ASCP Publishes Two New Consensus Papers To Guide Psychopharmacology Practice
(MENAFN- EIN Presswire)
Both Task Forces used a two-round Delphi process, in which international expert groups independently rated clinical statements against a prespecified threshold of at least 75% agreement or disagreement.
Together, the publications identify areas of shared clinical judgment and questions requiring further research. The findings represent expert consensus on published research rather than new treatment trials or evidence-graded clinical practice guidelines.
Esketamine and Ketamine Reveal Substantial Gaps Between Practice and Evidence:
A 21-member international panel led by Gerard Sanacora, MD, PhD, with Joseph F. Goldberg, MD, MS, reached consensus on 35 of 105 items (33%). The limited agreement underscores unresolved questions about dosing, delivery methods, maintenance treatment and safety monitoring as clinical use expands.
Key findings include:
. An established role with important boundaries. Panelists supported esketamine/ketamine for treatment-resistant depression, while recognizing off-label applications and the need to distinguish expert judgment from regulatory approval. They considered these treatments inappropriate for bipolar mania but reasonable for bipolar depression.
. Individualized maintenance. Long-term treatment with ketamine or esketamine is appropriate when benefits persist and adverse effects remain acceptable, using the lowest dosing frequency that maintains response.
. Caution about home initiation and compounded products. Panelists opposed initiating ketamine treatment at home, even with remote supervision, and discouraged compounded oral ketamine lozenges between intravenous treatments because benefits and risks remain insufficiently established.
. Research priorities remain substantial. Important uncertainties involve oral and intramuscular formulations, high-dose infusions, ketamine-assisted psychotherapy and use beyond major depression. Panelists supported blood-pressure monitoring before and during treatment.
Article Citation
Sanacora G, Goldberg JF, et al. Ketamine/Esketamine in Clinical Practice: Areas of Consensus and Nonconsensus from an American Society of Clinical Psychopharmacology (ASCP) Delphi Panel Task Force. J Clin Psychiatry 2027;88(1):26cs16585. Published online November 2, 2026.
DOI:
Combination Psychopharmacology Emphasizes Rationale and Ongoing Reassessment:
A separate Task Force led by Joseph F. Goldberg, MD, MS, convened 60 academic clinical psychiatrists and psychiatric pharmacists from 16 countries. The panel reached consensus on 62 of 66 items (94%), providing principles for clinicians treating major psychiatric disorders when monotherapy or simpler regimens may be insufficient.
Key findings include:
. Clinical rationale matters more than medication count. Appropriate combinations should address illness complexity, comorbid disorders, treatment resistance or distinct symptom targets, with complementary rather than redundant drug mechanisms.
. Optimize treatment regimen before adding. Before augmentation, reassess diagnosis, adherence, dose and adequacy of prior treatment. When an existing medication produces minimal improvement, consider switching rather than retaining it and adding another agent.
. Avoid combinations of antipsychotic medicines other than when paired with clozapine. Strive to optimize a single antipsychotic and consider evidence-based alternatives, including clozapine when appropriate for treatment-resistant schizophrenia, before escalating to complex combinations.
. Weigh cumulative harms and patient priorities. Evaluate drug interactions and the combined adverse effect burden and use shared decision-making to align treatment with patient preferences.
. Consider alternatives to additional medication. Adjunctive psychotherapy may sometimes be preferable to further pharmacologic augmentation. Regimens should remain open to reassessment as benefits, risks and treatment goals change.
Article Citation
Goldberg JF, Gin MS, Jha MK, et al. The American Society of Clinical Psychopharmacology Task Force Consensus Statement on Combination Psychopharmacology. J Clin Psychiatry 2026;87(4):26cs16574. Published online November 9, 2026.
DOI:
The two reports offer complementary resources for practitioners: one maps uncertainties in a rapidly expanding treatment area, while the other identifies broadly supported principles for constructing and maintaining coherent multidrug regimens. Both highlight the need for clinical studies that better reflect the patients and prescribing decisions encountered in everyday practice. These studies also build on prior ASCP consensus statements involving when and how to deprescribe psychotropic medications that may not be appropriate for continued or indefinite use (; ; ) and distinguishing signs of relapse from physical discontinuation symptoms after stopping antidepressants ( ).
These publications reflect ASCP's ongoing commitment to providing clinicians with practical, expert-driven guidance on complex psychopharmacologic decisions, particularly in areas where available evidence and existing treatment guidelines do not adequately address the challenges of everyday clinical practice.
About ASCP
The American Society of Clinical Psychopharmacology (ASCP) is a professional organization dedicated to advancing the science, practice, and education of clinical psychopharmacology to improve the health and well-being of patients. ASCP serves a diverse membership of psychiatrists, researchers, and other mental health professionals across the USA and internationally, providing access to cutting-edge research, educational opportunities, and networking with leaders in psychiatric treatment. The organization publishes resources through its official journal, The Journal of Clinical Psychiatry, and hosts an annual scientific meeting for professionals in the field. For more information, visit ascpp.
Two separate ASCP Task Forces address real-world esketamine and ketamine treatment and the rational use of psychotropic medicine combinations.
BRENTWOOD, TN, UNITED STATES, November 9, 2026 /EINPresswire / -- The American Society of Clinical Psychopharmacology (ASCP) has announced the publication of two consensus papers in The Journal of Clinical Psychiatry, developed by separate ASCP Task Forces. The reports address practical prescribing decisions that often extend beyond the available clinical-trial evidence: how to use esketamine and ketamine in routine care, and when and how to combine psychiatric medications for patients with complex or difficult-to-treat disorders.Both Task Forces used a two-round Delphi process, in which international expert groups independently rated clinical statements against a prespecified threshold of at least 75% agreement or disagreement.
Together, the publications identify areas of shared clinical judgment and questions requiring further research. The findings represent expert consensus on published research rather than new treatment trials or evidence-graded clinical practice guidelines.
Esketamine and Ketamine Reveal Substantial Gaps Between Practice and Evidence:
A 21-member international panel led by Gerard Sanacora, MD, PhD, with Joseph F. Goldberg, MD, MS, reached consensus on 35 of 105 items (33%). The limited agreement underscores unresolved questions about dosing, delivery methods, maintenance treatment and safety monitoring as clinical use expands.
Key findings include:
. An established role with important boundaries. Panelists supported esketamine/ketamine for treatment-resistant depression, while recognizing off-label applications and the need to distinguish expert judgment from regulatory approval. They considered these treatments inappropriate for bipolar mania but reasonable for bipolar depression.
. Individualized maintenance. Long-term treatment with ketamine or esketamine is appropriate when benefits persist and adverse effects remain acceptable, using the lowest dosing frequency that maintains response.
. Caution about home initiation and compounded products. Panelists opposed initiating ketamine treatment at home, even with remote supervision, and discouraged compounded oral ketamine lozenges between intravenous treatments because benefits and risks remain insufficiently established.
. Research priorities remain substantial. Important uncertainties involve oral and intramuscular formulations, high-dose infusions, ketamine-assisted psychotherapy and use beyond major depression. Panelists supported blood-pressure monitoring before and during treatment.
Article Citation
Sanacora G, Goldberg JF, et al. Ketamine/Esketamine in Clinical Practice: Areas of Consensus and Nonconsensus from an American Society of Clinical Psychopharmacology (ASCP) Delphi Panel Task Force. J Clin Psychiatry 2027;88(1):26cs16585. Published online November 2, 2026.
DOI:
Combination Psychopharmacology Emphasizes Rationale and Ongoing Reassessment:
A separate Task Force led by Joseph F. Goldberg, MD, MS, convened 60 academic clinical psychiatrists and psychiatric pharmacists from 16 countries. The panel reached consensus on 62 of 66 items (94%), providing principles for clinicians treating major psychiatric disorders when monotherapy or simpler regimens may be insufficient.
Key findings include:
. Clinical rationale matters more than medication count. Appropriate combinations should address illness complexity, comorbid disorders, treatment resistance or distinct symptom targets, with complementary rather than redundant drug mechanisms.
. Optimize treatment regimen before adding. Before augmentation, reassess diagnosis, adherence, dose and adequacy of prior treatment. When an existing medication produces minimal improvement, consider switching rather than retaining it and adding another agent.
. Avoid combinations of antipsychotic medicines other than when paired with clozapine. Strive to optimize a single antipsychotic and consider evidence-based alternatives, including clozapine when appropriate for treatment-resistant schizophrenia, before escalating to complex combinations.
. Weigh cumulative harms and patient priorities. Evaluate drug interactions and the combined adverse effect burden and use shared decision-making to align treatment with patient preferences.
. Consider alternatives to additional medication. Adjunctive psychotherapy may sometimes be preferable to further pharmacologic augmentation. Regimens should remain open to reassessment as benefits, risks and treatment goals change.
Article Citation
Goldberg JF, Gin MS, Jha MK, et al. The American Society of Clinical Psychopharmacology Task Force Consensus Statement on Combination Psychopharmacology. J Clin Psychiatry 2026;87(4):26cs16574. Published online November 9, 2026.
DOI:
The two reports offer complementary resources for practitioners: one maps uncertainties in a rapidly expanding treatment area, while the other identifies broadly supported principles for constructing and maintaining coherent multidrug regimens. Both highlight the need for clinical studies that better reflect the patients and prescribing decisions encountered in everyday practice. These studies also build on prior ASCP consensus statements involving when and how to deprescribe psychotropic medications that may not be appropriate for continued or indefinite use (; ; ) and distinguishing signs of relapse from physical discontinuation symptoms after stopping antidepressants ( ).
These publications reflect ASCP's ongoing commitment to providing clinicians with practical, expert-driven guidance on complex psychopharmacologic decisions, particularly in areas where available evidence and existing treatment guidelines do not adequately address the challenges of everyday clinical practice.
About ASCP
The American Society of Clinical Psychopharmacology (ASCP) is a professional organization dedicated to advancing the science, practice, and education of clinical psychopharmacology to improve the health and well-being of patients. ASCP serves a diverse membership of psychiatrists, researchers, and other mental health professionals across the USA and internationally, providing access to cutting-edge research, educational opportunities, and networking with leaders in psychiatric treatment. The organization publishes resources through its official journal, The Journal of Clinical Psychiatry, and hosts an annual scientific meeting for professionals in the field. For more information, visit ascpp.
Rachel DeAngelo
American Society of Clinical Psychopharmacology
...
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