When Will My Depression Get Better?: Current Status of Rapid-onset Antidepressants in Hospice and Palliative Care.

Key Message: Rapid-onset antidepressants offer a quick and effective way to manage depression, anxiety, and existential distress in palliative care patients with advanced illness. This session explores their pharmacology, clinical use, safety, and potential to improve quality of life compared to traditional treatments.

Abstract: Rapid-onset antidepressants offer a groundbreaking approach to managing depressive symptoms in palliative care, especially for patients with advanced illness and poor prognosis. Unlike traditional antidepressants, which focus on biogenic amines and take weeks to show effectiveness, research has identified an ever-expanding list of newer pharmacotherapeutic agents with the potential to provide relief from depression within hours to days, often with just one dose. These agents are particularly beneficial in palliative care, delivering significant effect sizes, alleviating treatment-resistant symptoms such as anhedonia, and quickly reducing existential distress and suicidal thoughts. This session, led by experts in palliative care, psychiatry, and pharmacology, delves into the pharmacology, clinical applications, and safety of these agents in end-of-life care. Key compounds, including FDA-approved esketamine, and experimental psilocybin, are highlighted for their AMPA receptor potentiation, which facilitates rapid mood improvements. Attendees will: 1) Gain insight into the pharmacology and mechanisms of rapid-onset antidepressants; 2) Explore their use in addressing depression, anxiety, and existential distress in terminally ill patients; 3) Review safety profiles, including managing side effects like dissociation or bradycardia; 4) learn about appropriate dosing and administration routes (e.g., intravenous, intranasal, oral) tailored to hospice and monitored settings; 5) Examine case studies illustrating effective symptom control in palliative care; and 6.) Identify when to consider referral for transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT).. By comparing these agents to conventional therapies, the session highlights their ability to enhance the quality of life for patients with limited time, offering rapid relief from psychological suffering. This discussion equips clinicians to integrate rapid-onset antidepressants into palliative care, thereby expanding treatment options and fostering hope for patients and families facing end-of-life challenges.

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