Here’s the an area about the latest medications and therapies happening in psych. There are many ways to look up treatment and I tried to put them in the pages below or you can check out formal resources but here, I added some personal perspectives. Also, some of these treatments aren’t technically “new” but aren’t frequently prescribed mainly due to coverage but I wanted to place them in a common area with things that are emerging:
Quick Summary of the Newer (3rd/4th Generation) Medications
- Austedo (Deutetrabenazine): newest treatment for tardive dyskinesia (TD)
- Aplenzin XR (Bupropion Hydrobromide/HBr): treatment for depression, SAD
- Belsomra (Suvorexant): treatment for insomnia and Alzheimer’s-related insomnia
- Caplyta (Lumateperone): treatment for BP 1-2 and schizophrenia
- Deplin (L-methylfolate Ca): treatment for reduced folate levels
- Forfivo (Bupropion Hydrochloride): treatment for depression, SAD
- Hetlioz (Tasimelteon): to treat non-24-Hour Sleep-Wake Disorder in adults and nighttime sleep disturbances in Smith-Magenis Syndrome (SMS) patients 16 years of age and older. Also, sleep issues with TBI
- Ingrezza (Valbenazine): first medication approved for treating TD. Currently, being studied for Tourrettes Syndrome
- Latuda (Lurasidone): treatment for schizophrenia and bipolar depression
- Levomilnacipran (Fetzima): treatment for depression. DOC for severe OCD
- Lybalvi (Olanzapine + Samidorphan): the first antipsychotic approved to reduce significant weight gain associated with olanzapine. FDA-approved for schizophrenia and bipolar I disorder in adults
- Rexulti (Brexpiprazole): treatment for schizophrenia and depression, also may help with schizoaffective and PTSD
- Trintellix (Vortioxetine): newer treatment/class of treating depression. FYI the dosage doubles/interacts with bupropion –NIH
- Viibryd (Vilazodone): newest treatment/class to treat depression, possibly causing the lowest sexual side effects, somewhat activating/least drowsiness
- Vraylar (Cariprazine): treatment for schizophrenia and bipolar
| BRAND NAME (GENERIC) | KETALAR (KETAMINE) | TRINTELLIX (VORTIOXETINE) | FETZIMA (LEVOMILNACIPRAN) | VIIBRYD (VILAZODONE) |
|---|---|---|---|---|
| GENERIC | NO | NO | NO | NO |
| INITIAL APPROVAL DATE (FDA Indications ) | 02/19/1970 (general anesthesia) | 09/30/2013 (major depression) | 07/26/2013 (major depression) | 01/21/2011 (major depression) |
| Dosages Available | 10mg, 50mg, 100mg/ml (IV) | 5mg, 10mg, 20mg | 20mg, 40mg, 80mg, 120mg | 10mg, 20mg, 40mg |
| Dosing for Depression | N/A | 10-20mg QD | 40-120mg QD | 20-40mg QD |
| Average $$$ | >$500 (per infusion) | $300/month | $300/month | $220/month |
| Particular Qualities | rapid response, efficacy for treatment resistance depression | cognitive improvement | functional improvement; specifically (norepinephrine depression) | Low sexual side effects, may improve anxiety |
| Notes | Scheduled III medication. Currently also avail nasal spray, sublingual. Initial dosages/length of tx/increased cost of treatment varies | FDA denied approval of cognitive claims | No clear evidence of advantages over existing treatment | Claims not significantly substantiated |
Honorable Mentions
- Mydayis (mixed salts): an option for long-acting (>16 hours) mixed salts; unfortunately it’s hard enough to get coverage for the regular stimulants…
- Jornay PM: methylphenidate XR, the only ADHD dosed @PM. I had ONE patient on this but switched to AM dosing. Most people want and need to be more productive during the day. Although it’s dosed at night and you may wake up less exhausted or more focused…to continue throughout the day you will have to consider additional dosages even at the highest PM dose, which also equals having to spend more $$$$ and less coverage.
- Qelbree (Viloxazine): coverage is complicated and somewhat dependent on being aware of the coverage process to get a discount. At least they give samples. Indications: Adult ADHD (non-stimulant), may improve mood symptoms. Telefriendly; patients can text for a sample, and create a portal for the savings plan.
Newest Medications/Formulations & Unconventional (Off-Label)
- Auvelity (dextromethorphan 45mg/bupropion XR 105mg): yes this is cough medicine with bupropion. It claims to work <1 week, whereas most antidepressants take 4-6 weeks for efficacy. The rep explained how the cough syrup mechanism, is supposed to make the antidepressant work longer and work on different receptors to improve depression/decrease side effects… NMDA receptor antagonists i.e. Ketamine, PCP, NO, cough syrup, etc. may have some psych qualities, but the precise MOA is unknown. One of the doctors wanted to know why can’t we just take bupropion and chase it with cough syrup. I asked why is there a titration dose; the usual starting dosage of Auvelity for major depressive disorder (MDD) is one tablet once per day. After 3 days, your doctor may increase your dosage to one tablet twice per day. You’ll take each dose at least 8 hours apart. (-Medical News Today) …though someone told me, most meds start low, which is true but this is odd to explain to the patient without a clear reason…What is innovative and good about this medication is how it may be a Ketamine alternative, thus more affordable and lately, we’ve been having favorable results.
- Azstarys (serdexmethylphenidate/dexmethylphenidate): a prodrug methylphenidate formulation. The rep did a poor job explaining but basically, it has a sudden onset, and then it retains >16 hours of efficacy via the prodrug serdexmethylphenidate.
New Therapies & Treatment
- Alpha-Stim: using stimulation therapy for PTSD, anxiety, pain, and insomnia.
- ID Genetix: genetic testing that shows interactions with a combination of medications, instead of the individual medications like the other genetic test formats.
- Tera Wave Wand: a device that helps improve circulation and neuro and pain symptoms.
- Transcranial Magnetic Stimulation (TMS): considered one of the safest treatments for TRD and with pregnancy
Additional Websites
Quake Watch: some of these treatments are remixes of other things that did and didn’t work in the past. Here’s a website that lists alternative devices and treatments that have warnings.
THE LATEST TX, COMPARISONS, & COSTS
Here’s another summary of the newer/novel treatments against more traditional psychiatric treatments (SSRIs/SNRIs, older antipsychotics, ECT, standard psychotherapy), listed practical pros & cons, and realistic out-of-pocket cost ranges (U.S., without insurance) per ChatGPT, but would add personal comments:
1) Cobenfy (xanomeline/trospium) — new cholinergic antipsychotic for schizophrenia
Pros vs older antipsychotics: Novel non-dopaminergic mechanism → potentially less risk of extrapyramidal symptoms (EPS) and hyperprolactinemia common with D2 blockers. Option for patients who did not tolerate or respond to dopamine-blocking antipsychotics. I haven’t heard of anyone prescribing this probably due to insurance/costs…
Cons
- New drug → less long-term safety/real-world data than classic agents.
- Possible cholinergic/anticholinergic side-effect profile (dry mouth, constipation, etc.) depending on peripheral blocker effect.
- Likely high initial cost and potential access limits while prior authorization pathways are established.
Out-of-pocket cost (no insurance): roughly $1,800–$2,200 per prescription fill (retail retail price estimates vary; coupons may lower it). Source: retail pricing aggregators. (GoodRx)
2) Spravato (esketamine intranasal) — treatment-resistant depression (now approved as monotherapy in recent updates)
Pros vs SSRIs/SNRIs: Rapid onset (hours–days) vs weeks for traditional antidepressants — valuable for severe TRD and acute suicidality risk. Different mechanism (NMDA/glutamate pathway) → useful when monoaminergic drugs fail. More of my patients are responding well with Ketamine or TMS treatments, but MANY insurances/states/laws/malpractice insurances are still requiring a physician oversight or have unique challenges to implement in practice despite being in an independent full-practice NP state. Double check before going down these routes to not have issues with your license…
Cons
- Requires supervised administration (clinic setting) and post-dose monitoring (observation period).
- Side effects: dissociation, sedation, blood pressure elevations.
- Repeated clinic visits increase time & non-drug costs (transportation, clinic fees).
Out-of-pocket cost (no insurance): medication only ≈ $700–$1,700 per treatment pack/dose depending on dose; the total per-visit clinic cost (medication + administration + monitoring) will be higher (clinics often bill separately for the visit). Examples of quoted retail med prices: $761–$1,663 for common therapy-pack sizes. (SingleCare)
3) IV/subcutaneous Ketamine clinics (off-label ketamine infusions)
Pros vs oral antidepressants: Very rapid symptom relief for many with TRD (hours to days). Can be used as bridge therapy while waiting for slower antidepressants to work.
Cons
- Effects may be short-lived and require repeated/maintenance infusions.
- Addiction potential, dissociative side effects, need for medical monitoring.
- Mostly out-of-pocket (many insurers don’t cover off-label ketamine infusions).
- (Same issue as above)
Out-of-pocket cost (no insurance): $400–$800 per infusion is common; a standard initial course (often 4–6 infusions) typically totals $2,400–$4,800 (not including clinic/assessment fees or maintenance doses). Prices vary widely by clinic and region. (Southern Colorado TMS)
4) TMS (repetitive Transcranial Magnetic Stimulation)
Pros vs antidepressants / ECT: Non-invasive, few systemic side effects, no anesthesia needed. Good option for TRD when meds fail; safer cognitive profile than ECT (no general memory loss typical of ECT).
Cons
- Requires daily clinic visits over several weeks (time commitment).
- Not effective for everyone; response/remission rates moderate.
- Upfront cost can be substantial if not covered.
- (Same issue as above)
Out-of-pocket cost (no insurance): Typical full course ≈ $6,000–$15,000 (about $300 per session on some sliding scales, with total depending on # sessions and technology used). (Axis Integrated Mental Health -)
5) Deep Brain Stimulation (DBS) — for refractory depression/OCD (mostly experimental or tightly selected use)
Pros vs other neuromodulation: Can provide long-term, programmable neuromodulation for severe, otherwise untreatable cases. Helpful when multiple treatments (meds, ECT, TMS) have failed. (Same issue as above)
Cons
- Invasive brain surgery with surgical risks (infection, hemorrhage).
- High cost and ongoing device maintenance (battery replacement, programming).
- Access limited to specialized centers and carefully selected patients.
- (Same issue as above)
Out-of-pocket cost (no insurance): total costs commonly quoted $35,000–$100,000+ for implantation and perioperative care; replacements/repairs can be very expensive (battery replacement alone can exceed $15k in some reports). (Get Lab Test)
6) Vagus Nerve Stimulation (VNS)
Pros: Option for chronic, refractory depression; implanted device provides ongoing stimulation without daily clinic visits.
Cons:
- Surgical implantation and device-related risks; annual device costs and follow-up; inconsistent response in some studies.
- (Same issue as above)
Out-of-pocket cost (no insurance): implantation + first-year costs often in the tens of thousands; studies report substantially higher annual cost profiles for cohorts with VNS vs meds-only but some data suggest cost-neutrality for specific populations over time. (PMC)
7) Focused ultrasound / MR-guided neuromodulation (emerging non-invasive brain-targeting)
Pros: Non-invasive, focal targeting of deep brain regions — potential to treat refractory depression without implants. Short procedure times in ambulatory settings.
Cons
- Newer technology — limited long-term data and variable availability.
- Cost structure and insurance coverage still evolving.
- (Same issue as above)
Out-of-pocket cost (no insurance): site-dependent; not yet standardized — may be less than DBS but often still thousands to tens of thousands depending on whether hospital-level MR guidance and device use are billed. (FUS Foundation)
8) Psychedelic-assisted and psychoplastogen drugs (e.g., DLX-159, GM-5022, psilocybin/MDMA protocols) — investigational or in limited clinical programs
Pros: Rapid and durable effects observed in many trials when combined with psychotherapy. Some newer molecules aim to provide neuroplastic benefits without hallucinatory experience.
Cons
- Mostly experimental or available in controlled clinics/trials — pricing varies widely and insurance rarely covers non-FDA or trial treatments.
- Therapy includes many hours of clinician time (raises total cost).
- Legal/regulatory and standardization issues remain for some agents.
- Again this isn’t a common option for NPs, double check local/state practices…
Out-of-pocket cost (no insurance): varies widely — approved psychedelic therapeutic protocols (where available in pilot clinics or through state programs) have been reported in ranges from $3,000–$15,000+ depending on drug, number of therapy hours, and setting; investigational agents typically have no public retail price until approved. (MGMT Digital)
Practical Comparisons (Summary)
- Efficacy speed: Newer glutamatergic/psychoplastogen approaches and ketamine act much faster than SSRIs/SNRIs (hours–days vs weeks). This is a major clinical advantage in severe TRD or suicidal crises. (See Spravato/ketamine notes.) (SingleCare)
- Tolerability: Some novel agents avoid classic dopamine/serotonin side effects (e.g., Cobenfy avoids primary D2 blockade), but bring their own side-effect profiles (cholinergic effects, dissociation, blood-pressure changes). (GoodRx)
- Access & cost: Many new options are clinic-based and expensive out of pocket, often far costlier than generic SSRIs/SNRIs (which can be <$10–$50/month). Neuromodulation and implantable devices are especially high cost. (Cognitive FX)
- Durability & evidence base: Some treatments (TMS, ketamine, esketamine) have substantial evidence and established clinical pathways; others (new psychoplastogens, some neuromodulation forms) are earlier in development and lack long-term real-world data. (Cognitive FX)
Last Updated Sept. 2025
