April 5). FDA OKs first new ADHD drug in over a decade for children. AP News. https://apnews.com/article/attention-deficit-hyperactivity-disorder-cafc56c871b014b60521737a0f246276.
