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Overview

For three decades, the psychopharmacologic armamentarium for the treatment of depression and many psychiatric disorders has centered on the “Monoamine Hypothesis” – the assumption that that epinephrine, norepinephrine and dopamine comprise the neurotransmitters most influential in symptom control. Psychiatry has thus witnessed the development of many SSRIs and SNRIs that are molecular permutations of each other, with few agents presumed able to leverage novel mechanisms, and most requiring greater than 6 weeks to elicit clinical response. Ketamine, classical psychedelics, and interventional neurotherapeutics, however, may significantly change the static status quo. Within the realms of “novel/emerging” and “potential” (pipeline) interventions,  mechanistically novel ketamine and esketamine have prompted cautious optimism for select patient populations; looking to the near-term future, pipeline agents MDMA and psilocybin appear poised as potential best-in-class new agents, with pivotal phase III psilocybin data expected shortly. With potential promise also comes potential peril, however. Misinformation in popular culture and social media abounds, and the dissemination of evidence-based, data-driven knowledge about these agents and psychiatry’s emerging next chapter is paramount. At this unique moment in psychiatric history, join us for a rapid overview of key agents capturing public and professional attention in a spirit of cautious optimism.

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Learning Objectives

  • Identify the unique challenges of “translational” medicine in the current era of rapidly emerging pipeline medications and therapies, while emphasizing evidence-based practice, safety, and the impact of misinformation and regulatory gaps
  • Conceptualize ketamine and esketamine as first-in-class examples of emerging translational therapies, focusing on their clinical and mechanistic novelty, evidence-based use, key indications, and side effects
  • Recognize the clinical potential and mechanistic differences of next-generation, allied treatments in the translational pipeline, including psilocybin and MDMA