Comparative effectiveness of esketamine in the treatment of anhedonia in bipolar and unipolar depression

Delfino, Rodrigo Simonini; Del-Porto, José Alberto; Surjan, Juliana; Magalhães, Edno; Sant, Lorena Catarina Del; Lucchese, Ana Cecília; Tuena, Marco Aurélio; Nakahira, Carolina; Fava, Victor Augusto Rodoalho; Steglich, Matheus Souza; Barbosa, Matheus; Sarin, Luciana Maria; Lacerda, Acioly Luiz Tavares de

doi:10.1016/j.jad.2020.09.056

Cited by 35 publications

(29 citation statements)

References 18 publications

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“…Anhedonia was evaluated separately by item 8 of the MADRS (inability to feel), and improvement was observed 24 h after the first session (t = 4.007; p < 0.001), with a further reduction in anhedonia scores following repeated infusions. No significant differences were observed between MDD and BD (28).…”

Section: Mood Outcomementioning

confidence: 69%

“…Favorable results regarding both efficacy and safety were reported in case reports (21)(22)(23)(24)(25). Data from retrospective studies (20,(26)(27)(28)(29) and two clinical trials (17,18) also confirmed efficacy and a solid tolerability profile associated with SC administration of ketamine for depression. Considering the paucity of data, we will discuss efficacy and tolerability of these results qualitatively, keeping in mind the limited nature of the data at hand.…”

Section: Discussionmentioning

confidence: 86%

“…Of the selected articles, two were randomized clinical trials (17,18) five were case-reports (21,22) and five were retrospective studies (20,(26)(27)(28)(29) (see Table 2). From the retrospective studies, four of them (26)(27)(28)(29) were from the intervention in the same group of patients and, thus, will be presented together in Tables 2, 3.…”

Section: Synthesized Findingsmentioning

confidence: 99%

“…Our ability to evaluate the dose-response effect of the SC route measured in the two trials with ketamine, as well as the four retrospective studies (26)(27)(28)(29) and two case-reports (24,25) with esketamine in comparison to IV studies is limited since the latter studies used fixed doses. However, findings from dose-titration studies appear promising with patients remitting following low doses.…”

Section: Efficacymentioning

confidence: 99%

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Subcutaneous Ketamine in Depression: A Systematic Review

et al. 2021

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Background: Ketamine has been shown to produce a rapid and robust antidepressant effect. Though numerous routes of administration have been studied, subcutaneous (SC) has proven to be a convenient and cost-effective route making its use particularly relevant in developing countries. Here we provide a systematic review covering the use of SC racemic ketamine and esketamine in depression, including its efficacy, safety and tolerability.Methods: A systematic literature search was carried out, from inception through March, 2021, using PubMed/MEDLINE, EMBASE and Web of Science, with no limits of language. After identifying 159 potentially relevant articles, 12 articles were selected after applying our inclusion/exclusion criteria. These comprised two randomized clinical trials, five case-reports and five retrospective studies. Given the small number of studies found and their heterogeneous nature, a meta-analysis was not considered appropriate. Here we provide a synthesis of these data including participant characteristics, dose range, efficacy, safety/ tolerability. Risk of bias was accessed using the Cochrane risk of bias tool.Results: SC Ketamine was administered to unipolar and bipolar patients a single or multiple doses, weekly or twice-weekly, a dose-titration approach was made in major studies, dose ranged from 0.1 to 0.5 mg/Kg of racemic ketamine and 0.5–1 mg/Kg of esketamine. Across all studies, SC ketamine showed a rapid and robust antidepressant effect, with response/ remission rates from 50 to 100% following both single or multiple doses, with transitory side effects.Conclusion: SC racemic ketamine and esketamine in depression is a promising strategy showing beneficial efficacy and tolerability. Future studies exploring the SC route, its cost-effectiveness, and a direct comparison with IV and intranasal (IN) protocols are warranted.Systematic Review Registration: CRD42019137434

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Section: Mood Outcomementioning

confidence: 69%

Section: Discussionmentioning

confidence: 86%

Section: Synthesized Findingsmentioning

confidence: 99%

Section: Efficacymentioning

confidence: 99%

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Subcutaneous Ketamine in Depression: A Systematic Review

et al. 2021

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“…The N-methyl-D-aspartate receptor antagonist and glutamate modulator racemic ketamine and its (S)-enantiomer at subanesthetic doses have antidepressant efficacy in TRD. 56 The response rate has been shown to be as high as 70% in mostly Caucasian samples, 7 making it more effective than monoaminergic drugs, though there is variability in ketamine’s efficacy depending on the study. Antidepressant efficacy is also seen within hours-to-days, rather than weeks-to-months compared to standard antidepressant medications.…”

Section: Introductionmentioning

confidence: 99%

Biomarkers of ketamine’s antidepressant effect: a clinical review of genetics, functional connectivity, and neurophysiology

Alario

Niciu

2021

Chronic Stress

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Major depressive disorder (MDD) is one of the leading causes of morbidity and all-cause mortality (including suicide) worldwide, and, unfortunately, first-line monoaminergic antidepressants and evidence-based psychotherapies are not effective for all patients. Subanesthetic doses of the N-methyl-D-aspartate receptor antagonists and glutamate modulators ketamine and S-ketamine have rapid and robust antidepressant efficacy in such treatment-resistant depressed patients (TRD). Yet, as with all antidepressant treatments including electroconvulsive therapy (ECT), not all TRD patients adequately respond, and we are presently unable to a priori predict who will respond or not respond to ketamine. Therefore, antidepressant treatment response biomarkers to ketamine have been a major focus of research for over a decade. In this article, we review the evidence in support of treatment response biomarkers, with a particular focus on genetics, functional magnetic resonance imaging, and neurophysiological studies, i.e. electroencephalography and magnetoencephalography. The studies outlined here lay the groundwork for replication and dissemination.

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Research advances in the clinical application of esketamine

Zhang

Liu

et al. 2022

Ibrain

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Esketamine is dextrorotatory ketamine, which is an enantiomer of ketamine. Compared with ketamine, it has the advantages of a fast metabolism, fewer side effects, and strong pharmacological effects, so it is more suitable for clinical use. Esketamine has a powerful analgesic effect and has little effect on breathing. It has a wide range of applications in the fields of pediatric anesthesia, conscious sedation anesthesia, and emergency analgesia. In addition, it is also used for pain that is difficult to relieve with conventional drugs and to prevent postoperative pain. Various routes of administration are also suitable for patients who need short‐term analgesia and sedation. As a drug, esketamine inevitably brings some side effects when it is used clinically. In this article, by introducing the mechanism of action and pharmacological characteristics of esketamine, its clinical application is reviewed, and it provides a reference for the more reasonable and safe clinical application of esketamine.

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Comparative effectiveness of esketamine in the treatment of anhedonia in bipolar and unipolar depression

Cited by 35 publications

References 18 publications

Subcutaneous Ketamine in Depression: A Systematic Review

Subcutaneous Ketamine in Depression: A Systematic Review

Biomarkers of ketamine’s antidepressant effect: a clinical review of genetics, functional connectivity, and neurophysiology

Research advances in the clinical application of esketamine

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