The SSRIs you mention as “newer” antidepressants are likely to soon be eclipsed by NMDA receptor antagonists, which are in the approval pipeline now and seem to be working somewhat better and much faster than current standard of care antidepressants, without increased suicide risk.
There’s little doubt NMDA receptor antagonists can cause rapid alleviation of depressive symptoms in a majority of patients who have previously not benefitted much from SSRIs. The effect of a single dose seems to last days, often weeks and sometimes months. Off label use of ketamine is growing because of this.
Now the pharma companies are developing several similar but new (i.e. patentable) substances that they hope have less hallucinatory side-effects, such as lanicemine. Big money is going into this, so the evidence seems to be good enough.
How strong is the evidence?
Pretty good, actually.
There’s little doubt NMDA receptor antagonists can cause rapid alleviation of depressive symptoms in a majority of patients who have previously not benefitted much from SSRIs. The effect of a single dose seems to last days, often weeks and sometimes months. Off label use of ketamine is growing because of this.
Now the pharma companies are developing several similar but new (i.e. patentable) substances that they hope have less hallucinatory side-effects, such as lanicemine. Big money is going into this, so the evidence seems to be good enough.
Reddit thread on using DXM for depression. DXM beginner’s guide. Doesn’t seem that promising, although chronic use at regular cough syrup doses could be interesting?
My impression was that memantine was the safest NMDA antagonist and it doesn’t seem to work for depression.