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Esketamine: A Novel Option for Treatment-Resistant Depression.

Kevin M Bozymski1, Ericka L Crouse2, Erika N Titus-Lay3

  • 1Medical College of Wisconsin School of Pharmacy, Milwaukee, WI, USA.

The Annals of Pharmacotherapy
|December 5, 2019
PubMed
Summary

Intranasal esketamine offers a new treatment for treatment-resistant depression (TRD), significantly reducing symptoms. However, potential side effects and limitations may impact its widespread clinical use.

Keywords:
disease managementesketamineketaminepsychiatrytreatment-resistant depression

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Area of Science:

  • Pharmacology and Therapeutics
  • Psychiatry
  • Clinical Pharmacology

Background:

  • Treatment-resistant depression (TRD) affects a significant portion of patients with major depressive disorder.
  • Novel therapeutic agents with different mechanisms of action are needed for TRD.
  • Intranasal esketamine represents a novel pharmacological approach for managing TRD.

Purpose of the Study:

  • To comprehensively review the pharmacology, pharmacokinetics, efficacy, safety, and therapeutic role of intranasal esketamine for TRD.
  • To evaluate the clinical evidence supporting the use of intranasal esketamine in adult patients with TRD.
  • To assess the potential limitations and place in therapy for intranasal esketamine in the context of existing TRD treatments.

Main Methods:

  • A systematic literature search was conducted using PubMed and other databases for studies on intranasal esketamine for TRD.
  • Included English-language trials evaluating intranasal esketamine for TRD.
  • Data synthesis involved analyzing findings from short-term and long-term clinical trials, governmental sources, and manufacturer labeling.

Main Results:

  • Intranasal esketamine, when used with an oral antidepressant, showed statistically significant reductions in depression symptoms in short-term trials at specific doses.
  • Long-term studies suggested that the antidepressant effects of esketamine can be maintained with continued use.
  • Common adverse effects include dizziness, somnolence, dissociation, and potential cardiovascular changes; suicidal thoughts and behaviors were also noted.

Conclusions:

  • Intranasal esketamine demonstrates efficacy in reducing depressive symptoms in adults with TRD.
  • Tolerability issues and concerns regarding cost, administration, and potential for diversion may limit its clinical application.
  • Esketamine provides a novel option for TRD but requires careful patient selection and monitoring.