Uncovering the State of Antidepressants: Updates from Psych Congress

The 35^th annual Psych Congress featured explored the state of several mental health disorders, including depression. In a session titled “State of Depression,” Dr. Charles DeBattista, a Professor of Psychiatry at Stanford University, provides a comprehensive overview of the treatment options currently available for major depressive disorder (MDD).

The session also features a better understanding of how clinicians can individualize their approach to pharmacotherapy, minimize side effects, and use actionable strategies to improve adherence and promote patient engagement.

Following the session, Dr. DeBattista joined the Psych Congress network to explore the limitations of current antidepressants and share why emerging medications are different.

Currently Available Antidepressants

He began by detailing what current antidepressants are available, but then when on to explain that despite the availability of over 30 antidepressants, many patients don’t adequately respond to or tolerate these treatments.

“Oral monoamine antidepressants have been extremely helpful to many patients, but depression is a heterogeneous illness, and there are likely many different biological drivers of depression than can be adequately addressed with one predominant mechanism,” Dr. DeBattista explained. Because of this, he stresses the need for new therapeutic opportunities.

So what treatment options are on the horizon? Dr. DeBattista explains that there is a range of medications in development with novel mechanisms and that new technologies emerging may help clinicians in matching the best treatment for a specific situation. And while they’re not ready to be applied to clinical practice yet, biomarkers such as pharmacogenomic tests may help clinicians better predict the tolerability and efficacy of a specific agent to a specific patient are evolving.

A Look at Emerging Treatments

While these treatments continue to emerge and evolve, Dr. DeBattista stresses that there’s no substitute for doing a detailed history to evaluate the presence of depression subtypes, rule out comorbidities, and assess the side effects of each past treatment.

Dr. DeBattista then shared the challenges of maintaining patient engagement with some of the new medications, including psychedelics, esmethadone, and zuranolone are similar to what clinicians do to promote a therapeutic alliance. Some of the steps clinicians can take include:

• Educations about the risks and benefits of a given treatment
• Setting realistic expectations
• Maintaining close monitoring of the patient, especially early in the treatment course

But one of the biggest things clinicians can do is to encourage patients to reach out to them for questions and concerns that can come with new treatment options, and it’s important to avoid conveying any sense of hopelessness.

“It is also important to always provide hope and the expectation that the patient can get better and that we will be with them in pursuing this objective,” Dr. DeBattista. “It is important not to buy into the nihilism that many more severely or chronically depressed patients experience.”

Dr. DeBattista ended the session by addressing misconceptions surrounding antidepressants for MDD. And while we don’t have enough information to provide clinicians and patients with all of the answers, he’s optimistic that these treatments will work out.