New antidepressant medications
According to the World Health Organization (WHO), depression is a leading cause of disability worldwide, affecting over 264 million people.
The National Center for Health Statistics reports approximately 12.7% of Americans ages 12 and up used antidepressant medications in the past month, according to data from 2011 to 2014.
The Food and Drug Administration (FDA) recently approved two new antidepressant medications that represent new approaches to treating depression: brexanolone and esketamine.
Both of these medications carry a black box warning, which is the most serious warning from the FDA. It alerts you of potentially serious drug effects.
For brexanolone, there’s a warning for excessive sedation and sudden loss of consciousness. People taking this drug should have continuous pulse oximetry monitoring and must be accompanied during interactions with children.
For esketamine, warnings include:
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- Sedation and dissociation. After each treatment session, people who take this drug should be monitored for at least 2 hours.
- Abuse and misuse.
- Suicidal thoughts and behaviors. Antidepressants increase the risk of suicidal thoughts and behaviors in children and teens.
Brexanolone
Brexanolone (sold under the brand name Zulresso) was approved by the FDA in March 2019. A derivative of allopregnanolone (a naturally produced steroid), it’s a new type of antidepressant. It appears to begin working within hours.
Brexanolone is the first drug to have been scientifically shown to treat postpartum depression (PPD). PPD is a type of depression that can set in following childbirth. It often presents with symptoms such as anxiety, mood swings, and difficulty sleeping.
According to the Centers for Disease Control and Prevention (CDC), 1 in every 8 American women experience PPD.
How does it work?
Brexanolone modulates the function of the brain’s gamma-aminobutyric acid type A (GABA-A) receptors. GABA receptors may have an important function in altering vulnerability to anxiety and depression. How exactly brexanolone exerts its antidepressant effects isn’t known.
Side effects
Common side effects of brexanolone include:
- Dizziness
- Sedation
- Dry mouth
- Loss of consciousness
- Hot flushes
Esketamine
Esketamine (sold under the brand name Spravato) was approved by the FDA in March 2019.
Esketamine is in a new class of antidepressants, based on the pain medication and general anesthetic ketamine, a drug that has been used clinically for decades.
It’s the first ketamine-based antidepressant for people experiencing treatment resistant depression (TRD). TRD is depression that doesn’t get better after at least two antidepressant therapies.
Recently, the FDA also approved esketamine for people who are having suicidal thoughts or have attempted to harm themselves. Esketamine is recognized for its quick action — many people see symptoms of major depressive disorder reduced within 24 hours of the first dose. Other medications can take weeks before benefits are observed.
In both indications, esketamine is approved alongside an oral antidepressant. That means it will always be taken with another medication to treat these conditions.
