There are times in treatment when the usual pace just won’t do.

The patient is unraveling.

The situation is urgent.

And you don’t have six weeks to wait.

That’s when we reach for rapid-acting medications.

In Chapter 27 of Difficult-to-Treat Depression, Chris Aiken outlines eight options that can start working within days—not weeks: 

▸ Alprazolam 

▸ Eszopiclone 

▸ Auvelity (bupropion + dextromethorphan) 

▸ Ketamine/Esketamine 

▸ Pindolol 

▸ Thyroid (T3) 

▸ Zuranolone 

▸ Psychedelics

Some are familiar, some emerging.

But they share one thing: they’re fast.

Used wisely, they can interrupt a downward spiral or help someone regain footing after years of stalled progress.

But Aiken is clear: these medications should be used with purpose.

They can reduce symptoms quickly—but that relief is often short-lived unless something else changes alongside it.

That’s why he emphasizes: 

→ Setting a specific behavioral goal before starting the medication 

→ Pairing it with therapy or structured support 

→ Using it as an entry point to broader change—not as a stand-alone fix 

→ Avoiding casual “boosters” unless there’s a clear plan to build on the initial gainsIn other words: these treatments aren’t the whole intervention.

They’re a way to open the door—so patients can start moving again.

When you turn to a rapid-acting med, what guides your decision?

And how do you ensure it’s more than just another prescription?

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