TREATMENT

INTRODUCTION BY DR. PAUL BROWN, RIVERBEND’S NEW CHIEF MEDICAL OFFICER

What an exciting time this is to be a psychiatric provider. There are many promising therapies available already, with many more about to emerge into general use soon — hopefully this year. I am quite excited about the apparent efficacy of psychedelics for treating a broad range of addictions as well as severe depression, suicidal ideation, and post-traumatic stress disorder (PTSD). Psilocybin has shown remarkable outcomes in studies on refractory depression as well as intractable addictions, particularly alcoholism. Other psychoactive drugs like MDMA have also shown significant promise in the treatment of PTSD. Many in our field believe we are entering a “Golden Age” of the use of these and other psychedelics in psychiatry.

Another potential leap forward comes from encouraging research in the treatment of schizophrenia that has not responded well to other treatments. Xanomeline, when combined with Trospium to make the Xanomeline easily tolerable, has shown a remarkable effect on refractory psychosis. This combination has also brought about dramatic improvement in both positive and negative symptoms of severe Schizophrenia in Phase 3 clinical trials. Xanomeline has a mechanism of action that has never been enlisted to treat Schizophrenia before. It is likely to be quickly approved as a stand-alone treatment and also for use in combination with other existing medications in cases where those treatments alone have not produced the desired symptom remission. Many believe it will be approved for use as early as this year, and it could be a game-changer for the profession and some of our clients.

In recent months, the FDA has approved use of transcranial magnetic stimulation (TMS) for anxious depression and in treating refractory Obsessive-Compulsive Disorder. TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to address symptoms of depression and anxiety. This is an exciting, novel approach to brain stimulation that appears to be well-tolerated by clients. It has received growing interest for a broader range of indications with each passing year.

I was originally drawn to psychiatry because it was a field with so many exciting frontiers to explore and seemingly limitless potential for new understanding and innovation. We are learning more about the remarkable human brain with each passing month, and I am confident that evolving developments within psychiatry will offer us all a healing and hopeful journey in 2023 and in the years to come.