Several new psychiatric medications have recently been approved or are nearing approval. Auvelity, a combination of bupropion and dextromethorphan, is a novel antidepressant that speeds up response and remission compared to bupropion alone. Zuranolone, an oral medication for postpartum depression, works in just 14 days and shows improvement lasting 45 days. Gepirone, a 5HT1a receptor partial agonist, was approved for major depression with a favorable side effect profile. Cariprazine was approved as an adjunctive treatment for resistant depression, with easy dosing and lower metabolic side effects.
In people with treatment-resistant depression, adding esketamine nasal spray to an oral antidepressant is more effective than an antidepressant plus placebo for both acute and long-term treatment. For every 8 patients treated, one additional patient achieves a 50% or greater reduction in depressive symptoms; for every 6 patients, one additional patient achieves remission. Common side effects include dissociation, vertigo, nausea, dizziness, and dysgeusia, each occurring in roughly 1 in 5 to 1 in 4 patients. Discontinuation due to side effects is uncommon. Patients are about 3 times more likely to achieve remission than to stop treatment due to a side effect.