Racial-Ethnic Disparities in Ketamine and Esketamine Therapy for Major Depressive Disorder

Area of Science:

• Psychiatry and Mental Health
• Pharmacology
• Health Disparities Research

Background:

• Major depressive disorder (MDD) affects millions globally, with significant unmet treatment needs.
• Intravenous ketamine and intranasal esketamine offer novel therapeutic options for treatment-resistant MDD.
• Understanding racial-ethnic variations in treatment access is crucial for health equity.

Purpose of the Study:

• To investigate racial-ethnic disparities in the utilization of intravenous ketamine and intranasal esketamine therapies.
• To compare the prescription rates of ketamine and esketamine across different racial-ethnic groups for major depressive disorder.

Main Methods:

• Utilized the TriNetX platform to identify 861,179 patients with moderate-to-severe recurrent MDD (Jan 2019-Oct 2024).
• Stratified patients into non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic cohorts.
• Employed propensity score matching (PSM) and calculated risk ratios (RRs) with 95% confidence intervals (CIs) to assess utilization differences.

Main Results:

• Ketamine was prescribed less frequently to Black (RR=0.75), Hispanic (RR=0.71), and Asian (RR=0.65) patients compared to White patients.
• Esketamine use was lower in Black patients (RR=0.74) but higher in Hispanic patients (RR=1.45); no significant difference was observed in Asian patients.
• Black and White patients receiving ketamine/esketamine had more comorbid medical and psychiatric conditions than non-recipients.

Conclusions:

• Significant racial-ethnic disparities in ketamine and esketamine utilization for MDD were identified.
• Black patients appear particularly underserved by these advanced depression therapies.
• Further research is needed to understand the causes of these disparities and promote equitable access.