This educational activity teaches clinicians how esketamine works for depression, including its mechanism, how the body processes it, and its effects. It explains how to assess its effectiveness, choose doses, and apply clinical considerations for treatment-resistant depression and major depression with suicidal thoughts. The activity also covers identifying and managing common and serious side effects, along with monitoring and risk-reduction strategies under the REMS program.
Dextromethorphan/bupropion is an oral medication that pairs an NMDA receptor antagonist and σ-1 agonist (dextromethorphan) with a CYP2D6-inhibiting NDRI (bupropion). Bupropion's inhibition of CYP2D6 increases dextromethorphan's bioavailability and extends its half-life roughly threefold. The drug has two FDA-approved indications: major depressive disorder, where it shows rapid antidepressant effects by week 1, and agitation associated with Alzheimer's disease dementia, where it is the first non-antipsychotic option. Absolute contraindications include seizure disorder, current or prior eating disorder, abrupt discontinuation of alcohol/benzodiazepines/barbiturates/antiepileptics, and concurrent or recent MAOI use.
Dextromethorphan/bupropion is an oral NMDA receptor antagonist combination that produces rapid antidepressant effects within the first week of treatment. Bupropion inhibits CYP2D6, enhancing dextromethorphan's bioavailability. Absolute contraindications include seizure disorders, eating disorders, and abrupt discontinuation of alcohol or benzodiazepines. Dosing adjustments are needed for patients taking strong CYP2D6 inhibitors or those with moderate renal impairment. Clinical use requires assessing abuse potential, managing common adverse effects like dizziness and nausea, and monitoring for severe events such as serotonin syndrome and angle-closure glaucoma.