Psilocybin Bests SSRI for Major Depression in First Long-Term Comparison
“MILAN — Psilocybin leads to a better overall outcome in the treatment of moderate to severe major depressive disorder (MDD) than the selective serotonin reuptake inhibitor (SSRI) escitalopram, results of the first long-term comparison of the two treatments suggest.
“This is the first work to compare the long-term effects of these two drugs in the context of overall well-being, not just freedom from depression,” study investigator Tommaso Barba, PhD, candidate Imperial College London, London, England, said in a press release. “Psilocybin outperformed escitalopram in several measures of well-being, meaning in life, work, and social functioning.”
Findings from the 6-month follow-up study of a phase 2 double-blind, randomized, controlled trial were presented on September 22 at the 37th European College of Neuropsychopharmacology (ECNP) Congress and published simultaneously in The Lancet eClinicalMedicine….The initial single-center study included 59 adults with MDD (mean age, 41 years) who were randomized to receive either psilocybin or escitalopram over a 6-week period. The psilocybin arm (n = 30) received two 25-mg oral doses of psilocybin therapy (PT), and the escitalopram arm (n = 29) received 10-20 mg of daily escitalopram plus two (placebo-like) 1-mg doses of psilocybin (ET). Both groups received psychological support….The researchers conclude that while a short course of SSRIs combined with intensive therapeutic support (around 20 hours) “might be enough to induce sustained antidepressant effects,” patients treated with psilocybin showed greater improvements in general functioning, connectedness, and meaning in life.
Although not reassessed in the follow-up, the initial study showed that adverse events, particularly sexual functioning, favored psilocybin, said Barba.”
Family History of Alcohol Dependence Predicts Antidepressant Response to an NMDA Antagonist
LE Phelps reported in Biol. Psy (2009) that subjects with a family history of alcohol dependence showed significantly greater improvement in MADRS scores compared with subjects who had no family history of alcohol dependence.
They concluded that a family history of alcohol dependence appears to predict a rapid initial antidepressant response to the NMDA receptor antagonist ketamine.
Efficacy and Safety of Xanomeline-Trospium Chloride in Schizophrenia
Kaul, et al noted in Jama Psi (2024) that “In this phase 3, double-blind, randomized, placebo-controlled trial in 256 people with schizophrenia, xanomeline-trospium was associated with a statistically significant and clinically meaningful reduction in Positive and Negative Syndrome Scale total score compared with placebo. Xanomeline-trospium was generally well tolerated; the most common adverse events were primarily gastrointestinal effects, which were mild or moderate in intensity and generally transient in nature.
EMERGENT-3 confirms previously reported clinical trials (EMERGENT-1 and EMERGENT-2) demonstrating that xanomeline-trospium is efficacious and well tolerated in people with schizophrenia experiencing acute psychosis. Xanomeline is a dual M1/M4 preferring muscarinic receptor agonist with no direct D2 dopamine receptor blocking activity. KarXT combines xanomeline with the peripheral muscarinic receptor antagonist trospium chloride with the goal of reducing adverse events due to xanomeline-related peripheral muscarinic receptor activation.”
Bipolar Disorder Patients Respond to Ketamine, Esketamine Treatment
(Reposted from the Yale School of Medicine blog)
A small sample of patients with bipolar disorder displayed noteworthy improvement in their depressive symptoms after being treated with the rapid-acting antidepressant intravenous ketamine and the nasal spray esketamine, according to a new Yale led-study.
The study, published October 2 in the Journal of Clinical Psychiatry, also found that patients were not at higher risk of suffering a manic episode during the acute phase of treatment.
