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Mark Dreskin, MD, weighs in on depression treatment options


A recent article in ACP Internist explores the pros and cons of 2 recently FDA-approved medications for treatment-resistant depression – intranasal esketamine and brexanolone – as well as alternative choices and other considerations, including adverse effects, treatment adherence, availability, and costs.

Mark Dreskin, MD

The story points out that if starting with medication, it can be helpful to dovetail the treatment choice with other medical decisions. For example, Mark Dreskin, MD, primary care mental health clinical lead with the Southern California Permanente Medical Group, notes that bupropion is an excellent first-line antidepressant for a patient with cardiovascular disease because the drug also is used for smoking cessation.

Thanks to technology such as the availability of smartphone apps, cognitive behavioral therapy and other types of therapy may reach patients at earlier stages of depression. “This is where we can effectively intervene and prevent the condition from becoming chronic or recurrent,” Dr. Dreskin says in the article.

Such apps may appeal to younger patients who are more accustomed to being on their phones. Dr. Dreskin notes that apps used by Kaiser Permanente are compliant with HIPAA, or the Health Insurance Portability and Accountability Act of 1996, and are able to protect patients’ personal information. However, he says, physician practices should determine whether an app can meet both those criteria before considering an app vendor.

Dr. Dreskin adds that the stigma surrounding mental health seems to be lessening, especially among younger generations. Teens in particular are more open to participating in groups and in discussing mental health issues. “That would have been taboo several years ago,” he says. “But it’s not the case now.”

To read the full article, visit ACP Internist.

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