Future of C-L Psychiatry
This session will present two newly approved psychiatric medications.
Dr. Tal Weinberger: Brexanolone, approved by the FDA in March 2019, is the first FDA approved medication for postpartum depression, and demonstrates statistically significant effects within 24-48 hours. Brexanolone is an intravenous formulation of the neuroactive steroid allopregnanolone, a positive allosteric modulator of GABA type A receptors with known effects on anxiety, depression, and aggression; allopregnanolone levels increase during pregnancy and decrease rapidly after childbirth. In three multicenter phase 3 trials, brexanolone was administered as a sixty-hour IV infusion; 94% of patients who responded after 60 hours had not relapsed by 30 days. However, brexanolone presents unique challenges in its utilization in psychiatric practice, including length of infusion, monitoring requirements necessitating hospital admission and the need for childcare during the infusion, as well as cost.
Esketamine: A Breath of Fresh Air? (Dr. J.J. Rasimas)
Esketamine is the S enantiomer of racemic ketamine – a non-selective, non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor. It has pharmacologic similarity to phencyclidine, and thus carries both psychotomimetic and addictive potential. Analogous to ketamine, this intranasal compound has shown efficacy as a rapid-acting antidepressant, but relapse within days after each dose is essentially inevitable. Thus, longer term safety and efficacy data for continuation therapy with esketamine now support promise in treatment-resistant depression. This recently-approved medication also comes with risks related to individual patient selection, trends in practice, and public health.