Refining Your Treatment Options for Major Depressive Disorder (MDD)

When it comes to antipsychotics as an adjunctive treatment for major depressive disorder (MDD), "this is an area where I think a lot of [mental health clinicians] have had experience, but we could do a lot better with it," says Craig Chepke, MD, DFAPA, medical director, Excel Psychiatric Associates. 

In this video taken at the 2023 NP Institute in Boston, Psych Congress Network asked Dr Chepke to breakdown the 4 antipsychotic adjunctive treatments approved for MDD, and explain how clinicians might introduce them into patient treatment plans.

Want more expert insights for your practice? Visit our Major Depressive Disorder Excellence Forum.

Save the date for the 2024 NP Institute, March 20-23 in San Diego, California! For more information, visit the meeting website.

Read the Transcript:

Craig Chepke, MD, DFAPA: Hi, I'm Dr. Craig Chepke. I'm a psychiatrist and the medical director of Excel Psychiatric Associates in Huntersville, North Carolina. And I'm also an adjunct associate professor of psychiatry for Atrium Health, and I'm on the steering committee and the scientific advisor of Psych Congress

In my session at the Psych Congress NP Institute on antipsychotics and mood disorders, I focused on antipsychotics and major depressive disorder. And this is an area where I think a lot of us have had experience, but we could do a lot better with it.

We have four approved antipsychotics, adjunct to antidepressants, and they're all approved as adjuncts, none as monotherapy. And each one has strengths and weaknesses. That's really one of my key takeaways is that all four of the medications are actually all very different, so lumping them together as antipsychotics, we may start to think of them as interchangeable, and they're really not. They're all pharmacodynamically very different from each other.

Even the three aripiprazole, brexpiprazole, and caraprazine are very commonly lumped together as the partial agonist, which is referring to their dopamine partial agonism. They're all extraordinarily different medications, and we need to think about them differently and figure out which medications have the best strengths, weakness profile for each individual patient. And overall, just using them more most likely because we have some biases against using antipsychotics, I feel in the field. And when we have patients who could benefit from them, we really need to offer those as part of a shared decision making protocol.

Craig Chepke, MD, DFAPA, is a Board-Certified psychiatrist and a Distinguished Fellow of the American Psychiatric Association. Dr Chepke is the medical director of Excel Psychiatric Associates in Huntersville, NC as well as an Adjunct Associate Professor of Psychiatry for Atrium Health. As part of an interdisciplinary treatment team, he employs a person-centered care model to tailor treatments to each individual's needs, integrating traditional pharmacotherapy with psychotherapeutic and physical health and wellness interventions.