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FDA Approves Fast Acting Antidepressant – Auvelity

FDA Approves Fast-Acting Antidepressant: Auvelity

September 23, 2022

On August 19, the U.S. Food and Drug Administration (FDA) approved Axsome Therapeutics’ Auvelity for the treatment of major depressive disorder (MDD) in adults. This new drug has several significant benefits over traditional antidepressants, making it an exciting advancement that offers new hope for individuals struggling with depression.

Here are six key takeaways.

#1: It’s Rapid Acting

One of the main drawbacks of many oral antidepressants is that they can take a long time to work. For example, selective serotonin reuptake inhibitors (SSRIs), like Zoloft, Prozac, and Lexapro, can take four to six weeks before they even begin to take effect.


Given how debilitating depression and anxiety can be, rapid symptom relief is critical. Initial studies indicate that patients taking Auvelity showed improvements in depression severity scores in as little as one week.

#2: It Works Through a Novel Mechanism of Action

The standard array of antidepressants works primarily on one or more of three of the brain’s chemical messengers: serotonin, norepinephrine, and dopamine. More specifically, they increase the amount of these neurotransmitters in the space between neurons (nerve cells in the brain that receive and relay information to each other).


Auvelity contains two compounds, bupropion, and dextromethorphan. This treatment combination works by inhibiting N-Methyl-D-aspartate (NMDA) receptors, which increases the intracellular levels of glutamate, an excitatory neurotransmitter found throughout the central nervous system (CNS). This increase in glutamate causes the release of another chemical called brain-derived neurotrophic (BDNF) factor, which may help symptoms of depression by allowing neurons to form new connections more easily.


#3: It Can Be Taken Orally

Auvelity is the first FDA-approved NMDA antagonist for depression that can be taken orally as opposed to intravenously (through an IV), intramuscularly (injected into the muscle), or intranasally (sprayed into the nose). While these alternative routes of administration have their advantages, some may feel they lack the convenience of a pill that can be taken in the comfort of one’s home.


#4: It is Not Associated with Weight Gain or Sexual Dysfunction

Even when the standard antidepressants are effective, they can come with side effects that lead patients to discontinue them despite their therapeutic effects.


Likely due to its novel mechanism of action, dextromethorphan-bupropion was not found to be associated with weight gain or sexual dysfunction, two of the more commonly experienced side effects. Additionally, the clinical trials found that, unlike ketamine or Spravato (intranasal esketamine), dextromethorphan-bupropion did not cause transient psychotomimetic effects (i.e., delusions, delirium, perceived distortions of space and time, etc.). 


#5: It Can Be Used as a First-Line Treatment

Though there are other treatments for depression that work through novel mechanisms, such as Spravato and TMS, they are approved by the FDA for treatment-resistant depression (i.e., depression that has not responded to multiple oral antidepressants).


A lack of FDA approval often results in a lack of insurance coverage. This means patients who would prefer to try one of these novel treatments but have yet to undergo a series of trials with standard oral antidepressants must first wait through weeks or months of potentially unsuccessful treatments.


Auvelity changes this. Because it is FDA approved for major depressive disorder full stop, doctors can use it as a first-line treatment for depression before a patient has tried other antidepressants.


#6: It is Not the Same as Ketamine or Spravato

While ketamine, Spravato, and Auvelity are all NMDA antagonists, Auvelity is unique in ways that makes them difficult to compare. For example, Auvelity exerts its NMDA antagonism continuously but at a lower level of intensity. In contrast, ketamine and Spravato cause a flood of glutamate in a relatively short period of time. The differential effect of this on treatment outcomes is not yet known, as no studies have compared these medications directly. 


Talk with your doctor to determine whether this treatment is right for you, or you can schedule an appointment with one of our team of psychiatrists or therapists to advise you on this or any other potential treatments for depression, including ketamine, Spravato, and TMS. Call us at 805-204-2502 or request an appointment here.

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Study Finds Ketamine Provides Rapid Relief from Severe Suicidal Ideation​

Study Finds Ketamine Provides Rapid Relief from Severe Suicidal Ideation

September 20, 2022

Each year, around 800,000 people die from suicide, and nearly 20 times that number attempt it. 


Though the causes of suicide and suicide attempts are varied, it is often preceded by suicidal ideation (i.e., contemplations, wishes, and preoccupations with death and suicide). As a result, researchers have increasingly been searching for compounds that treat these thoughts and feelings. 


Ketamine has stood out as a promising candidate, with several studies indicating that it is highly effective against suicidal ideation. While these results are encouraging, they generally have not focused on patients experiencing more severe suicidal ideation (SI) or in the middle of a suicidal crisis. Additionally, as far as outcomes go, many studies have measured the number of “treatment responders” (i.e., individuals who experience at least a 50 percent reduction in symptom severity) as opposed to the amount who experience remission (i.e., a complete absence of suicidal ideas).  


To fill in these gaps, a team of researchers led by Dr. Mocrane Abbar conducted a double-blind placebo study to assess the effects of ketamine on cases of severe SI. Due to its double-blind placebo-controlled structure, half of the subjects were given an inactive ingredient not known to improve SI. Additionally, neither the subjects nor the experimenters knew whether ketamine or the placebo was given. 

Key Findings

Below are some of the key findings from this study.



The Majority of Patients Achieved Full Remission

Sixty-three percent of the severely depressed subjects achieved complete remission of their suicidal ideation after just three days and two ketamine infusions.


It Worked Rapidly

SI is an urgent condition warranting an immediate and swift response. As such, it’s vital that ketamine not only works for many patients but also exerts its effects quickly and robustly.


As the graph above shows, many patients achieved remission almost immediately. Specifically, 43.8 percent of participants suffering from severe suicidal ideation achieved remission of their symptoms only two hours after their first infusion.



The Effect was Persistent

Immediate and robust relief of SI is a significant result on its own. However, this finding may have a limited impact if SI promptly returns. Fortunately, the researchers found that the effect lasted six weeks for nearly 70 percent of the patients.

While far from permanent, the six-week reprieve many patients experienced is promising for several reasons. For one thing, given that suicidal ideation is strongly associated with suicide attempts, these subjects may be far less likely to attempt suicide within those six weeks. Second, repeated infusions may lengthen this period of relief even further. Additionally, patients who have yet to create a holistic system of support to supplement their pharmacological treatments with other forms of therapy may find they have more energy to do this while the ketamine is lifting the heavy mental burden of severe SI.



The Effect was Strongest for Those Suffering from Bipolar Disorder

The research team found that ketamine’s therapeutic effect on SI generally depended on the mental condition the patient was suffering from.  More specifically, they found that ketamine infusions had the strongest impact on SI in patients who have bipolar disorder.


Among individuals suffering from depression, the effect was more moderate, with 42 percent of subjects experiencing a remission of their SI.  To shed light on the result, the researchers note that “one study of treatment-resistant depression suggests that repeated doses of ketamine might be necessary for some patients to achieve remission of severe suicidal ideas.” In other words, it may be that this group would have experienced a more significant improvement in their SI symptoms had they undergone more ketamine infusions.  Future studies will need to verify whether this is true.



It Alleviated “Mental Pain”

In addition to compiling more robust, reliable evidence that ketamine is a good treatment for severe SI, the research team collected data that may shed light on why it is so effective. In particular, they measured patients’ levels of “mental pain” and looked for correlations with remission levels.


They found that patients’ self-reported mental or psychological pain was strongly correlated with the severity of their SI and that the ketamine infusions had the most substantial positive effect on their SI when they alleviated psychological pain. This suggests that ketamine’s impact on SI is, at least partly, the result of its ability to relieve psychological pain.


Research continues to verify ketamine’s therapeutic effect on SI. This study provides some of the strongest evidence to date, suggesting that ketamine can provide rapid relief in cases of suicidal crises. It also sheds light on why ketamine has this effect and indicates that the degree to which it is helpful may depend on the individual’s particular mental health condition. 


If you are experiencing symptoms of SI, please contact the Suicide Crisis and Prevention Lifeline at 988


If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists who can see you in as little as one day via teletherapy.  

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Telepsychiatry Vs Teletherapy. What’s the Difference?

Telepsychiatry Vs. Teletherapy. What's The Difference?

December 16, 2022

Previously carried out primarily through in-person appointments where both practitioners and patients interacted in the same physical space, psychiatry and therapy visits increasingly began to take place through digital mediums (e.g., phone calls or video chats). According to UnitedHealth Group, there were 14 million telemental health visits in 2022 alone


Therapy and psychiatry are different but collaborative disciplines.


Like other areas of health different providers have different functions.  While teletherapy and telepsychiatry may accidentally be used in conversation interchangeably, what they are and what they do for their patients is different. Understanding how a therapist and psychiatrist differ and understanding how they operate in telemedicine may help you chose the best service for you.

What Is Teletherapy

In online therapy, patients meet remotely with a licensed mental health professional to talk through their emotions, thoughts, and feelings, receive a diagnosis if necessary, and treat their ailment with a non-medical or behavioral approach.

Some of the more common types of therapy include:

What Is Telepsychiatry

Just like teletherapy, telepsychiatry is also conducted digitally.

However, the goals and strategies of these appointments are different. While psychiatrists may incorporate behavioral techniques, they also focus on the biological causes of behavioral health issues. Utilizing their medical training, professional experience, and the latest academic research, psychiatrists attempt to determine whether a patient would benefit from medical treatment or intervention, and prescribe the most effective one based on the patient’s needs.

Advantages of Telemental Health Care

Though telepsychiatry and teletherapy arose primarily out of necessity, mental health professionals and their clients have found several advantages associated with virtual mental health care, including:

  • Cost: While the cost of mental health services varies, virtual appointments are generally cheaper than in-person ones.
  • Accessibility: To see a telemental health provider, you don’t need to travel far or even have access to transportation of any kind. You only need access to the internet or phone service and a quiet place to talk.
  • Time: Since there is no need to drive anywhere or sit in a waiting room, telemental health services take up much less time than in-person alternatives.
  • Selection of practitioners: With in-person appointments, your choice of practitioner is limited both by what you can afford and how far you can drive. With virtual care, your menu of offerings expands beyond your physical and financial constraints, meaning you can pick a professional who better suits your needs.
  • Less perceived stigma: Some people struggle to let go of the stigma associated with mental health care and may believe others will judge them for getting help. Virtual sessions allow patients to receive care with greater anonymity.
Considerations When Seeking Telemental Health Care

As telemedicine has become more mainstream provider’s skills in offering digital care has improved. However there are a few obstacles to keep in mind when seeking telehealth providers:

  • Nonverbal communication: Fcial expressions and body language often say as much about how we are feeling as our words. Studies have found that our ability to pick up on these nonverbal cues can be compromised in virtual settings, meaning practitioners can’t use them as easily to guide or inform their treatment. Providers may overcome this by tuning in to the changes they can see on camera, and also asking additional questions. Patients may want to consider how they can continue to interpret their nonverbal responses and verbalize them if possible.
  • Privacy: Because we share personal information in therapy, we typically prefer to keep what is said private or confidential. Privacy in virtual appointments depends on the patient’s ability to find a space away from other people where they can’t be heard. When considering telemedicine consider your privacy, and also discuss any privacy concerns that may come up with your teletherapist or telepsychiatrist. They may have insight and offer suggestions.
  • Sense of connection: For some, part of the benefit of therapy comes from voicing their concerns to someone they have developed a relationship with. Without face-to-face interactions, these connections can be harder to build and sustain. If physical proximity feels like a meaningful aspect of care for you and you find it difficult to overcome with other strategies, be open with your teleprovider and ask if referring to a provider that offers in-person care may be best for you.
Embarking on Treatment

Telepsychiatry and teletherapy are critical resources in our mental health toolkits. Though they share many similarities, they utilize significantly different approaches to treatment. While therapists emphasize talk and behavioral strategies, psychiatrists prescribe medication and medical treatments.


Therapy and psychiatry often go hand in hand for a patient’s care, and it can be tricky to go between providers employed through different companies.


At Heading we have found it beneficial to provide patients access to both therapists and psychiatrist so that care is collaborative between the patient and their team of providers. With many services like medication management for traditionally prescribed oral antidepressants (i.e. Celexa, Paxil etc.), or talk therapy (i.e. cognitive behavioral therapy, dialectical behavior therapy, trauma therapies, and psychodynamic therapies etc.) these services can be offered via telehealth. However we also acknowledge that not all treatments are best done from home, and also offer transcranial magnetic stimulation (TMS), and IM Ketamine and Spravato® treatments in our Austin and Dallas Centers. Our fully remote and hybrid dynamics of care require that all providers involved in patient care stay in collaboration with one another. Our team-based approach allows for more ease in the process. 


It is important to feel good about both the relationship you personally have with your therapist and psychiatrist. Also consider the relationship and communication between these two key members of the mental healthcare team.



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Ketamine and Alcohol Use Disorder​

Ketamine and Alcohol Use Disorder

September 13, 2022

Alcohol Use Disorder (AUD), a condition characterized by a problematic pattern of alcohol consumption despite physical, mental, and social consequences, is among one of the most common and costly psychiatric conditions. According to National Center for Drug Abuse Statistics, the condition affects around 10 percent of Americans aged 12 and older and is responsible for three million deaths every year.


Because AUD remains a difficult condition to treat, researchers are actively seeking novel therapeutic solutions. Due largely to its well-documented effects on depression, many experts are investigating whether ketamine may prove helpful against AUD. As Professors Celia Morgan and Amy McAndrew note:


Depressive symptoms are common in individuals entering treatment for AUD, and the likelihood of alcohol relapse is elevated in patients with such symptoms.


Ketamine may support alcohol abstinence by temporarily alleviating depressive symptoms during the high-risk relapse period in the weeks after detoxification.


Early experiments have produced promising results, with several studies finding ketamine improved abstinence and lowered relapse rates. For example, one study found that 66 percent of patients with AUD who received ketamine infusions alongside psychotherapy were abstinent one year later compared to 24 percent of patients who did not receive ketamine.


Recent Study Suggests Therapy Makes Ketamine a More Effective Treatment For AUD

While some experts feel that ketamine can be highly impactful when delivered on its own in the absence of any therapy, others feel patients must be supervised and receive guidance from experts during and after treatment for it to be consistently effective. As Rosaline Watts, a leading scholar in the field of psychedelic research, explains when discussing one of her recent experiments, “the drug was a catalyst to the therapeutic process, not the therapeutic process itself.”


With the importance of therapy in mind, a team of researchers led by Morgan and McAndrew set out to directly assess the role of therapy in ketamine-based treatments with a focus on mindfulness. In their study, they reason that:


The subjective experiences that accompany ketamine infusions may provide a new perspective that may be helpful in psychological therapy. Ketamine induces a dose-dependent sense of dissociation and disembodiment that has been described as facilitating an “observer state” similar to that described in mindfulness, which may be helpful for allowing patients to consider thoughts and emotions from a more removed perspective.




The researchers conducted a double-blind-placebo controlled study to assess the importance of therapy in ketamine-assisted treatments for AUD. This means special precautions were taken so that neither the subjects nor the experimenters knew what treatment they received, which helps ensure the results are more objective, reliable, and free from bias.


Because the researchers wanted to examine the effects of both ketamine and therapy on AUD, they needed two placebos (i.e., “inactive” treatments), resulting in four possible treatment combinations.


  1. Ketamine infusions with psychological therapy/mindfulness-based relapse prevention
  2. Saline (drug placebo) infusions with psychological therapy/mindfulness-based relapse prevention
  3. Ketamine infusions with alcohol education (“therapy placebo” where subjects were taught general facts about addiction and alcohol use disorder)
  4. Saline infusions with alcohol education


Findings – Efficacy and Safety

After three treatment sessions the researchers noticed several important outcomes. They found the number of days abstinent at three and six months after treatment was higher in the groups that received ketamine either with or without therapy, corroborating findings from earlier experiments.

                                                                                               Photo Credit to Professors Morgan and McAndrew


The team found some promising results when it comes to whether mindfulness makes ketamine a more effective tool against AUD. In particular, they found that relative to the subjects that received saline with alcohol education (i.e., both placebos), the group that received ketamine alongside mindfulness-based relapse prevention showed the largest percentage increase in the number of days they remained abstinent. However, the latter finding was not statistically significant, meaning future studies will need to verify that the combination of ketamine infusions with mindfulness-based relapse prevention is more effective than ketamine alone.


Because ketamine has the potential for abuse when used in recreational settings, Morgan and McAndrew sought to assess whether this might make it a less viable option for individuals with AUD. To do so, they tracked whether subjects used ketamine during the follow-up portion of the experiment after the supervised ketamine infusions had been administered.


They found that around six percent of the subjects reported using ketamine on one occasion during this period. Importantly, these individuals stated they had used ketamine recreationally before the experiment. Future studies will be needed to further determine whether AUD puts one at a greater risk of using ketamine outside supervised settings.



Though the research is in its early stages, evidence suggests that ketamine, whether used alone or in conjunction with therapy, may help individuals recovering from AUD maintain sobriety.


As researchers continue to explore and identify new psychiatric uses for ketamine, it is becoming increasingly clear that psychological therapy is required to unlock the full benefits of this treatment. Patients and practitioners alike should bear this in mind as they consider ketamine as a therapeutic alternative.

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Panic Attack Types, Diagnoses, and Treatments​

Panic Attack Types, Diagnoses, and Treatments

September 12, 2022

A panic attack is a sudden and brief episode of intense fear and anxiety which triggers a host of unpleasant physiological and psychological symptoms, including:


  • Accelerated heart rate
  • Chest pain or discomfort
  • Chills or hot flashes
  • Shortness of breath
  • Derealization and/or depersonalization
  • Sweating
  • Fear of dying
  • Fear of losing control or going crazy
  • Feeling of choking
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Feelings of numbness or tingling sensations
  • Nausea or abdominal pain
  • Trembling or shaking
Types of Panic Attacks

Though all panic attacks involve a sudden surge of anxiety, they differ in significant ways that can impact diagnosis, treatment, and prognosis. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V), there are two types of panic attacks: unexcepted and expected.


Unexpected Panic Attacks

Some individuals experience a panic attack out of the blue without a clear cause. Seemingly out of nowhere, their anxiety will rise dramatically, despite knowing they are not in a dangerous situation.  


These types of panic attacks can be particularly stressful for the people who experience them, especially the first few times they happen. Not knowing why you are feeling intense fear can make the feeling of panic even worse. Once one learns they experience unexpected panic attacks, they may spend lots of time worrying about when the next one will happen since they can’t identify causes or triggers.



Expected Panic Attacks

Some panic attacks have a clear and identifiable cause. One of the more common triggers is being exposed to something you are extremely fearful of. For example, someone who has a phobia of spiders may experience a panic attack upon finding a spider in their house. Likewise, someone who fears flying may have a panic attack when thinking about an upcoming flight. 


Expected panic attacks can also be brought on by your environment, even when you know there is nothing dangerous about it. For example, in one case study, an individual tended to experience panic attacks while driving, traveling alone, in enclosed spaces, and in crowds, even though they had no specific fears associated with those circumstances. 


These panic attacks are importantly different from unexpected panic attacks because they are predictable. Since they have an identifiable source, those who experience them may have an easier time avoiding them. 

Panic Attacks and Mental Health Conditions

While panic attacks are intensely stressful events regardless of their type, they are not always a sign that one suffers from a mental health condition. One reason for this is that some events are simply very scary and warrant a lot of fear and anxiety. If you only experience panic attacks in these situations, you may not receive any mental health diagnosis.



Panic Attacks and Phobias

Some situations don’t warrant intense fear. For example, there is little reason to be scared when enjoying your favorite ice cream while sitting at home and watching tv. If you consistently have panic attacks in response to a situation, idea, or object that is not a direct and immediate threat, you may be diagnosed with a specific phobia disorder.



Panic Attacks and Panic Disorders

Some people experience one panic attack and never have another. However, others experience them repeatedly. If this happens to you and your panic attacks are of the unexpected variety, you may have what is known as a panic disorder.


Panic Attacks and Other Mental Health Conditions

Panic attacks may also occur as a symptom of several other mental health conditions, including:


  • Generalized Anxiety Disorder (GAD)
  • Major Depressive Disorder
  • Bipolar Disorder
  • Obsessive-Compulsive Disorder (OCD)
  • Social Anxiety Disorder
  • Post-Traumatic Stress Disorder (PTSD)

Treatments for panic attacks vary depending on the type of panic attack you experience and the condition it is a symptom of.



Exposure Therapy

If you experience panic attacks resulting from phobias, you may undergo what is known as exposure therapy. For this treatment, individuals are gradually exposed to what they are afraid of until their fear response goes away or no longer interferes with their daily lives.


Recently, this form of therapy has been combined with virtual reality (VR). By offering immersive virtual environments, VR allows patients to get one step closer to their fears without encountering the real thing. Studies have found that this modified version of exposure therapy is a promising alternative to the standard approach.  




Exposure therapy doesn’t work for the unexpected panic attacks common in panic disorders. Physicians typically treat panic disorders with medications (e.g., selective serotonin reuptake inhibitors and benzodiazepines). Some studies have found that ketamine can resolve panic disorders, though more experiments are needed to confirm this result.  


If you feel you may suffer from panic attacks or have additional questions about them, please give us a call at 512-777-2591 and we would be happy to assist you.

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