Chapter 22: Emerging Treatments for Psychiatric Disorders

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Welcome back to the Deep Dive.

We're diving into some pretty cutting -edge stuff this time.

We're talking about the future of psychiatric treatments and, well, frankly, some of it's a lot of buzz, a lot of excitement, but also some healthy skepticism surrounding these emerging treatments.

For sure, and that's exactly why we're here to break it all down.

You sent us chapter 22 and 23 from the ninth edition of the Handbook of Clinical Psychopharmacology for Therapists.

Yeah, these chapters really give us a glimpse into what's on the horizon for mental health care.

A glimpse into the future.

I like that.

The book starts by highlighting the sheer number of new treatments in development, which is really exciting.

There are over two dozen new medications in pre -release research right now.

Okay, two dozen new medications.

I'm already intrigued, but I guess the big question is, where do we even begin?

Well, why don't we start with one that's already making wigs?

Ketamine.

Ketamine.

Okay, yeah, I've seen those ketamine clinics popping up.

It's really interesting how ketamine has gone from being used as an anesthetic, you know, back in the Vietnam War, and now being explored as a potential treatment for depression.

Yeah, like, almost overnight.

Well, not quite that fast, but it is true that ketamine is gaining traction, especially for people with severe treatment -resistant depression.

In fact, ascetamine, the nasal spray form, has actually received FDA approval for this use.

Wow, FDA approval.

That's a big deal.

So what makes ketamine so different from the antidepressants that are already available?

Well, it all comes down to how it works in the brain.

Ketamine blocks something called the NMDA receptor.

The NMDA receptor.

And that's completely different from how traditional antidepressants work.

Those usually target serotonin or norepinephrine.

So it's like taking a totally different path to get to the same destination.

Exactly.

And because of this unique mechanism, ketamine seems to work much faster.

Oh, really?

Yeah.

People often experience relief within hours, whereas with traditional antidepressants, it can take weeks or even months to see any improvement.

That's huge, especially for people who are struggling with suicidal thoughts, where obviously rapid intervention is critical.

Exactly.

And that's one of the areas where ketamine shows the most promise.

This is really helpful for people who haven't had success with other treatments.

But are there downsides?

What are the risks?

There are some things to consider.

The effects of ketamine are pretty short -lived.

They usually only last a few days to a week, which means patients need infusions, intravenous infusions pretty regularly to keep those benefits going.

Okay.

So it's not a one -time fix.

Unfortunately not at this point.

And there are potential side effects too, like hallucinations and this feeling of being detached from reality.

These usually go away quickly, but I mean, they can be unsettling for some people.

Yeah, I could imagine.

And what about long -term effects?

I mean, we hear so much about the potential benefits, but is there enough research on its safety over time?

That's a valid concern.

And honestly, that's an area where we need more research.

We know ketamine has been used safely as an anesthetic for decades, but its long -term effects, when it's used repeatedly for mental health conditions, we still don't have all the answers.

It seems like with any new treatment, there's that balance between the potential benefits and the unknown risks.

It's a tough call.

It is.

It really is.

And speaking of weighing potential benefits and risks, let's talk about cannabis.

Okay.

Cannabis.

I mean, that's everywhere in the news these days, right?

It is.

And there are more and more states legalizing it for medical and recreational use.

But when it comes to the science, whether it actually works for mental health conditions, well, that's a bit more complicated.

Complicated how?

Well, a lot of people think cannabis is helpful for things like PTSD and anxiety, but the evidence from rigorous clinical trials is pretty limited.

So there's this gap between public perception and the scientific evidence.

Exactly.

I mean, 33 states have legalized medical marijuana, and about two -thirds of those states allow it for PTSD.

But here's the thing.

Back in 2017, the National Academies of Sciences did a big review, and they found very little evidence to back up its effectiveness for PTSD or anxiety.

Oh, wow.

So how do we navigate that disconnect?

I mean, you've got people who swear by it, but then the science isn't quite there yet.

It seems like a tricky situation.

It is tricky.

We have to be careful not to let anecdotal evidence or what we see in the media overshadow the need for solid research.

I hear that.

We need to base decisions on facts, not just what's trending on social media.

Exactly.

And that tension between public perception and scientific evidence, it becomes even more, I don't know, pronounced when we start talking about psychedelics.

Oh, that's a whole other can of worms, right?

I remember reading that they were used in psychiatry way back in the day, but then basically they were banned.

You're right.

They got classified as schedule I drugs, meaning they were considered to have no currently accepted medical use and a high potential for abuse.

That pretty much shut down research and clinical use for a long time.

Wow.

So what's changed?

Why are we seeing this resurgence of interest now?

Well, even with stigma and legal restrictions, there were a few researchers who kept exploring the potential benefits of psychedelics.

And now with mental health awareness growing and seeing the limitations of current treatments, there's this movement to kind of reevaluate the role of psychedelics in psychiatry.

So are they being used clinically now?

Not widely, no, but there are a lot of promising clinical trials going on.

Oh, okay.

For example, psilocybin.

That's the active ingredient magic mushroom.

Exactly psilocybin.

They're looking at it as a treatment for things like depression and anxiety often combined with psychotherapy.

Interesting using psychedelics along with therapy.

I'm really curious to see where that research goes.

What other psychedelics are being explored?

Well, MDMA also known as ecstasy is gaining attention.

They're studying it for PTSD.

Okay.

And researchers are even revisiting LSD.

Those studies are still in their early stages though.

It seems like there's a lot of potential there, but also a lot of caution.

You're absolutely right.

We definitely need more research, especially on long -term safety before we even think about using these substances more widely.

These are powerful substances that affect the brain and we have to proceed with a lot of, I guess you could say a lot of respect and caution.

It's a fine line to walk, isn't it?

Between hope and being cautious.

But it's good that these conversations are finally happening.

I agree.

And you know, it's not just about these newer,

maybe more controversial treatments.

There's also a lot of exciting work being done with repurposing existing medications.

Repurposing.

You mean using drugs that were already developed for other things to treat mental health condition.

Exactly.

It's actually a really clever approach because you can bypass a lot of the time and expense of developing brand new drugs.

And the great thing is we already know a lot about their safety.

So which existing drugs are showing potential?

I'm super curious.

One example that might surprise you is NSAIDs.

Wait, NSAIDs, those are like common pain relievers, right?

Like ibuprofen and stuff.

That's right.

Really?

Pain relievers for mental health.

It might seem strange, but there's actually growing evidence that NSAIDs can have antidepressant effects, especially for people whose depression might be linked to inflammation in the body.

Oh, wow.

That's so interesting.

It's like we're discovering this hidden talent in medications we already use.

Are there other examples of repurposing like this?

Oh, definitely.

Researchers are exploring statins.

Those are the cholesterol lowering drugs.

And then there are the polyunsaturated fatty acids.

Those are in fish oil supplements.

Even pioglitazone, which is a diabetes drug, those are all showing some promise.

That's incredible.

It feels like the possibilities are endless.

It does feel like the field is on the cusp of some major breakthroughs.

The authors of the handbook emphasize the need for what they call a deliberate, measured, and reasonable approach.

They want to avoid rushing into things even when there's pressure to move quickly.

That makes sense.

You don't want to just jump on the bandwagon with something as important as mental health treatment.

But how do you balance scientific caution with the needs of people who are suffering right now?

You mentioned veterans with PTSD, for example, and how there's this huge demand for cannabis, even though the evidence isn't that strong.

You're right.

That's a really difficult question.

And that's exactly the tension the authors highlight.

They use that cannabis example to show how sometimes political and social forces can outpace the science.

They warn about letting those pressures, those really powerful forces,

override the need for solid data.

So it's a reminder that good science takes time.

We need to be patient, even when people are understandably desperate for solutions.

I think so.

It's a call for making informed decisions both for individuals and for policymakers.

We need to think critically, ask questions, and look for the evidence.

Well, this has been an incredible overview, to say the least.

We've covered so much from ketamine's journey to the complexities of cannabis and now the re -emergence of psychedelics.

And honestly, it feels like we've just scratched the surface.

There's definitely a lot more to unpack, and I'm excited to delve into medication discontinuation in the next part of our deep dive.

Yes, stay tuned listeners.

We'll be back shortly to continue this fascinating exploration.

Welcome back.

Glad we can dive a little deeper into medication discontinuation.

It's something that doesn't always get the attention it deserves.

It really does it.

You're right.

I mean, it's not something you really want to think about when you're first starting a medication, but it's so important.

Chapter 23 really emphasized that.

And honestly, it was a bit eye -opening.

Yeah, it stresses how important it is to have a plan, you know, not just stop a medication, cold turkey.

That can be pretty risky.

Yeah, for sure.

They even use the example of benzodiazepines.

If someone just stops those suddenly, they could actually have seizures.

Oh, wow.

Yeah, that's serious.

So what are the things that determine like how someone should discontinue a medication?

Well, the type of Medicaid is a big one.

Some meds need to be papered off much more slowly than others.

How long the person has been taking it matters too.

Someone who's been on a medication for years will probably need a longer paper than someone who's only been on it for a few months.

Okay, yeah, that makes sense.

So like a gradual process.

Exactly.

And then, of course, you have to consider what condition is being treated.

The goal is always to discontinue safely, right, and minimize the risk of relapse or withdrawal symptoms.

Right, right.

So are withdrawal symptoms common even when you're tapering off slowly?

They can be, unfortunately, even when you're doing everything right.

That's why it's important to be aware of that possibility and, you know, have open communication with your throughout the process.

So what kind of withdrawal symptoms are we talking about?

It really depends on the specific medication.

I mean, it could be anything from just mild discomfort to, you know, more intense things like flu -like symptoms, anxiety, mood swings, even problems sleeping.

It's wild.

The book even mentions that just switching to a shorter acting version of a medication can sometimes trigger these symptoms, even if the dosage is the same.

Wow.

So even subtle changes can have a big impact.

What can people do to manage those symptoms if they do experience them?

Again, I think communication with your doctor is key.

They can help adjust the tapering schedule, maybe offer supportive therapy or even prescribe meds to specifically target those withdrawal symptoms.

So it's a whole process.

It's not just about stopping the medication.

It's about managing that transition.

It's a lot more complex than I realized.

It definitely can be.

And there's this other layer of complexity.

The book talks about something called medication

unresponsiveness.

Medication unresponsiveness.

OK, that sounds a little scary.

What is that exactly?

Well, it's basically when someone stops a medication, then has a relapse and then finds that the same medication that worked for them before, it doesn't work anymore.

So even if it was effective before, there's no guarantee it'll work again after you've been off it for a while.

That's right.

Wow.

That's a little unsettling.

Yeah, it can be.

And we don't fully understand why it happens.

The book mentions it's been seen with lithium for bipolar disorder, some antidepressants and antipsychotics.

Some researchers think it might have to do with in the brain, like neurophysiological changes that happen after each episode, like of mania, depression or psychosis.

So it's like the brain is adapted to the medication and then when you stop, those adaptations sort of stick around and make it less effective.

Something like that, yeah.

That's so complex.

So if someone does experience that, that unresponsiveness, what are their options?

It's definitely challenging.

Their doctor might try adjusting the dosage or adding another medication or even switching to a completely different class of drug.

It often takes a bit of trial and error to find what works after a relapse.

It sounds like a very individualized process.

There's no one -size -fits -all approach.

Absolutely.

It requires planning, communication and a willingness to adapt.

And speaking of individualized approaches, we can't forget about the special considerations during pregnancy.

Oh, right.

The book did touch on that, how certain psychiatric meds can potentially affect newborns.

Exactly.

They specifically mentioned psychostimulants and benzodiazepines.

If the mother's taking those during pregnancy, the baby might experience withdrawal symptoms after birth.

Wow.

That's something I never really thought about.

It really highlights the need to think about the long -term effects and not just the immediate benefits, right?

Absolutely.

You have to consider all the angles.

It makes you realize that medication management is much more than just taking a pill.

It's about understanding this whole complex interplay between the medication and the brain and the individual's needs and everything else going on.

I completely agree.

It requires scientific knowledge, clinical expertise and that open communication between patient and doctor.

And speaking of that balance, I mean, this whole deep dive has really been an eye -opener.

We've talked about so much the potential of new treatments, the importance of scientific rigor, now the intricacies of medication discontinuation.

It feels like mental health care is at a turning point.

I think you're right.

It feels like we're moving towards treatment that's more personalized, moving away from that one -size -fits -all approach, really embracing the uniqueness of each person's brain and experiences.

So it's not just about new drugs.

It's about a new way of thinking about mental health altogether.

Exactly.

It's about understanding how biology, psychology and even social factors all intertwine.

And that's where the real hope lies in an approach that combines cutting -edge science with compassionate, individualized care.

Okay, but let's play devil's advocate for a second.

What about the downsides of all this innovation?

Sometimes technology moves faster than our ability to, you know, grasp the consequences.

Are there any red flags we should be watching out for?

That's a great point.

Like, with any powerful tool, there's always the potential for misuse.

One concern is access and affordability.

Will these new treatments be available to everyone who needs them, regardless of, you know, that they're in your home or insurance?

Like that saying, a rising tide doesn't lift all boats.

We don't want these advancements to create a bigger divide between those who can afford cutting -edge care and those who can't.

Absolutely.

And then there's the whole ethical dimension to consider.

As we learn more about the brain and how it works, we're going to be faced with some really tough questions.

Questions about, you know, personal autonomy, privacy, even the very definition of what it means to be human.

Whoa, that's getting pretty deep.

It's like those sci -fi movies where technology starts to blur the lines between, you know, what's real and what's artificial.

Right.

Do we really want to go down that road with our brains?

I think that's a conversation we need to have now before it's too late.

We have to make sure these powerful tools are used responsibly, ethically, and in a way that benefits everyone.

This deep dive has definitely given us a lot to think about.

We've covered so much ground.

I'm curious, what stood out to you the most from these chapters?

For me, it was that sense of cautious optimism that I felt throughout the book.

They're excited about the possibilities, but they also acknowledge the challenges and potential risks.

I agree.

It's like balancing act between hope and realism.

We need to keep striving for progress, but we also need to be mindful of the ethical and social implications.

I think that's a great point to kind of wrap up this part of our discussion, but we're not done yet.

We still need to answer that thought -provoking question we posed earlier.

So don't go anywhere.

Okay.

So we're back for the final part of our deep dive into these emerging psychiatric treatments.

And remember that question we had earlier, you know, like if you were a researcher in this field, what area would you be most interested in?

Yeah, I'm curious to hear what sparked your interest.

I mean, there's just so much going on in mental health research right now.

It's hard to pick just one thing, you know.

I know, right?

After reading these chapters and talking with you, it's like we're really at this

turning point.

But honestly, this fluff about psychedelics that really caught my attention, it just seems like, I don't know, this untreaded territory.

So much promise, but also kind of mysterious, even a little maybe a little scary.

Yeah, I can see why you'd be drawn to that.

Psychedelics, I mean, they really do represent a whole different way of thinking about treating mental illness.

For so long, we've focused on, you know, addiction and a potential for harm.

But now we're starting to see that maybe, just maybe, they could be the key to like unlocking new ways to help people heal.

Yeah, that's what's so fascinating to me.

Like, if I were a researcher, I'd want to be part of figuring that out, you know, understanding how they work in the brain, like on a really deep level, and how we can use them, but use them safely to create real lasting change.

It's exciting, right?

Like opening up this whole new realm of possibilities.

Imagine like being able to use these substances to help people overcome trauma or break free from these, you know, these negative thought patterns to help them experience like a profound shift in how they see the world.

It's a powerful idea.

But of course, there's that whole history, right?

They've been misunderstood.

And that led to some real problems.

Absolutely.

That's why it's so important to approach this research carefully, you know, with solid scientific methods, ethical guidelines,

and well, just a deep respect for the power of these substances, we have to make sure they're used safely and for the right reasons.

It seems like we need a whole new way of thinking about psychedelics, right?

Something that moves past that fear based approach we had in the past, and embraces a more, I don't know, a more nuanced science driven perspective.

Yeah, I think you're hitting the nail on the head there.

It's about shifting the narrative from

dangerous drugs to potential tools for healing.

But that's going to take all of us researchers, clinicians, policymakers, even the public.

We all need to be part of this conversation, you know, an open, honest and evidence based conversation.

It's like we're at this crossroads.

We have a chance to, I don't know, rewrite the story of psychedelics to reclaim their potential for good.

I love that.

And it's not just about psychedelics either.

It's about this whole shift happening in mental health care, this move towards more personalized care, a more holistic approach, really understanding each person as an individual.

It's a pretty exciting time to be following all of this.

And I'm so glad we had this chance to really dig into these chapters.

Me too.

It's always inspiring to have these kinds of discussions and see what's on the horizon for mental health care.

And to all of you listening, thank you for joining us on this journey.

We hope you found it as fascinating as we did.

It's a reminder that the world of psychiatric treatment is constantly changing and it's up to all of us to stay informed, keep asking questions and advocate for safe, effective and accessible mental health care for everyone.

Until next time, stay curious.