Positioning Faster-Acting MDD Therapies and Their Monitoring Demands

This episode, "Positioning Faster-Acting MDD Therapies and Their Monitoring Demands," features the panel examining what the waiting period actually costs.

Dr. Alva argues the lag before an antidepressant works is not merely an inconvenience but a window of dropout and risk. He asks Dr. Oyedeji which patients earn a faster-acting option up front rather than after a failed trial.

Dr. Oyedeji brings the question back to the patient, noting many of hers have never been asked what they prefer or what would be meaningful to them. She positions herself as a firm advocate for early intervention, and says offering a newer agent is not unusual in her practice. Patients feel refreshed, she says, when told there may be an option beyond what they have already tried. Her practical rule is that the only interventions that work are the ones patients will actually take. That means asking what fits their daily life before deciding what to prescribe. For a partial responder, she looks to build on gains with an adjunctive agent. When a traditional antidepressant has produced nothing, she looks to a newer mechanism where response may appear within one to two weeks.

Dr. Alva then notes that faster onset means faster decisions but also a different safety surface, and asks Dr. Shirikjian about monitoring cadence. She distinguishes agents delivered through a REMS program, where treatment centers handle monitoring and patients sit for a couple of hours twice weekly at first. What does not change is the boxed warning for suicidal thoughts and behaviors, which these medications carry regardless of trial findings. She checks in more frequently with younger adults and gathers collateral from parents and roommates in the first several weeks. She brings new patients back within two weeks for adverse effect monitoring, not to assess benefit.

In "Dosing MDD Therapies in Medically Complex Patients: Metabolism and Interactions," the panel will work through what comorbidities do to dosing when urgency is pushing the other way.