I’ll never forget her.

She was so paranoid she didn't even give me her name, just the letter T.

T was in her 30s, living alone in a top-floor apartment. She was convinced there were machines living in the attic. Machines that came down at night to inject her with unknown drugs and mess with her stuff; changing her tv channels and filling out her crosswords with the wrong answers.

She was terrified. And depressed. And stuck.

And very, very psychotic.

She wasn’t always like this. Before the paranoia set in, T had been happy, fun, friendly. But over the years, the fear took over and the meds could never help enough.

She’d tried nearly everything: Seroquel, Abilify, antidepressants, benzos, first-gens, second-gens. Some worked a little. Most made her feel worse.

T was severely overweight from side effects, rarely left home, and didn’t trust the medical system. But she still cared about treatment enough to always show up to our virtual appointments.

She was afraid to take her meds because she thought they’d interact with whatever drug the “machines” were injecting her with. But without them, the paranoia grew stronger. It was a heartbreaking cycle.

I knew T didn’t trust the system but she trusted me enough to keep showing up. And every time she logged on, I hoped I’d finally have something new to offer. But I didn’t.

I thought of her the moment I read about Cobenfy.

Because Cobenfy isn’t just a new brand name slapped on the same old kind of antipsychotic we're used to.

It’s actually different.

It works through a completely different pathway, the muscarinic cholinergic system, and it may help patients like T, where our usual treatments have fallen so short.

Here's your quick intro to this brand new medication, Cobenfy! (and FYI I have no affiliation with this medication or it's parent company, I'm just an interested psychiatrist excited about new ways to help people who suffer)

Not into video? Here are 5 key takeaways:

1. Cobenfy is the first antipsychotic to target the cholinergic system (M1/M4 receptors) instead of dopamine (which is our usual medication target)
2. It’s a combo drug: xanomeline which activates brain receptors + trospium which blocks peripheral side effects
3. It helps with both positive and negative symptoms, like hallucinations and flat mood, which is new and really important for treating all symptoms schizophrenia
4. It avoids common dopamine related side effects like weight gain, tremors, and hormonal issues (like prolactin elevation)
5. It works quickly with symptom relief often starting in just a couple weeks

I mean, there's a whole lot more to this medication than these 5 points but this is a good start!

And if you ever feel down on the progress of psychiatric treatments, this video can give you a boost. It's increased my optimism for sure! New, novel medications with fewer side effects? Yes, please!

The clinic where I treated T was bought out and I haven't seen her for years. I'm hopeful that someone has seen her as a perfect fit to try this new medication and I'm optimistic that she's doing well. (Don't judge me for my sunny outlook, it helps with the hard work we do!)

I don't currently have a patient in my private practice that would benefit from this medication, but I will be keeping it in mind and following it's published data and case reports as I see them.

Fingers crossed!

Cheers to healthy brains,

Dr. B

Jessica Beachkofsky, MD

Your friendly, online psychiatrist!

P.S. Here's MY video link for Cobenfy!​

P.P.S. Here's a link to Cobenfy's website where they have some great info and resources

P.P.P.S. We gotta stay positive! Sometimes hope is all we've got but new meds might help too!