Esketamine (January)

Date of Issue: 01/01/2020 | Volume: 18 | Number: 1

Issue Links:Learning Objectives | Editorial Information

Esketamine (Spravalto) may be FDA-approved for treatment-resistant depression, but that has not put to rest concerns about its long-term safety. Nolan Williams, MD, explains why. Plus on-and off-label options for tardive dyskinesia, when to stop antipsychotics, TMS devices compared, and new findings on polypharmacy in schizophrenia.

In This Issue

Article

How to Treat Tardive Dyskinesia

Topics: Amantadine | Austedo | Deutetrabenazine | Ginkgo | Ingrezza | Keppra | Levetiracetam | Melatonin | Psychopharmacology | Psychopharmacology Tips | Side Effects | Tardive dyskinesia | Valbenazine | Vitamin B6 | Vitamin E | VMAT2 Inhibitors

The VMAT2 inhibitors are FDA approved for tardive dyskinesia (TD), but there are 8 off-label options to consider as well. See how they stack up here, and learn why the atypical antipsychotics ─ with one exception ─ have not put an end to this insidious side effect.

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Expert Q&A

Getting Uncomfortable with Esketamine

Topics: Antidepressant Augmentation | Antidepressants | Brain Devices | Depression | Depressive Disorder | ECT | Esketamine | Ketamine | Neurotoxicity | Novel Medications | rTMS | Suicidality | TMS | Transcranial Magnetic Stimulation | Treatment-Resistant Depression

The FDA approval of esketamine (Spravalto) left some unanswered questions, including suicide, addiction, withdrawal, neurotoxicity, and bladder inflammation. Nolan Williams addresses those risks and looks at where esketamine fits among other options like TMS and ECT. Dr. Williams directs the Interventional Psychiatry Clinical Research Program and Brain Stimulation Lab at Stanford University.

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Article

Antipsychotic Maintenance: How Long is Enough?

Topics: Antidepressant Augmentation | Antidepressants | Antipsychotics | Bipolar Disorder | Deprescribing | Depression | Depressive Disorder | Mania | Metabolic syndrome | Mood Stabilizers | olanzapine | Psychopharmacology | Psychopharmacology Tips | Risperidone | Side Effects | Tardive dyskinesia

Atypical antipsychotics can work quickly in mood disorders, but their long-term risks give us pause. When is it safe to discontinue them? The answer, it turns out, depends on whether we look to industry-supported or industry-independent trials.

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Research Update

TMS: Deeper is not Better

Topics: Depression | Depressive Disorder | Pharmaceutical Industry | Research Update | rTMS | TMS | Transcranial Magnetic Stimulation | Treatment-Resistant Depression

Two devices are available for transcranial magnetic stimulation (TMS). Neurostar came first with the figure-8 coil, which is now off-patent, while Brainsway’s H-coil which claims to reach deeper into the cerebral cortex. See how they compare in the first head-to-head controlled trial, undertaken without industry support.

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In Brief

In Brief: Antipsychotic Update

FDA Clears the Path for Magic Mushrooms. Psilocybin, the psychedelic compound in magic mushrooms, was fast-tracked by the FDA for major depression in November 2019.

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CME Post-Test

CME Post-Test - Esketamine, TCPR, January 2020

Topics: CME Post-Test

The post-test for this issue is available for one year after the publication date to subscribers. By successfully completing the test you will be awarded a certificate for 1 CME credit.

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