SNRI‐NaSSA combination therapy for treatment‐resistant depression

Abstract

Although more quality research is required to inform clinical practice, serotonin‐noradrenaline reuptake inhibitor ‐ noradrenaline and specific serotonergic antidepressant (SNRI‐NaSSA) combination therapy shows promise for treatment‐resistant depression. Here, Dr Pandarakalam discusses the rationale behind the use of this combination and some of the evidence gained so far for its efficacy. Copyright © 2010 Wiley Interface Ltd

Decoding Clozapine-Induced Agranulocytosis: Unraveling Interactions and Mitigation Strategies

“…Although clozapine is considered the gold standard treatment for TRS, other antipsychotic medications may be suitable alternatives in specific cases. The British Journal of Medical Practitioners suggested that combinations of antipsychotics such as olanzapine and amisulpride might be effective in cases where clozapine is unsuitable [ 61 ]. Additionally, various augmentation strategies, including other antipsychotics, mood stabilizers, benzodiazepines, lithium, electroconvulsive therapy, and repetitive transcranial magnetic stimulation, have been used, although there is a lack of strong evidence for these interventions [ 61 ].…”

“…The British Journal of Medical Practitioners suggested that combinations of antipsychotics such as olanzapine and amisulpride might be effective in cases where clozapine is unsuitable [ 61 ]. Additionally, various augmentation strategies, including other antipsychotics, mood stabilizers, benzodiazepines, lithium, electroconvulsive therapy, and repetitive transcranial magnetic stimulation, have been used, although there is a lack of strong evidence for these interventions [ 61 ]. It is also noted that combining depot antipsychotics with oral drugs from different classes is a generally accepted practice [ 61 ].…”

“…Additionally, various augmentation strategies, including other antipsychotics, mood stabilizers, benzodiazepines, lithium, electroconvulsive therapy, and repetitive transcranial magnetic stimulation, have been used, although there is a lack of strong evidence for these interventions [ 61 ]. It is also noted that combining depot antipsychotics with oral drugs from different classes is a generally accepted practice [ 61 ]. A systematic review of the use of granulocyte colony-stimulating factor in clozapine rechallenges by [ 62 ] found that patients who had previously experienced CIA were treated with granulocyte colony-stimulating factor (G-CSF), such that, for example, filgrastim might shorten the period of agranulocytosis by approximately five days.…”

Phase 2 Results Indicate Evenamide, A Selective Modulator of Glutamate Release, Is Associated With Clinically Important Long-Term Efficacy When Added to an Antipsychotic in Patients With Treatment-Resistant Schizophrenia

“…Clozapine, approved for TRS, is vastly under-utilized, due to its blood monitoring requirement and side-effects (neutropenia, metabolic syndrome), and at least 30% of patients do not respond to clozapine. Other strategies to treat TRS, such as combining 2 APs are ineffective ( Elkis and Buckley, 2016 ; Nucifora, et al, 2019 ; Pandarakalam JP, 2019 ), as glutamatergic mechanisms have been shown to be involved in the etiopathogenesis of schizophrenia ( Schwartz, 2012 ; Egerton et al, 2020 ). This is supported by data from patients with TRS and first-episode nonresponders who demonstrate normal dopamine synthesis capacity ( Kim et al, 2017 ; Jauhar et al, 2018 ) but higher levels of glutamate in the anterior cingulate cortex ( Egerton et al, 2012 ).…”