In the second installment of a series examining advancements in depression treatment, experts Julie Carbray, PhD, and Kristian Dambrino, DNP, discuss newer interventions for treatment-resistant depression (TRD). They highlight the emerging roles of zuranolone and bupropion-dextromethorphan as promising options for patients looking for quick relief, especially those who have faced setbacks with previous therapies.
Zuranolone, a neurosteroid, is notable for its rapid onset, often alleviating depressive symptoms within days, making it particularly beneficial for women in the later stages of pregnancy or postpartum. This oral medication can be used short-term and is effective when immediate symptom reduction is critical.
Bupropion-dextromethorphan, while not FDA-approved specifically for TRD, can also show effects within a week. This rapid response can be pivotal for patients who have previously struggled with long-term treatment without success. There is also potential for cognitive benefits associated with this treatment, as it may influence neuroplasticity and synaptic growth.
Carbray and Dambrino stress the importance of patient education regarding these new medications. They note that while treatments like ketamine and esketamine have shown promise, they require careful consideration of the patient’s financial situation and support systems, as these treatments often necessitate multiple visits for administration.
Ketamine, while not yet FDA-approved for standard use, has gained recognition in clinical settings. Esketamine, however, is FDA-approved as an adjunctive treatment for TRD, designed to be used alongside an existing antidepressant. Patients typically undergo treatment twice weekly initially, transitioning to weekly sessions as they progress.
A crucial aspect of these treatments is the potential side effects, such as dissociation, particularly with ketamine and esketamine. Clinicians must prepare patients for possible experiences of dissociation and ensure they have adequate support during and after treatment.
Overall, while the rapid alleviation of depressive symptoms is encouraging, experts emphasize the need for ongoing research into the long-term effects and necessary treatment protocols for these newer medications. They advocate for a patient-centered approach, ensuring that treatments align with individual lifestyle and financial situations.
As new treatments continue to emerge, the focus remains on building hope and effectively supporting patients with treatment-resistant depression.
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