Expert opinion on pharmacotherapy
December 1, 2024
Millie C Kirchberg, Claire Pinson, Guido K W Frank
9 citations
Anorexia nervosa has one of the highest mortality rates among mental illnesses, yet no approved pharmacological treatments exist. This narrative review examines traditional pharmacotherapy and novel treatments—including dissociative anesthetics, psychedelics, cannabinoids, hormones, neurosteroids, and ketogenic nutrition—for altering neurobiology and behavior. The authors recommend a neuroscience-based medication approach targeting dopamine receptors to enhance cognitive flexibility and reduce food-related dread when psychotherapy fails. Treating comorbid anxiety, depression, and obsessive-compulsive disorder is essential, as these conditions persist even after successful anorexia treatment. Novel strategies show promise for improving mood and reducing specific anorexia psychopathology and may soon enter clinical practice.
Expert opinion on pharmacotherapy
March 1, 2024
Georgios D Kotzalidis, Federica Fiaschè, Alessandro Alcibiade et al.
3 citations
Suicidal behavior is common among people with bipolar disorder and is the leading cause of death in this group, with rates remaining high despite standard treatments like lithium, antidepressants, and psychotherapy. A review of PubMed identified few studies on acute suicidality and lithium or clozapine, but 14 studies on ketamine, esketamine, or glutamate-related treatments. Glutamatergic abnormalities are present in both bipolar disorder and suicide. The NMDA antagonist ketamine and its S-enantiomer esketamine appear to decrease acute suicidality, possibly by rapidly remodeling glutamate activity. Intranasal esketamine or subcutaneous ketamine, and possibly other glutamate receptor modulators, may improve suicidal behavior in unipolar and bipolar depression, suggesting glutamatergic modulators could reduce acute suicidality and mortality in bipolar disorder.
Expert opinion on pharmacotherapy
February 1, 2026
Alessandro Cuomo, Mario Pinzi, Andrea Fagiolini
Major depressive disorder remains a leading cause of disability globally. Many patients do not respond adequately to traditional antidepressants. This review examines phase 3 clinical trial evidence for newer agents, including brexanolone, intranasal esketamine, dextromethorphan-bupropion, vortioxetine, and glucagon-like peptide-1 receptor agonists. These treatments offer rapid symptom relief and potential cognitive or metabolic benefits for conditions like postpartum depression, acute suicidal ideation, and treatment-resistant depression. However, limited integration into clinical guidelines, insufficient long-term data, and implementation barriers restrict their use. The authors call for clearer treatment sequencing strategies and harmonized recommendations to support more individualized depression management.
Expert opinion on pharmacotherapy
February 1, 2025
Alejandra Pulido-Saavedra, Anna Borelli, Razi Kitaneh et al.
Substance use disorders remain a public health challenge; few have FDA-approved treatments, and those that do suffer from high dropout rates. This narrative review examined clinical evidence for non-psychedelic medications that primarily target the 5-HT2A receptor. Results on craving and abstinence were mixed, with some positive effects but no consistent pattern. Comparing these findings with those for psychedelic agents (which are typically 5-HT2A agonists) suggests that mixed results are not unique to non-psychedelics. Because most non-psychedelic agents reviewed are 5-HT2A antagonists, while psychedelic agonists show more uniformly positive outcomes, the authors propose that 5-HT2A receptor agonists are a promising avenue for treating substance use disorders, possibly by addressing a common underlying chronic hypodopaminergic state.