Alexandra Ward, MA

Alyssa Johnsen MD, PhD

Before we sign off, I’d love to hear from everyone any advice or practice pearls for other APPs [advanced practice providers] that are either new or established in the management of plaque psoriasis. Darren, let’s start with you.

Try your best to get your office to get you a good biologic coordinator, because no matter how much we know and can prescribe these medications, having a team effort in the access of these medications is very important. I know recently they had a biologic coordinator day. We’re getting more and more recognition in this, but you have to have somebody you can work with. Advanced practice providers seem to be the default providers who see psoriasis anyway, so we really want to make it streamlined as much as possible. Our patients deserve the best. We take the most time with them, it seems. I’m always spending as much time as I can with them until I’m forced out of the room. I love these medications. These are incredible.

Our toolbox is definitely full, and to Doug’s point, the quiver is full. There are so many different weapons we can use now. It is incredible. We just have to feel safe and comfortable with a lot of these. We’ve had a lot of years of using biologics and small molecules now. And there are different medications and newer creams are coming out, and you just have to use them. That’s going to be the biggest thing we can do—have a whole team that works with this. I know the companies are helping us a little with some of this access to medications, but we want to make sure everyone has access to it. And being a team player with someone in your office, like a biologic coordinator, is my biggest help. Otherwise, it’s daunting. It’s just too much work.

What’s kind of amazing is pharmaceutical companies are now sponsoring biologic coordinators to be speakers for their company to help other biologic coordinators get medication approved. I love that so much. Because there’s only so much that we know and so much we can help our biologic coordinators with and vice versa. It’s just like us talking with our peers and colleagues. It’s the same thing, and I love that that community is blowing up.

Absolutely, and they deal with all the patients. They’re the ones talking. They’re making the phones calls. They’re behind the scenes. We know the medications, we prescribe them, and it’s great, but they really do a lot of the background work and all the hard work in some cases.

There’s a biologic coordinator council and society now. They have a journal and a publication. Last month, I received the first publication of biologic coordinator council, so it’s really neat to see all that happen.

For APPs who potentially want to expand their knowledge of psoriasis and the toolbox and things we use—I know sometimes I hear that it’s a little daunting just because we have so many tools now. When you look at clinical data, I would encourage to look at not only your primary end points but also a little further out. Look out to week 52 or week 60. It kind of gives an understanding or a general feel of the trajectory of medication. Then also looking at data out a couple years down the road that maybe some companies will have. Some companies publish that as that comes out for you to understand what you may see in your clinical practice, and each medication is going to work a little differently. So its not just primary end point but some of these longer end points, too.

There are certain nuances, like with deucravacitinib. Just because they monitor for certain things doesn’t necessarily mean there’s a high incidence of safety events. Clinical monitoring is not always 100% correlated with clinical incidence. That’s something that is the other nuance, too, with medications. With some medications, clinical incidence is more frequent, which is why we justify monitoring for certain safety signals. It’s kind of just teasing out those nuances. It does get overwhelming sometimes. And like what Darren was saying with bio coordinators and them understanding the insurance part and helping us through that guidance, that is a super useful tool for us as clinicians, for the paperwork and getting medications to our patients.

The labor of love for us as clinicians is understanding the products we’re using. At least now the products and medications we’re using have delivery of really high outcomes in a tolerable vehicle for our patients. It’s kind of just grouping your medications and trying to decipher which way you go and almost having a playbook for your psoriasis treatment on how you stratify your topicals, how you stratify your systemics, and then templating it. A lot of times, having a system may help you through this process, too. It’s kind of our own flavor of what system works best for us as individual clinicians.

Awesome. Jayme, what pearls do you have, whether they’re educational or clinical? Is there anything you would give advice on for other practitioners?

I think we have a responsibility. We need to be that beacon of hope for these patients. They have such a physical and emotional burden for their disease. It’s very hard. We also have a responsibility to support one another. I feel very lucky to say I know the panelists here today, and I have a great deal of respect for them. It’s really nice to be able to reach out to somebody. Even if somebody I don’t even know were to reach out, I would be more than willing to help them just like I help the other colleagues in my office.

We always need to make sure our patients get what they need. Sometimes it’s just making sure we know all our resources. Like Darren said, it is just an invaluable resource to have a biologic coordinator. It’s very difficult. We need to know all these programs. We need to know how we can get access for our patients. To do that, we need to continue reaching out to one another. We need to continue to support one another, we need to educate one another, and we need to educate our patients. We need to always let patients know that when they leave, they are supported, we do care, and we are going to help them. That’s our commitment to dermatology, and that’s why we have been entrusted as PAs [physician assistant] and NPs [nurse practitioner] to go ahead and take on this dynamic role to help patients with psoriasis.

Douglas, do you have any advice or any practice pearls for other APPs, whether new or established, in managing plaque psoriasis?

I can only echo what my great colleagues have already said. There’s obviously a theme here: get to know the medications, take the time to understand these medications, and practice presenting them to patients. Maybe you practice by pulling your nursing assistants together and say, “Let’s talk about these medications.” Maybe you meet with colleagues that are in your office. Maybe you reach out to someone you met at a conference, or reach out to any of us. I know we’re all willing to talk to people. There’s a great supportive network in the NP and PA community, as well as with our physician supervisors.

We want to do what’s best for our patients, so the takeaway pearl is to realize the power you have at your disposal. This is not power that’s meant to lift you up. It’s power to be transferred to your patients to change their lives. What an awesome opportunity it is to do that. My pearl is to take a little bit of time. If you got into medicine and you don’t consider yourself a lifetime learner, then you may be in the wrong place. Because if you’re not a person who’s willing to get up sometimes on a Saturday morning or stay up a little bit later—I’m just a believer that what you do from 9 am to 5 pm is not as important as what you do between 5 pm and 9 am. It takes a little bit of some buy-in to be someone [who’s] going to be on the cutting edge, that’s going to be evidence based, and that’s going to be empathetic. That empathy is shown by giving patients the best options we have. Your patients deserve it, they love it, and we’re all capable of doing that. It makes it fun. That’s my encouragement to you—be a prescriber of hope. Tell patients we’ve got great things- there are great things available to them. Speak that positivity into their life when you first see them, because that begins to change things right off the bat that I’ve seen at least in my practice.

Darren, I think I cut you off before. Was there anything else you wanted to add?

We have an obligation to treat our patients, and I think we do a disservice to our patients when they walk through the door, take the time to come in and see us, and we just give them a cream and turn them loose. We need to understand these medications. We need to understand how well they work. We need to give our patients hope. I think that’s why they come and see us. I think the advantage of us being in this industry today is that we have so many tools to work with. We have the advantage on our side, and we can change lives forever. It’s incredible. I’m glad we’re a part of it these days. The companies that have put a lot of effort and work into getting these drugs to market, and the research and development we see today, is incredible. We need to all work together. We don’t have all these amazing drugs just to sit on the shelf. We need to be bold enough to try them out. We need to be not fearful in prescribing these and just jump off that ledge and do it and see how it works.

I’m not saying this, but I’ve heard others say this—others that are much more influential and are in this space. They feel like we’re getting to a point, very close in time, that not offering a patient who has severe disease a systemic agent—I’ll keep it in the category of severe—may be considered malpractice in the near future. Because we know, with severe disease, the chance of them creating a destructive joint, having a heart disease, and all the other problems we’ve mentioned—not addressing that is something that is such a disservice. I’ve heard others who are far more influential than me make those bold statements from the podium. I’m not sure I’m willing to make that bold of a statement from a podium yet, but I sit there and shake my head and agree. We’ve got these tools and we’ve got to put them to work.

Think about deciding to not treat an uncontrolled diabetic. We have to get into that mindset of the systemic condition, and I think that is changing. Psoriasis is no longer a skin condition. We just talked about all the comorbidities, all these things that come along with it, and we have to continue to relay that message to each other and our patients. I think we can always continue to learn, like Douglas said.

Thanks to all of you for this rich and informative discussion. Thank you for watching this 

 discussion. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming peer exchanges and other great content right in your inbox.

Experts in dermatology share practice pearls to advanced practice providers and community dermatologists for the management of plaque psoriasis.

Clinical Pearls and Educational Needs in Plaque Psoriasis

Douglas DiRuggiero, DMSc, PA-C, Skin Cancer and Cosmetic Dermatology Center 

Hope Cook, PA-C, is a physician associate, a podcaster for a show called Recharting Your Life with Hope, and an author of a new book titled 'Healing Clinician Burnout: How to Revive Your Life and Career.'

Top Clinical Insights from SDPA 2025: Eczema, Alopecia, Burnout, Vitiligo, JAK Inhibitors

In late June, physician assistants convened at the 

SDPA Annual Summer Dermatology Conference

 in Washington, DC, from June 25 – June 29th, to attend talks from other physician assistants and clinicians.

in people of color. This edition of HCPLive Five spotlights interviews on tips for treating chronic hand eczema, using trichoscopy to differentiate alopecia subtypes, preventing career burnout, breaking down vitiligo misconceptions, and the workup before initiating JAK inhibitors for alopecia.

Tips to Optimize Diagnosis, Management of Chronic Hand Eczema with Adam Friedman, MD

Adam Friedman, MD, professor, chair of dermatology, and director of the Supportive Oncodermatology Program at The George Washington University School of Medicine & Health Sciences, shared clinical insights on diagnosing and managing chronic hand eczema (CHE), emphasizing its diagnostic complexity. CHE has symptoms that overlap with conditions, such as psoriasis, lichen planus, and secondary syphilis. In his interview, Friedman underscored the importance of patient history, especially recurrence, duration, and occupational exposure, and highlighted visual cues to differentiate CHE from other dermatoses.

He also noted that CHE often lacks sharp demarcation, unlike palmoplantar psoriasis, which favors pressure-prone areas. Recognizing patterns like lichenification and confluence helps inform diagnosis.

Trichoscopy Provides Clearer Differentiation of Alopecia Subtypes, With Amy Spizuoco, DO, FAOCD

Amy Spizuoco, DO, FAOCD, a board-certified dermatologist at True Dermatology and a clinical instructor at Mount Sinai, highlighted how trichoscopy enhances diagnostic accuracy in alopecia by revealing key patterns such as black dots, yellow dots, exclamation hairs, and follicular loss. She explained that recognizing these visual cues, like exclamation hairs in alopecia areata or follicular plugging in telogen effluvium, can distinguish scarring from non-scarring forms and guide proper treatment.

Discussing Ways to Help Clinicians Facing Career Burnout, with Hope Cook, PA-C

Hope Cook, PA-C, a physician associate from Georgia Skin Cancer & Aesthetic Dermatology, shared strategies for addressing clinician burnout, emphasizing that burnout is not the end—it can mark a new beginning.

In her session and interview, she introduced her CPR framework: Cocooning (inner reflection and awareness), Planning (evaluating what needs to change), and Revamping or Resigning (deciding whether to reshape or leave one’s role). Using a controlled burn metaphor, Cook illustrated how burnout can clear space for growth and career renewal. Drawing from her book (“Healing Clinician Burnout: How to Revive Your Life and Career”) and podcast, she offered practical, realistic steps clinicians can take to move from feeling stuck to rediscovering purpose in their professional lives.

Breaking Down Vitiligo Misconceptions at SDPA 2025, With Gina Mangin, PA-C

Gina Mangin, MPAS, PA-C, from Sand Lake Dermatology Center, addressed common vitiligo misconceptions, underlining that treatment is possible, even after years of the disease. In an interview, she highlighted the importance of using a Wood’s lamp to confirm diagnosis, especially in patients with skin of color.

Mangin discussed when to escalate to systemic therapy, using markers like rapid progression, confetti depigmentation, and inflammatory borders to assess disease activity. She also said harder-to-treat areas like hands and feet may require both topicals and phototherapy. With new therapies emerging alongside narrowband UVB, Mangin shared her optimism about re-pigmentation and maintaining results through an aggressive, tailored approach.

The Workup Before Initiating a JAK Inhibitor for Alopecia, With David Cotter, MD, PhD

David Cotter, MD, PhD, an assistant clinical professor at the University of Nevada, outlined key steps in evaluating patients with alopecia areata before starting a JAK inhibitor. His recommended workup includes a CMP, fasting lipids, TB and hepatitis B screening, QuantiFERON gold, and often varicella zoster titers—even beyond guideline recommendations—to assess shingles risk. He also considers pregnancy and HIV testing when appropriate.

Cotter stressed that clinicians should feel confident prescribing JAK inhibitors, as long as baseline labs are clear. Follow-up labs are crucial at 12 weeks, with frequency adjusted by patient risk. While many patients see significant regrowth, safety monitoring remains essential throughout treatment.

Check out insights from SDPA 2025 on eczema, alopecia, vitiligo, burnout, and JAK inhibitor workups—key tips to improve dermatology care.

HCPLive Five at SDPA 2025

Hope Cook, PA-C

Dhiren Patel, PharmD, CDCES, BC-ADM, BCACP:

 Jen, for you in terms of…obviously there’s the prescribing of it, but I think you’ve served an equally important role in educating other HCPs [health care professionals], especially pharmacists. And so how do you, A, address this with patients? But also more importantly, there is a ton of confusion. Because even within the prescription, like Dr Bhatt alluded, there’s ones that have had data and there’s the ones that don’t have data. And then you have maybe that pharmacist that doesn’t know where it’s not covered, and they say it’s an IL-6 [interleukin 6] on the left-hand side. Which you also don’t want. If you can maybe walk us through kind of the over the counters and even within the prescription ones, how do you sort it, how do you not only educate your patients but also pharmacists and other HCPs?

Jennifer Goldman, RPh, PharmD, CDCES, BC-ADM, FCCP:

 I’m glad you asked that because I was listening to the 3 other panelists and what they’re saying and what they’re talking about is evidence that when I think back to 30 years ago, and I’ve been practicing over 30 years and my colleagues have been practicing quite a long time as well, and we gave drugs based on biomarkers, we were giving the fabric acid derivatives to lower a biomarker, but based on clinical trial, specifically the REDUCE-IT trial, and Dr Bhatt, we now have evidence. We have actual evidence that if we use icosapent ethyl [Vascepa] we not just lower a biomarker, we actually decrease cardiovascular events and so forth. So we have evidence. You can't just use the evidence when you feel like it. If you know the evidence, you have to use that evidence. The other fish oils, the various prescription plus supplements that are over-the-counter have been studied. They have been studied. And yes, they may reduce a biomarker. The triglyceride number might go down, but that does not translate to an outcome that we care about. So it doesn’t end up translating to a decreased cardiovascular event. So I think that’s 1 first educational piece that needs to go out to health care providers, but also to patients and particularly to pharmacists who are in the community, who might be the kind of end stop or the last provider that somebody actually speaks to. I’ll have patients that will come in and they’re on over-the-counter fish oil, and I’ll say, “Why are you taking that?” And they’ll say, “I don’t know. My doctor told me to take it.” So having that conversation. The other conversation is to make sure that everyone is educated about that biomarker. The point you just asked me about, Dhiren, is pharmacists in general. Supplements, fish oil supplements have been studied. They are not regulated. You don’t know what is in them. There could, there are all kinds of impurities in these supplements. The supplements that have been studied have not been shown to improve anything. When I have patients on that and when I advise other pharmacists, no, they’re wasting their money. Don’t get it. They’re not helping themselves. And the same thing with the prescription availability. The ones…you have to follow the evidence. So Dr Bhatt has done that for us. And Dr Busch is participating. For pharmacists out there in the community and for primary care, it’s not OK to just say go to the wholesale store and buy a big 5000 pills of fish oil. It’s not the same. So you can’t use evidence when it’s convenient. It’s all the time.

Joyce Ross, MSN, RNC, CRNP, CS, FNLA, FPCNA:

 I just wanted to jump here and say that there’s 2 points that I wanted to add to what you’re saying, Jen, which is so true. The patients don’t realize what they’re getting when they’re getting something over the counter. So really going through that. But what is worrisome to me is that we understand that the oxidized element of the fish oil over the counter, we have oxidation of the LDL [low-density lipoprotein], which is part of the problem. But we also have an increase in the LDL cholesterol in many of those products. And that is critically important. Saying to a patient, I think we’re shooting ourself in the foot when we’re just taking something that we know may increase your LDL cholesterol when all this time we’ve been working to reduce it. So again, taking the terms, look in the name of the trial, REDUCE-IT tells us all those things that are useful for education, both for the health care provider and for the patient as well.

 Yeah, no, absolutely. And I think hopefully what you saw here is that triglycerides are pretty well-established body of evidence now associated with it, but there’s a little bit of navigation that Jen, you pointed out that we need to make sure they get on the right product. Because there’s been a fair number of trials that haven’t had the positive cardiovascular data. And I say at the end of the day, we want to do things [that] are moving the needle from a population health standpoint and not just treating numbers that numerically make us feel better and they look pretty in a chart. At the end of the day that’s what we’re all here to do. So that’s excellent.

What pharmacists and providers need to know to counsel patients on when discussing the use of prescription or over-the-counter fish oil supplement as treatment for dyslipidemia and hypertriglyceridemia.

Efficacy of Prescription Vs OTC Fish Oil Products  

Jennifer Goldman, RPh, PharmD, CDCES, BC-ADM, FCCP

Liver Lineup: Progress, Policy, and Barriers in Hepatitis C Elimination

Liver Lineup: Updates & Unfiltered Insights

, hosts Kimberly Brown, MD, a professor of Medicine at Michigan State University and Wayne State University, associate medical director of the Henry Ford Hospital Transplant Institute, and medical director of Transplant Outreach Services at Henry Ford Hospital, and Nancy Reau, MD, a professor of internal medicine, the Richard B. Capps Chair of Hepatology, associate director of solid organ transplantation, and the section chief of hepatology at Rush University Medical Center, discuss the progress and persistent challenges in eliminating 

With highly effective, short-course oral therapies now available, Brown and Reau emphasize that curing HCV is more achievable than ever. The discussion explores the major policy, clinical, and structural milestones enabling this effort—and the critical gaps in diagnosis, treatment access, and health policy that still impede progress.

Reau opens by emphasizing the revolutionary nature of curative HCV therapies, which not only improve individual health outcomes but also reduce transmission, presenting a rare opportunity for public health impact on a global scale. She and Brown discuss how national and international efforts, including World Health Organization goals and US legislation, have aligned to prioritize viral hepatitis elimination.

Specifically, the hosts discuss the role of the US Preventive Services Task Force and the Affordable Care Act in establishing HCV screening as a covered preventive service. Outlining the evolution from birth cohort screening to universal screening for adults 18 and over, Reau and Brown discuss a recent legal challenge to the Affordable Care Act’s preventive service mandate that threatened access to HCV screening. The Supreme Court’s 6–3 decision to uphold this provision was, in their view, a critical win for public health and HCV elimination.

Despite these advances, both experts acknowledge major challenges remain in the HCV care cascade. Many patients are lost between screening and cure, often due to provider restrictions, system fragmentation, and lack of prioritization. They emphasize the need for government-backed elimination efforts, drawing lessons from successful national programs in countries like Egypt and Georgia.

The conversation also underscores the role of grassroots advocacy, emphasizing the critical role clinicians and patients alike can play in supporting federal hepatitis elimination legislation. Most importantly, they encourage patients to share their stories with legislators—a strategy proven effective in other public health movements, including HIV.

Reau additionally calls upon listeners to write to their local senators to support bipartisan legislation from senators Bill Cassidy (R-LA) and Chris Van Hollen (D-MD) to eliminate hepatitis C using the following link: 

Ask Senators to Cosponsor the Cure Hepatitis C Act

Editors’ note: Relevant Disclosures for 

 include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for 

 include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal.

Hosts Kimberly Brown and Nancy Reau discuss policy, clinical, and structural milestones enabling HCV elimination efforts and critical gaps impeding progress.

Kimberly A. Brown, MD

Exploring Oral Systemic Therapies for Plaque Psoriasis: Efficacy, Safety, and Clinical Considerations

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Lauren Miller, MPAS, PA-C; Jayme M. Heim, MSN FNP-BC, and Kirk Gautier, PA-C, discuss recent advancements in plaque psoriasis treatment, focusing on novel oral systemic therapies like the TYK-2 inhibitor deucravacitinib and its clinical trial data, to inform therapeutic decisions for this systemic disease.

Exploring Oral Systemic Therapies For Plaque Psoriasis: Efficacy, Safety, and Clinical Considerations

Lauren Miller, MPAS, PA-C

2025 Revolutionizing Atopic Dermatitis (RAD) Conference

 editorial team spoke to a variety of leading experts in the field of dermatology regarding their presentations at the atopic dermatitis-focused conference.

One such presenter was Lisa A. Swanson, MD, a dual board-certified clinician in dermatology and pediatric dermatology, who presented a talk alongside Anne Marie Singh, MD, on the topic of managing 

 and on allergy’s connection to the disease. Swanson was asked in her Q&A interview about what she believes are the most notable takeaways from the session, and the transcript of her discussion is included here:

During your session on pediatric atopic dermatitis, what would you say were some of the most notable take-home points for attending healthcare providers?

: I think the biggest take-home point is that patients with eczema have increased rates of food allergies, but it's actually quite rare. Dr. Singh shared that it happens only 2% of the time where the food allergy is actually triggering the atopic dermatitis, so most of the time these are coexisting conditions, rather than a cause and effect relationship. She also shared something that was quite new for me.

She said that in patients with food-triggered eczema, 2% of patients with eczema are in a situation where food is triggering it. If you avoid that food completely, you actually have a greater chance of developing an IGE hypersensitivity response to that food, so much so that if a patient has food driven atopic dermatitis, Dr. Singh will continue to have them introduce little bits of it into their diet in order to prevent them from developing an IGE hypersensitivity.

Outside of this session and its topic, is there any research or pipeline news that you are looking forward to learning more about?

 I am looking forward to developments in the treatment of hidradenitis suppurativa and vitiligo. We need more for both of these conditions. Does any condition stink as bad as hidradenitis suppurativa? No, it is the worst. It is very painful, with a huge impact on quality of life, and we haven't had enough really good therapeutic advances in treating hidradenitis suppurativa. I'm hoping for that to change sometime soon. In addition, with vitiligo, we have noticed really great improvement in our patients using topical ruxolitinib, but we're limited to 10% [body surface area]. We need the approval of some systemic agents, allowing us to help patients repigment more body surface area.

What would you say is the value of disease-centric conferences like RAD 2025?

I'm a first timer here at RAD, and I'm loving it. I think most of the reason I love it is because, as a pediatric dermatologist, I spend 25% of my day talking about atopic dermatitis. I live and breathe atopic dermatitis, all day, every day, and so coming to a meeting devoted to that topic has been very educational for me and very informative for me. I'm really soaking it all up and living the dream. I love it because atopic dermatitis is what I do.

For any additional information on Swanson’s presentation at RAD, or related topics in the field of dermatology covered at the meeting, view our 

The quotes contained in this interview summary were edited for the purposes of clarity.

The 2025 Revolutionizing Atopic Dermatitis (RAD) Conference featured insights from experts like Dr. Lisa A. Swanson, who discussed pediatric atopic dermatitis and its link to allergies. A key takeaway was that food allergies rarely trigger atopic dermatitis, occurring in only 2% of cases. Introducing small amounts of the allergenic food may prevent IGE hypersensitivity. Dr. Swanson also expressed interest in advancements for hidradenitis suppurativa and vitiligo treatments. She emphasized the educational value of disease-centric conferences, particularly for specialists deeply involved in specific conditions.

This Q&A interview with Lisa Swanson, MD, features a discussion of the highlights of Swanson’s talk at RAD 2025 regarding pediatric atopic dermatitis.

Discussing Allergy and Pediatric Atopic Dermatitis, with Lisa Swanson, MD

Lisa A. Swanson, MD

While we’re waiting for these new treatments to come about, let’s talk a bit about, how can we improve adherence to our treatments, and awareness and communication and education of our patients and our colleagues? Greg, you’re certainly a master educator and communicator. What advice would you have?

: I think one of the keys is breaking down stigma. There are stigmas with all of our health conditions, including depression. I was part of a study recently, Andy, where we asked patients, “Where do you face stigma when you’re battling depression?” And a significant chunk, about 1 in 5, said they had internal stigma. “I beat up on myself about having this condition.” Those feelings of, “I’m lazy, dumb, stupid…get up off the couch. Also, there’s stigma in my society. People around me may not understand why I have depression. How come you’re not doing those things?” The biggest place of stigma was occupational stigma. For patients struggling with depression, 83% said, “I face stigma or perceive stigma in the workplace.” It’s OK to tell my employer I need to take a day off because I’m having asthma attacks. It’s OK to tell them I’ve had a flare-up of my arthritis, I’ve got to get some steroids. Most people are reluctant to tell their employer, “I have to take a day off because I’m struggling with depression and I need to go see my mental health provider.”

Breaking down that mental health stigma is part of a couple of initiatives right now with One Mind. The One Mind at Work initiative is working with employers across the country to break down mental health stigma within the workplace. Putting in engagement paradigms, where it’s OK to come and ask for help. We want you to be at a healthy workplace. We know it’s one of the biggest causes of disability within our workplace, and if you’re struggling with this, please come in and get help. I think those are some of the really important initiatives right now.

: Sagar, what do you think are some misconceptions out there among our colleagues in various disciplines of medicine? What are some of the needs that they might have in better understanding depression?

: I’m a little more optimistic. I think there have been a lot of antistigma efforts over the years. There’s been a lot of attention on depression at health care providers. While there is stigma across a lot of mental disorders, I think for the most part, most clinicians are understanding depression as a real thing, and as something worthy of treatment, and not a particularly shameful thing. I will go down on the side of optimism and positivity and say we’ve made progress in stigma. Where we saw, and where Greg started us off was commenting on the tsunami of depression because of the pandemic and everything like that. And as we already knew, the particularly vulnerable people are adolescents.

I think our strategy should be let’s go where the action is. I’m really happy to say that at the University of Michigan, we’ve had 2 major programs that are delivered in high schools. One program teaches principles of CBT [cognitive behavioral therapy] to teachers and other educational providers right in the schools. The second program is directly aimed at the students themselves, and it mobilizes students to create depression awareness programs for their own school. These work in complementary ways. One works on teachers and principals and things like that. In the old way of thinking when we were in high school, we went to gym class to learn the basics of physical fitness. So, why don’t we do that with mental health? Why don’t we start not only shooting a basketball, but also shooting down negative thoughts or learning some other mental health skills? Learning some CBT skills informally, before we’re clinical, in high school as a prophylactic against future depression. Simultaneously, address the issues of any potential stigma through other kinds of awareness, so that adolescents early in the course of illness, maybe we prevent some, maybe we delay some illness. And when the illness occurs, they are motivated to get treatment quicker.

That’s really exciting, Sagar. I love the idea of reaching out and being proactive, and like you said, getting to the source and meeting people where they already are. I suppose that kind of program could also be done in workplace environments and other areas. Greg, as we wrap up here, what would you say are some of the remaining unmet needs in recognition and/or treatment of depression?

: Once again, depression is nobody’s fault, and depression doesn’t discriminate. We’ve all had friends, family members, loved ones, people we know who have been touched by depression. I think prescribing with hope, Sagar’s comment about being optimistic with our patients, relating to them as people, not just as illnesses. “Who are you, what’s important to you? What are your values? What’s this journey together as we go through it?” I think that’s the exciting thing. Then for those of us who are clinicians, let me just say, it’s never been a more exciting time as far as all the things right now that are in development: digital interventions, therapeutic tools that have totally different mechanisms of action, treatments that can be taken as needed instead of on a chronic treatment basis. It’s an exciting time to be in neuroscience.

I want to thank you gentlemen for this rich and informative discussion. Before we conclude, I’d like to get final thoughts from each one of you. Greg, what would you like to leave our audience with when we’re thinking about depression?

: I’m going to go back to a common theme in our talk today, and that’s hope. There is hope for our patients who have been struggling. There’s hope with medicines that have novel mechanisms of action. There’s hope to move the needle in ways we haven’t been able to, with our use of digital tools, and digital therapeutics. Hope would be what I’d leave the audience with.

: I’d say to our clinicians, be proud of the work that you do, no matter what the environment was when you were a kid and maybe your parents said, “What? You’re going into psychiatry?” You know what? Our turn has come. Society has accepted that mental illness is real, and there are a variety of strategies that can be helpful. And the work that we do, the work that you do, is critical to the individual and society, so be damn proud.

Sounds great, and I’d add one final thing. I think it is very exciting that we’re developing these new tools, and ideally, we’ll be able to do a better job of individualizing and personalizing our treatments, just like people do in other fields of medicine.

I want to thank you too, our audience, for watching this 

. If you enjoyed the program, please subscribe to our e-newsletters to receive upcoming programs and other great content right in your inbox. Thank you.

Andrew J Cutler, MD; Gregory Mattingly, MD; and Sagar V. Parikh, MD, FRCPC, comment on the need to improve awareness around depressive disorders and break the stigma of mental health treatment.

Improving Awareness for Depressive Disorders

Sagar V Parikh, MD, FRCPC

In this HCPLive Special Report, experts review ensifentrine's role as a novel maintenance therapy for COPD.

A Promising Pipeline for COPD

 Special Report – RX Reviews, Antonio Anzueto, MD, professor of medicine and section chief of pulmonary at South Texas Veterans Healthcare System, provides a review of the clinical trial data supporting ensifentrine (Ohtuvayre) as a maintenance treatment for patients with 

chronic obstructive pulmonary disease (COPD).

The US Food and Drug Administration (FDA) approved Verona Pharma’s application for ensifentrine on June 26—moments after the recording of this segment—on the basis of Anzueto and colleagues’ findings from the phase 3 ENHANCE trials.

 The indication made ensifentrine the first COPD therapy with a novel mechanism of action approved by the FDA in more than a decade.

Here, Anzueto provides a detailed breakdown of the supporting clinical trial data for ensifentrine, as well as a review of its unique clinical benefit as an inhaled, nonsteroidal, dual inhibitor of the dual inhibitor of the phosphodiesterase 3 and 4 (PDE3; PDE4) pathways. Additionally, he and panel moderator David M. Mannino, MD, chief medical officer of the COPD Foundation and professor at the University of Kentucky, discuss the current state drug development in COPD, and what impact the FDA approval of ensifentrine may have on clinicians and their patients.

Check out the entire 3-part Special Report series, ‘COPD: New Therapy Breakthroughs’:

Part 1: What the Ensifentrine FDA Approval Means for COPD

David M. Mannino, MD, Chief Medical Officer and Co-Founder of the COPD Foundation, and Professor of Internal Medicine, Pulmonary, Critical Care and Sleep Medicine at the University of Kentucky.

Antonio Anzueto, MD, Professor of Medicine and Section Chief of Pulmonary at South Texas Veterans Healthcare System.

Stephanie Christenson, MD, Associate Professor of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine at University of California, San Francisco.

Kunzmann K. FDA Approves Ensifentrine (Ohtuvayre) for COPD. 

. Published June 26, 2024. https://www.hcplive.com/view/fda-approves-ensifentrine-for-copd

Kunzmann K. Ensifentrine Significantly Improves COPD Lung Function, Exacerbations. 

. Published August 9, 2022. https://www.hcplive.com/view/ensifentrine-significantly-improves-copd-lung-function-exacerbations

Authors