From addressing borderline personality disorder to preventing drug-drug interactions and more, Psych Congress faculty shared useful diagnostic and treatment information. The featured speakers, which included Psychiatric Times’ Editorial Board members Phillip Resnick, MD, and Thomas Kosten, MD, discussed hot issues in psychiatry during the four-day conference.
Several sessions addressed the complexities of treating patients as well as new potential treatment options. For instance, Marlene Freeman, MD, Director of Clinical Services in the Perinatal and Reproductive Psychiatry Program at Massachusetts General Hospital, shared tips and insights for treating women of reproductive potential. One important point she impressed on attendees is balancing the risk of psychopharmacological agents with the risk associated with an untreated mental disorder. For instance, untreated antenatal depression is associated with the risk of low birth weight, prematurity, small gestational age, and neonatal behavioral differences (eg, irritability and decreased activity). Yet recent findings indicate the absolute risk of selective serotonin reuptake inhibitor exposure in pregnancy is small. Similarly, case-control studies have shown inconsistent data regarding teratogenic risk of SSRIs. Thus, for moderate-to-severe depression, Freeman suggested clinicians discuss the risks and benefits of antidepressants with mothers and, when warranted, use the lowest effective dose. She also emphasized that non-medication alternatives, such as psychotherapy, should be maximized.
On the opposite side of the spectrum, Rick Doblin, PhD, founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS), shared insights in using methylenedioxy-methamphetamine (MDMA) to treat posttraumatic Stress Disorder. Although MDMA has received a bad rap as an illicit party drug (eg, Molly, Ecstacy), Dobin explained its pharmacology could be utilized in patients who do not respond fully to psychotherapy alone. According to Doblin, MDMA increases the release of serotonin, norepinephrine, and dopamine and it enhances the release of oxytocin, prolactin, vasopressin, and cortisol. Brain bioimaging studies have shown that the positive effects of MDMA can counter the negative neurological effects of PTSD.
MAPS concluded its Phase 2 trial of MDMA-assisted psychotherapy with positive results. They found that 56% of patients no longer met criteria for PTSD following the treatment, compared with 23% in the placebo group. Plus, the number grew over time for the MDMA group, with 68% no longer meeting criteria at 12-month follow-up. Building on this success, MAPS has initiated Phase 3 studies, with the hope of obtaining FDA approval for the treatment at the conclusion of these studies.
On the attention-deficit/hyperactivity disorder front, Timothy Wilens, MD, Chief of the Division of Child and Adolescent Psychiatry and Associate Professor of Psychiatry at Harvard Medical School in Boston, discussed newer medications and those in development to treat children and adolescents. New formulations have come out in recent years that allow easier treatment, including dissolving and chewable pills.
Now, the focus is on new pharmacological approaches to treating ADHD. Wilens noted a few drugs that are recently approved or in the later stages of study. For instance, dasotraline, which is a novel dual-acting dopamine and norepinephrine reuptake inhibitor, is in the registration phase with the FDA. Centanafadine, a triamine reuptake inhibitor that works with dopamine, serotonin, and norepinephrine, is in Phase 3 trials. Molindrone (SPN-810) is being studied to address impulsive aggressive behavior associated with ADHD; it is in Phase 3 trials. Another norepinephrine reuptake inhibitor, known as SPN-812, is in Phase 3 randomized control trials for ADHD in adolescents. Wilens also reported that the norepinephrine reuptake inhibitor mazindol, which was previously approved by the FDA for the treatment of obesity, had positive results in Phase 2 studies.
The editors at Psychiatric Times invited speakers to share highlights of their sessions with readers. The diverse faculty and topics underscore the wide variety of issues facing psychiatrists and their patients. As always, Psychiatric Times strives to keep our valued readers up-to-date with practical clinical information and guidance to help your practices and patients. In doing so, we welcome your feedback!