Innovative Strategies for Treatment of Major Depressive Disorder: A Brief Review of Recent Developments
Michael E. Thase, MD
Innovative Strategies for Treatment of Major Depressive Disorder: A Brief Review of Recent Developments
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study demonstrated the need for alternate medications for patients who do not benefit from standard antidepressants. Innovative strategies that target novel mechanisms like ketamine, esketamine, brexanolone, and SAGE-217 may fill some of the unmet needs.
After an exhilarating epoch of drug development that led to the introduction of more than a dozen secondgeneration antidepressants, the pace of discovery slowed to a virtual standstill; most of the “new” drugs introduced after 2000 were metabolites, stereoisomers, or reformulations of existing medications and virtually all targeted serotoninergic or noradrenergic neurotransmission.1,2 As underscored by the results of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study,3 the need for alternate medications for patients who do not benefit from standard antidepressants remains unmet. In 2019,2 antidepressants with truly novel mechanisms of action were approved by the US Food and Drug Administration (FDA). This article will summarize these and other recent developments in antidepressant therapy.
Available at www.mdedge.com/MDD
After completing this activity, the participant should be better able to:
- Treat major depression within 2 weeks.
- Use evidence based treatments to achieve remission in major depression.
- Discuss novel targets including glutamate for treating major depression.
- Utilize treatments with innovative mechanisms to treat major depression.
Roger S. McIntyre, MD, FRCPC
Michael E. Thase, MD
JOINT ACCREDITATION STATEMENT
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Global Medical Education. Postgraduate Institute for Medicine is jointly accredited by the American Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
PHYSICIAN CONTINUING MEDICAL EDUCATION
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CONTINUING NURSING EDUCATION
The maximum number of hours awarded for this Continuing Nursing Education activity is 1 contact hour. Designated for 0.4 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
DISCLOSURE OF CONFLICTS OF INTEREST
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Roger S. Mcintyre, MD, FRCPC
Consulting Fees: AstraZeneca, Bristol-Myers Squibb, Eli-Lilly, Forest, JanssenOrtho, Johnson & Johnson, Lundbeck, Mitsubishi, Moksha8, Otsuka, Pfizer, Purdue, Shire, Sunovion, Takeda
Speakers’ Bureau: AstraZeneca, Bristol-Myers Squibb, Elli-Lilly, Forest, JanssenOrtho, Johnson & Johnson, Lundbeck, Mitsubishi, Moksha8, Otsuka, Pfizer, Purdue, Shire, Sunovion, Takeda
Research Grants: Allergan, AstraZeneca, JanssenOrtho, Lundbeck, Otsuka, Pfizer, Purdue, Shire,
Michael Thase, MD
Consulting Fees: Acadia, Akili, Alkermes, Allergan, Cerecor, Fabre-Kramer, Gerson Lehrman Group, Guidepoint Global, Johnson & Johnson, Moksha8, Nestlé, Neuralstrim, Novartis, Otsuka, Pfizer, Sunovion
Contracted Research: Acadia, Agency for Healthcare
Research and Quality (AHRQ), Alkermes, Allergan, AssureRX Health, Avanir, Axome, Intracellular, Johnson & Johnson, National Institutes of Health / National Institute of Mental Health (NIMH), Otsuka, Patient-Centered Outcomes
Research Institute (PCORI), Takeda
Royalties: American Psychiatric Foundation, Guilford Publications, Herald House, W.W. Norton & Company
Spouse: Peloton Advantage
PLANNERS AND MANAGERS
The PIM planners and managers have nothing to disclose.
The Global Medical Education planner and manager, Prakash Masand, MD, has disclosed the following:
Consulting Fees: Allergan, Lundbeck, Sunovion, Takeda
Speakers’ Bureau: Allergan, Lundbeck, Sunovion, Takeda
Contracted Research: Allergan
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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