Rapid-acting antidepressant troches for depression that hasn’t responded to other treatment
Compounded NMDA-receptor antagonist troches or lozenges, taken at home on a written plan built for you, with a check-in visit every week. For adults who’ve already tried other treatments without enough relief.
An option when first-line treatment hasn’t worked
This treatment can help some people with depression that hasn’t improved after other treatments. It’s not a first-line treatment, and it isn’t right for everyone — which is why it starts with a careful evaluation rather than a prescription.
The troches and lozenges we prescribe are a compounded NMDA-receptor antagonist, used off-label for depression — that means the medication itself is an established, FDA-approved medication, but this particular form and use for depression isn’t an FDA-approved indication. We’ll walk you through what that means, and the alternatives, at your evaluation.
Four steps, done mostly from home
Evaluation
We review your history, past treatments, current medications, blood pressure, and anything that would make this treatment unsafe for you.
Your written plan
If it’s a fit, you get a printed plan: your dose, calculated from your weight, whether it’s a troche or a lozenge and how to take it, your session schedule, and your blood pressure limits.
Sessions at home
You take each dose at home, somewhere quiet and safe, then rest while it takes effect. No driving for the rest of that day.
Weekly check-ins
A visit every week to go over your sessions, your blood pressure readings, and any side effects — and to adjust the plan.
What you’ll need at home
- An automatic blood pressure cuff — the upper-arm kind. Required. Details at right.
- A trusted adult nearby during your sessions, at least until you know how you respond.
- A quiet, safe place to lie down for the session, away from stairs and anything you’d need to do.
- The rest of the day clear. No driving, no work, and nothing important to decide.
- An empty stomach. Skipping food for a couple of hours beforehand makes nausea less likely.
- No alcohol or sedatives on session days.
- A locked place to keep your medication. This medication is a controlled substance and has to be stored securely.
Blood pressure, before every session
This medication raises blood pressure for a while after each dose. You’ll check yours before every session with your own cuff and write it down.
Your written plan sets your limit. If your reading is above it, you skip that session and let us know — you don’t take the dose and hope for the best.
We review your readings at every weekly visit. A cuff costs about as much as a tank of gas and is available at any pharmacy.
What to expect, and when to get help
Common and expected
- Feeling detached, floaty, or dreamlike during the session
- Dizziness or drowsiness
- Nausea
- A temporary rise in blood pressure
These usually pass within a couple of hours. Tell us about them at your weekly visit.
Call 911 right away for
- Chest pain or a pounding, irregular heartbeat
- A sudden, severe headache
- Trouble breathing
- Confusion or agitation that isn’t wearing off
- Fainting, or someone who can’t be woken
If you’re having thoughts of harming yourself
Don’t wait for your weekly visit. Call or text 988 for the Suicide & Crisis Lifeline, any hour. If you’re in immediate danger, call 911.
Who this isn’t safe for
These are the things we screen for at your evaluation. Some rule this treatment out entirely; others just need a closer look.
- Pregnancy, or breastfeeding
- High blood pressure that isn’t well controlled
- Significant heart disease, or a recent heart attack or stroke
- A history of aneurysm or raised pressure inside the head
- A history of psychosis, schizophrenia, or mania
- Current alcohol or drug use disorder, or past misuse of this medication
- Some liver conditions
- Under 18
This compounded treatment usually isn’t covered by insurance, and the troches or lozenges are purchased directly from the compounding pharmacy. We’ll go over every cost with you before you start, so there are no surprises.
Ask whether it’s a fit
Call to set up a consultation. We’ll talk through what you’ve tried so far and whether this treatment makes sense for you — or whether something else would serve you better.