Here’s an area about the latest medications and therapies happening in psych. There are many ways to look up treatment and I tried to put them in the pages below or you can check out formal resources but here, I added some personal perspectives and currently making plans to put updated and even peculiar things in this section. Also, some of these treatments aren’t technically “new” but aren’t frequently prescribed mainly due to coverage but I wanted to place them in a common area with things that are emerging:
Medications
- Austedo (Deutetrabenazine): newest treatment for tardive dyskinesia (TD)
- Aplenzin XR (Bupropion Hydrobromide/HBr): treatment for depression, SAD
- Belsomra (Suvorexant): treatment for insomnia and Alzheimer’s-related insomnia
- Caplyta (Lumateperone): treatment for BP 1-2 and schizophrenia
- Deplin (L-methylfolate Ca): treatment for reduced folate levels
- Forfivo (Bupropion Hydrochloride): treatment for depression, SAD
- Hetlioz (Tasimelteon): to treat non-24-Hour Sleep-Wake Disorder in adults and nighttime sleep disturbances in Smith-Magenis Syndrome (SMS) patients 16 years of age and older. Also, sleep issues with TBI
- Ingrezza (Valbenazine): first medication approved for treating TD. Currently, being studied for Tourrettes Syndrome
- Latuda (Lurasidone): treatment for schizophrenia and bipolar depression
- Levomilnacipran (Fetzima): treatment for depression. DOC for severe OCD
- Lybalvi (Olanzapine + Samidorphan): the first antipsychotic approved to reduce significant weight gain associated with olanzapine. FDA-approved for schizophrenia and bipolar I disorder in adults
- Rexulti (Brexpiprazole): treatment for schizophrenia and depression, also may help with schizoaffective and PTSD
- Trintellix (Vortioxetine): newer treatment/class of treating depression. FYI the dosage doubles/interacts with bupropion –NIH
- Viibryd (Vilazodone): newest treatment/class to treat depression, possibly causing the lowest sexual side effects, somewhat activating/least drowsiness
- Vraylar (Cariprazine): treatment for schizophrenia and bipolar
| BRAND NAME (GENERIC) | KETALAR (KETAMINE) | TRINTELLIX (VORTIOXETINE) | FETZIMA (LEVOMILNACIPRAN) | VIIBRYD (VILAZODONE) |
|---|---|---|---|---|
| GENERIC | NO | NO | NO | NO |
| INITIAL APPROVAL DATE (FDA Indications ) | 02/19/1970 (general anesthesia) | 09/30/2013 (major depression) | 07/26/2013 (major depression) | 01/21/2011 (major depression) |
| Dosages Available | 10mg, 50mg, 100mg/ml (IV) | 5mg, 10mg, 20mg | 20mg, 40mg, 80mg, 120mg | 10mg, 20mg, 40mg |
| Dosing for Depression | N/A | 10-20mg QD | 40-120mg QD | 20-40mg QD |
| Average $$$ | >$500 (per infusion) | $300/month | $300/month | $220/month |
| Particular Qualities | rapid response, efficacy for treatment resistance depression | cognitive improvement | functional improvement; specifically (norepinephrine depression) | Low sexual side effects, may improve anxiety |
| Notes | Scheduled III medication. Currently also avail nasal spray, sublingual. Initial dosages/length of tx/increased cost of treatment varies | FDA denied approval of cognitive claims | No clear evidence of advantages over existing treatment | Claims not significantly substantiated |
Honorable Mentions
- Mydayis (mixed salts): an option for long-acting (>16 hours) mixed salts; unfortunately it’s hard enough to get coverage for the regular stimulants…
- Jornay PM: methylphenidate XR, the only ADHD dosed @PM. I had ONE patient on this but switched to AM dosing. Most people want and need to be more productive during the day. Although it’s dosed at night and you may wake up less exhausted or more focused…to continue throughout the day you will have to consider additional dosages even at the highest PM dose, which also equals having to spend more $$$$ and less coverage.
- Qelbree (Viloxazine): coverage is complicated and somewhat dependent on being aware of the coverage process to get a discount. At least they give samples. Indications: Adult ADHD (non-stimulant), may improve mood symptoms. Telefriendly; patients can text for a sample, and create a portal for the savings plan.
Newest Medications/Formulations & Unconventional (Off-Label)
- Auvelity (dextromethorphan 45mg/bupropion XR 105mg): yes this is cough medicine with bupropion. It claims to work <1 week, whereas most antidepressants take 4-6 weeks for efficacy. The rep explained how the cough syrup mechanism, is supposed to make the antidepressant work longer and work on different receptors to improve depression/decrease side effects… NMDA receptor antagonists i.e. Ketamine, PCP, NO, cough syrup, etc. may have some psych qualities, but the precise MOA is unknown. One of the doctors wanted to know why can’t we just take bupropion and chase it with cough syrup. I asked why is there a titration dose; the usual starting dosage of Auvelity for major depressive disorder (MDD) is one tablet once per day. After 3 days, your doctor may increase your dosage to one tablet twice per day. You’ll take each dose at least 8 hours apart. (-Medical News Today) …though someone told me, most meds start low, which is true but this is odd to explain to the patient without a clear reason…What is innovative and good about this medication is how it may be a Ketamine alternative, thus more affordable and lately, we’ve been having favorable results.
- Azstarys (serdexmethylphenidate/dexmethylphenidate): a prodrug methylphenidate formulation. The rep did a poor job explaining but basically, it has a sudden onset, and then it retains >16 hours of efficacy via the prodrug serdexmethylphenidate.
New Therapies & Treatment
- Alpha-Stim: using stimulation therapy for PTSD, anxiety, pain, and insomnia.
- ID Genetix: genetic testing that shows interactions with a combination of medications, instead of the individual medications like the other genetic test formats.
- Tera Wave Wand: a device that helps improve circulation and neuro and pain symptoms.
- Transcranial Magnetic Stimulation (TMS): considered one of the safest treatments for TRD and with pregnancy
Additional Websites
Quake Watch: some of these treatments are remixes of other things that did and didn’t work in the past. Here’s a website that lists alternative devices and treatments that have warnings.
