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Axsome Therapeutics, Inc. AXSM

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The bet you're really making is that Auvelity, Axsome's fast-acting depression pill combining dextromethorphan and bupropion, keeps winning patients from older SSRIs, and that a migraine tablet and a coming narcolepsy drug turn one product into a family. You're betting the company earns its first real profit around 2028, because today it still loses money on every quarter of record sales. Right now it is going well, with one thing to watch: sales grew 46% to $218 million last quarter, while the loss ran wider than Wall Street expected for the fourth quarter straight. You pay about 16 times the profit analysts pencil in for 2028, on a company that has never earned a dollar to measure against.

Key data

Price$206.68
52-week range$112.90 – $260.19
P/E (TTM / FY28E)nm / 16.5x
EV/Sales (TTM)13.6x

AXSM · price with moving averages

Daily · 6MWeekly · 3Y
$42$99$156$214$271 Sep '23Apr '24Nov '24Jul '25Feb '26Sep '26 BID
EMAs82140

Source: market data.

The business

Axsome is a central-nervous-system drugmaker with three products on pharmacy shelves and one engine. That engine is Auvelity, an oral pill combining dextromethorphan and bupropion, approved in 2022 for major depression. Unlike the SSRIs it competes with, it works within a week rather than a month, and it drives every number here. The dextromethorphan blocks the NMDA glutamate receptor and acts on the sigma-1 receptor, while the bupropion mainly stops the liver from clearing the dextromethorphan too fast, keeping blood levels high enough to act. The pivotal was the GEMINI Phase 3 trial (NCT04019704), published in the Journal of Clinical Psychiatry in 2022. Alongside it sit Sunosi (solriamfetol), a wakefulness drug bought from Jazz for daytime sleepiness, and Symbravo, a meloxicam-and-rizatriptan migraine tablet launched in 2025. The moat is patent-protected drug combinations plus a specialty psychiatry salesforce that is costly to rebuild. What the patient holds is a once-daily tablet a psychiatrist reaches for when an SSRI has failed and time matters.

Inside the complete Back of Napkin

  1. 01The business
  2. 02The numbers
  3. 03Management
  4. 04How it fails or surprises you
  5. 05Closing thoughts
  6. 06Methodology

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