State of practice
Every year the FDA approves a handful of psychiatric drugs, and every year the label lags what practicing clinicians actually know about them. These pieces track the newer approvals as they land in real practice. Each one summarizes the trial data, walks through dosing and monitoring, and gives a candid read on where the drug fits (and where it doesn't).
These are point-in-time reviews. Sources are cited. Recommendations belong to the treating clinician, not the article. If you want the underlying drug page, follow the link on each piece.
Cobenfy (xanomeline-trospium): state of practice
The first non-dopamine antipsychotic in seven decades. Trial data from EMERGENT, dosing and titration, GI tolerability, drug interactions, and where Cobenfy actually fits in schizophrenia care right now.
Onyda XR and newer non-stimulant ADHD approvals: state of practice
Onyda XR (extended-release liquid clonidine), Qelbree (viloxazine), and the state of non-stimulant ADHD prescribing right now. Where these drugs actually fit, dosing, and how they compare to stimulants for kids and adults.
Ketamine and esketamine (Spravato) for depression: state of practice
IV ketamine and intranasal esketamine (Spravato) for treatment-resistant depression have moved from experimental to established. Practice models, dosing, monitoring, and how these fit alongside Auvelity and traditional antidepressants.
Lecanemab and donanemab: state of practice for anti-amyloid mAbs
The first two disease-modifying drugs for Alzheimer's disease. Patient selection, MRI monitoring for ARIA, infusion logistics, ApoE4 status, and where anti-amyloid antibodies actually fit in dementia care right now.
Rexulti (brexpiprazole) for Alzheimer's agitation: state of practice
Brexpiprazole received FDA approval for Alzheimer's-related agitation in June 2023, the first drug with this specific indication. Trial data, dosing, boxed warning framing, and where it fits alongside non-drug interventions.
Aristada Initio: rapid LAI initiation for aripiprazole
Aristada Initio, approved 2018, enables same-day initiation of aripiprazole LAI treatment with a single-injection loading dose plus one oral aripiprazole dose. Replaces 14 to 21 days of oral overlap required by Abilify Maintena.
Journavx (suzetrigine): state of practice
The first non-opioid acute pain drug in a new class in decades. A selective Nav1.8 sodium channel blocker. Why it matters for psychiatric patients on serotonergic medications, dosing, trial data, and how suzetrigine fits into pain management right now.
Caplyta (lumateperone) for bipolar depression: state of practice
Lumateperone received FDA approval for bipolar I and bipolar II depression in 2021 (monotherapy) with adjunctive approval in 2022. Novel mechanism (5-HT2A, D2, D1, serotonin transporter), minimal weight and metabolic effects, and how it fits in bipolar depression treatment.
Zurzuvae (zuranolone): state of practice
The first oral drug specifically approved for postpartum depression. A 14-day course of a GABA-A positive allosteric modulator. SKYLARK trial data, dosing, sedation, breastfeeding considerations, and how zuranolone is being used in real practice.
Auvelity (dextromethorphan-bupropion): state of practice
The first oral NMDA-modulating antidepressant for MDD. GEMINI trial data, dosing, drug interactions via CYP2D6, and how Auvelity is settling into real-world use after three years on market.
VMAT2 inhibitors for tardive dyskinesia: Ingrezza and Austedo state of practice
Valbenazine (Ingrezza) and deutetrabenazine (Austedo) transformed TD treatment when FDA-approved in 2017. Dosing, tolerability, and how these fit alongside drug switching and clozapine for tardive dyskinesia management.