Axsome Therapeutics, Inc.AXSM
NasdaqGM•Healthcare•Biotechnology
Axsome Therapeutics, Inc., a biopharmaceutical company, develops and delivers novel therapies for the management of central nervous system (CNS) disorders in the United States. The company's commercial product portfolio includes Auvelity (dextromethorphan-bupropion), a N-methyl-D-aspartate receptor antagonist, sigma-1 receptor agonist, aminoketone, and CYP2D6 inhibitor indicated for the treatment of major depressive disorder in adults; Sunosi (solriamfetol), a dopamine and norepinephrine reuptake inhibitor, trace amine-associated receptor 1 agonist, and 5-HT1A agonist indicated for the treatment of excessive daytime sleepiness in patients with narcolepsy or obstructive sleep apnea; and Symbravo (MoSEIC meloxicam rizatriptan), or AXS-07, a rapidly absorbed, multi-mechanistic, selective COX-2 inhibitor, and 5-HT1B/1D agonist indicated for the acute treatment of migraine with or without aura. It also develops AXS-05 (dextromethorphan-bupropion), an investigational N-methyl-D-aspartate receptor antagonist, which has completed Phase III clinical trial to treat Alzheimer's disease agitation, as well as that has completed phase II clinical trial for the treatment of smoking cessation; AXS-12 (reboxetine), a highly selective and potent norepinephrine reuptake inhibitor and cortical dopamine modulator, which has completed Phase II trial to treat narcolepsy; AXS-14 (esreboxetine), a selective and potent norepinephrine reuptake inhibitor that has completed Phase III trial for the treatment of fibromyalgia and other conditions; and Solriamfetol, a dopamine and norepinephrine reuptake inhibitor, which is in Phase III trial for treating attention deficit hyperactivity, major depressive, binge eating, and excessive sleepiness associated with shift work disorder. It has a research collaboration agreement with Duke University for evaluating AXS-05 in a Phase 2 clinical trial in smoking cessation treatment. The company was incorporated in 2012 and is based in New York, New York.
Axsome Therapeutics, Inc. (AXSM) reported trailing twelve months revenue of $708.24M as of March 2026, a 63.9% increase year-over-year. Quarterly revenue reached $191.20M, reflecting continued top-line momentum.
Axsome Therapeutics, Inc. reported a TTM net loss of $188.30M, with quarterly EBITDA of $-63.36M. The operating margin expanded from -46.9% to -33.1%, suggesting improving cost efficiency and pricing discipline.
The spread between operating margin (-33.1%) and net margin (-33.8%) indicates tight cost control with minimal non-operating drag. Net margin has improved from -48.9% a year ago, signaling stronger bottom-line efficiency.
AXSM trades at a P/S of 18.3x. The price-to-book ratio of 237.7x indicates a significant premium over book value.
The company reported negative free cash flow of $-20.82M, indicating cash consumption over the period. The balance sheet shows $713.61M in total assets with $117.85M in long-term debt against $54.59M in stockholders equity for a debt-to-equity ratio of 2.2, a relatively leveraged position. Data based on the most recent quarterly reports.
Competitive analysis based on 21 quarters of fundamental data
Operating margins are under pressure, averaging -44.5%. The business may lack pricing power or face rising costs.'
ROE is low or negative, suggesting limited competitive advantage or capital allocation challenges.
Only 1 of the last 8 quarters had positive FCF — the business may require external capital to sustain operations.
TTM revenue has grown consistently (7 of 7 quarters up), with ~143.0% growth over the period. Strong demand durability.
Data-driven red flags and warnings across 21 quarters
The company posted negative operating margins in recent quarters — core operations are unprofitable.
Free cash flow has been negative in 7 of the last 8 quarters — earnings are not translating to cash.
D/E ratio of 2.2 is elevated. Monitor for further debt accumulation.
Revenue is stable or growing over recent quarters — demand appears durable.
The last 5 consecutive quarters had negative FCF — the company is burning cash and may need external funding.
Shares outstanding increased 7.6% — significant dilution, likely from stock compensation or capital raises.