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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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    Telepsychiatry Vs Teletherapy. What’s the Difference?

    Telepsychiatry Vs. Teletherapy. What's The DIfference?

    September 13, 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


    While teletherapy and telepsychiatry may be used interchangeably, their treatment strategies are importantly different. Understanding how they differ and their relative advantages and disadvantages over in-person care is essential for deciding which service is right 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:

    • Cognitive behavior therapy (CBT)
    • Dialectical behavioral therapy (DBT)
    • Exposure-response therapy (ERP)
    • Interpersonal therapy (IPT)
    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 generally focus on the biological causes of behavioral health issues. Utilizing their training, professional experience, and the latest academic research, psychiatrists attempt to determine whether a patient would benefit from medical treatment 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.
    Limitations of Telemental Health Care

    While telemental health has its benefits, there are a few drawbacks.

    • Nonverbal communication: Our facial expressions and body language say just as much about how we are feeling as our words do. 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. 
    • 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.  
    • 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.

    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 medical treatments.

    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 1 day via teletherapy. 


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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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