Growing Concerns Over Valproate Teratogenicity Present an Opportunity for Lithium
Valproic acid is one of the most frequently prescribed mood-stabilizing agents for bipolar disorder, and in some regions of the world, it now competes with lithium as the preferred treatment of choice for bipolar maintenance. There may soon be restrictions on the use of valproic acid, however, because of the risk in neural tube defects and major congenital malformations in children born to mothers and fathers who take it. In this podcast, Dr. Samuel Dotson, from the Northeast Georgia Health System in Gainesville, Georgia, and Emory University in Atlanta, and Dr. Andrew Nierenberg, from the Dauten Family Center for Bipolar Treatment Innovation at Massachusetts General Hospital and Harvard Medical School, discuss the current state of research regarding the benefits and risks of valproic acid in comparison to lithium use. They also discuss the importance of informing patients about their options, noting that lithium use has sometimes been perceived as riskier than it is. Dr. Dotson and Dr. Nierenberg are the authors of a Guest Editorial titled “Growing Concerns Over Valproate Teratogenicity Present an Opportunity for Lithium” in the March-April 2025 issue of The Journal of Clinical Psychopharmacology.
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Clinical Management of Designer Benzodiazepine Intoxication: A Systematic Review
"Designer benzodiazepines" are lab-created chemical derivatives of prescription benzodiazepines. They have not been approved for medical use and there is limited information on their safety and toxicity. More potent than their prescription counterparts, this subset of novel psychoactive substances have been growing in popularity in recent years and pose the potential for dangerous levels of intoxication. In this podcast, Dr. Sahil Munjal, program director of the Atrium Health Wake Forest Baptist psychiatry residency program, leads a discussion of the article “Clinical Management of Designer Benzodiazepine Intoxication: A Systematic Review," with his coauthors Dr. Gregory Noe, Katelyn Li, and Nicholas McDuffee. They provide an overview of designer benzodiazepines in comparison to prescription benzodiazepines and describe the findings from their review of 35 case reports. They discuss clinical presentations of designer benzodiazepine intoxication, common approaches to clinical management, and key takeaways from their review of the literature. Their article appears in the March-April 2025 issue of The Journal of Clinical Psychopharmacology.
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At Last, a Nondopaminergic Agent for the Treatment of Schizophrenia: The Combination of Xanomeline and Trospium (Cobenfy)
Dr. Donald C. Goff, Marvin Stern professor of psychiatry at NYU Grossman School of Medicine, gives an overview of a new combination drug recently approved by the U.S. Food and Drug Administration for the treatment of schizophrenia. It will be marketed as Cobenfy, and its component active ingredients are xanomeline and trospium chloride, representing the first non-dopaminergic antipsychotic approved by the FDA. Dr. Goff briefly explores the decades of pharmaceutical treatment of schizophrenia and lays out the steps toward developing the new combination drug. He offers details on next steps, treatment, more extensive trials of the new drug, related approaches, and refers listeners to his editorial for prescribing information. His guest editorial, “At Last, a Nondopaminergic Agent for the Treatment of Schizophrenia: The Combination of Xanomeline and Trospium (Cobenfy),” is published in the March-April 2025 issue of The Journal of Clinical Psychopharmacology.
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Ethics in Psychedelic Science: Promises and Responsibilities
Dr. Julia Ann Koretski, a psychiatrist and Digital Editor of the Journal of Clinical Psychopharmacology (JCP), leads a conversation about the guest editorial “Ethics in Psychedelic Science: Promises and Responsibilities” with its author, Dominic Sisti, PhD, a medical ethicist from the Perelman School of Medicine at the University of Pennsylvania, and a JCP podcast panel of Editor-in-Chief Dr. Anthony Rothschild and Associate Editor Dr. Richard Balon. Dr. Sisti provides an overview of recent regulatory actions in this area and summarizes the history of “utopian hype” in the field. The editorial and the podcast discussion detail what elements are required to build a solid ethics infrastructure for psychedelics research and clinical delivery that is free of hype and bias. Sisti advises moving ahead with caution, while noting that “the range of potentially treatable conditions is wide—including PTSD, major depression, anxiety disorder, obsessive compulsive disorder, anorexia nervosa, and substance use disorders.” The guest editorial is published in the January-February 2025 issue of JCP.
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Broad-Spectrum Micronutrients or Antidepressants for Antenatal Depression: Effect on Maternal and Infant Birth Outcomes in an Observational Secondary Analysis of NUTRIMUM
About 20% of women experience depression while they are pregnant, and untreated depression has been associated with increased rates of adverse birth outcomes and complications. In this podcast, Julia J. Rucklidge, PhD, of the University of Canterbury in Christchurch, New Zealand, discusses nutrition, pregnancy, and mental health in detail with psychiatrist and Journal of Clinical Psychopharmacology (JCP) Digital Editor Dr. Julia Ann Koretski. Dr. Rucklidge is the senior author of the article “Broad-Spectrum Micronutrients or Antidepressants for Antenatal Depression: Effect on Maternal and Infant Birth Outcomes in an Observational Secondary Analysis of NUTRIMUM,” which is published in the January-February 2025 issue of JCP. The article reports the outcomes of a randomized clinical trial in which women with depressive symptoms were randomized to receive daily micronutrients or a placebo for 12 weeks during their pregnancy. As reported by Dr. Rucklidge and her colleagues, the micronutrients used to alleviate depression in pregnancy may mitigate negative effects of depression on birth outcomes and have more favorable birth outcomes compared with antidepressants.
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