Ketamine and Esketamine augmentation for suicidal ideation: A randomized, double-blinded clinical trial

Vieira, Flávia; Correia-Melo, Fernanda S.; Santos-Lima, Cassio; Souza-Marques, Breno; Leal, Gustavo; Jesus-Nunes, Ana Paula; Mello, Rodrigo P.; Caliman-Fontes, Ana Teresa; Bandeira, Igor D.; Marback, Roberta Ferrari; Telles, Manuela; Argôlo, Felipe Coelho; Lins-Silva, Daniel H.; Echegaray, Mariana V.F.; Beanes, Graziele; Araújo-de-Freitas, Lucas; Silva, Samantha S.; Cardoso, Taiane; Kapczinski, Flávio; Turecki, Gustavo; Lacerda, Acioly L.T.

doi:10.1016/j.genhosppsych.2020.12.011

Cited by 16 publications

(18 citation statements)

References 9 publications

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“…Responder and remission rates were 50% and 29% for the esketamine group and 52% and 24% for the ketamine group, respectively, confirming non-inferiority. There was a trend toward a more prolonged antidepressant effect over the 7-day follow-up of racemic ketamine, but the difference was not statistically significant ( Correia-Melo et al, 2020 ; Vieira et al, 2021 ).…”

Section: Resultsmentioning

confidence: 86%

“…Of these, 590 were discarded after reviewing titles and abstracts. Of the remaining 58 full-text articles, 24 met the inclusion criteria ( Ajub and Lacerda, 2018 ; Barbosa et al, 2020 ; Bartova et al, 2018 , 2015 ; Correia-Melo et al, 2017a , 2017b , 2020 ; Del Sant et al, 2020 ; Delfino et al, 2021 ; Falk et al, 2020 ; Findeis et al, 2020 ; Kallmünzer et al, 2016 ; Kavakbasi et al, 2021 ; Lewis et al, 2019 ; Liu et al, 2020 ; Lucchese et al, 2021 ; Paslakis et al, 2010 ; Paul et al, 2009 ; Ritter et al, 2020 ; Segmiller et al, 2013 ; Singh et al, 2016 ; Veraart et al, 2021a ; Vieira et al, 2021 ; Wang et al, 2020 ). Nine articles included the same four cohorts of patients.…”

Section: Resultsmentioning

confidence: 99%

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The antidepressant effect and safety of non-intranasal esketamine: A systematic review

et al. 2022

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Background: The introduction of esketamine into the field of psychiatry comes on the heels of excitement from studies on racemic ketamine. While the intranasal route has been the most studied to date, other modes of administration of esketamine may also be of interest in the management of depression. Aims: To systematically review the literature on non-intranasal esketamine for depression in terms of its antidepressant effect and safety. Methods: We searched PubMed, Embase, the Cochrane Library, and Google Scholar from inception up to February 2021. Search terms included a combination of Medical Subject Headings and text words indicative of esketamine and depression. We selected both controlled and uncontrolled studies examining non-intranasal esketamine for the treatment of depression. Results: We identified four randomized controlled trials (RCTs) on intravenous esketamine and 15 open-label studies on intravenous ( n = 80), subcutaneous ( n = 73), and oral ( n = 5) esketamine. We found intravenous, subcutaneous, and possibly oral administration of esketamine to be effective in reducing depressive symptoms in most patients with major depressive disorder, bipolar depression, and (severe) treatment-resistant depression. Clinical response to repeated administration of esketamine persisted over the course of treatment. Esketamine was well tolerated by most patients, but open-label data indicate marked psychotomimetic symptoms in exceptional cases. The overall quality of the controlled studies was considered high, the overall quality of the uncontrolled studies low to moderate. Conclusions: Intravenous, subcutaneous, and possibly oral esketamine may offer an effective and safe addition to the depression treatment armamentarium. However, as most included studies lacked a control group and had small sample sizes, the quality of our results is limited. Different types and formulations of ketamine remain to be compared directly.

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Section: Resultsmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

The antidepressant effect and safety of non-intranasal esketamine: A systematic review

et al. 2022

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“…Im Direktvergleich wurde nur eine RKS mit Suizidgedanken als Behandlungsergebnis publiziert [ 40 ]. In dieser eher kleinen Studie zur behandlungsresistenten Depression wurde (Es)ketamin intravenös verabreicht.…”

Section: Ergebnisseunclassified

Suizidpräventive Effekte von Ketamin und Esketamin

Plöderl¹,

Hengartner²,

Volkmann³

2022

Nervenheilkunde

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ZUSAMMENFASSUNGKetamin und Esketamin werden als rasch und stark wirksame Mittel zur Reduktion von Depressivität und Suizidalität beschrieben. Dieser Beitrag gibt einen Überblick zur Wirksamkeit von Ketamin und Esketamin zur Reduktion von suizidalen Gedanken und Handlungen, basierend auf randomisierten kontrollierten Studien, die bis Dezember 2021 publiziert wurden. Für Ketamin gibt es Hinweise für eine beträchtliche Reduktion von Suizidgedanken, aber nur in den ersten 3 Tagen und die tatsächliche Effektstärke ist aufgrund der Schätzunsicherheit ungewiss. Für suizidale Handlungen fehlen zudem Daten. Die wenigen, aber qualitativ hochwertigeren Studien zu Esketamin fanden bestenfalls schwache Effekte bezüglich Suizidgedanken, auch unter Berücksichtigung der Schätzunsicherheit, und für suizidale Handlungen können keine gesicherten Aussagen getroffen werden. Das Nutzen-Schaden-Verhältnis von Ketamin und Esketamin in der Suizidprävention ist deshalb ungewiss.

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“…Psychopharmacological treatment of mood disorders is a protective factor, such as antidepressants (AD) and mood stabilizers 16,17 . Lithium and ketamine are effective for reducing suicide and suicidal ideation 17‐19 . Psychological treatments for suicidality can be prescribed based on diagnoses, such as MDD, BD (including bipolar depression), borderline personality disorder and substance use disorder 16,17 …”

Section: What Is New and Objectivementioning

confidence: 99%

“…16,17 Lithium and ketamine are effective for reducing suicide and suicidal ideation. [17][18][19] Psychological treatments for suicidality can be prescribed based on diagnoses, such as MDD, BD (including bipolar depression), borderline personality disorder and substance use disorder. 16,17 For MDD, the recommended treatment is a combination of selective serotonin reuptake inhibitors and cognitive-behavioural therapy (CBT), behavioural activation therapy (BA) or interpersonal therapy.…”

Section: What Is Ne W and Objec Tivementioning

confidence: 99%

Behavioural activation and trial‐based cognitive therapy may be beneficial to reduce suicidal ideation in major depressive disorder: A post hoc study from a clinical trial

Hemanny

Sena

Oliveira

2021

Clinical Pharmacy Therapeu

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What is known and objective The suicidality spectrum is a clinical challenge because of the difficulty of its management and its association with mortality. Few studies have investigated psychotherapies for reducing the components of suicidality. In this study, we compared the effect of behavioural activation (BA), trial‐based cognitive therapy (TBCT) – both added to antidepressant (AD) treatment – and treatment as usual (TAU) in mitigating suicidal ideation in patients with major depressive disorder (MDD). Methods A post hoc study was conducted with data from a randomized clinical trial. Secondary analyses compared the treatments using scores from the items that evaluated suicidal ideation with the HAM‐D (HAM‐D‐3) and BDI (BDI‐9). A composite measurement was constructed by summing the scores from the two items (HAM‐D‐3 plus BDI‐9). Results and discussion Seventy‐six patients were analysed (BA + AD = 24; TBCT + AD = 26 and TAU = 26). In HAM‐D‐3, the BA + AD group showed a statistically greater reduction than the TAU group. In BDI‐9, the three groups did not show significant differences. In the HAM‐D‐3 plus BDI‐9, TBCT + AD reduced ideations more than the TAU group. There were no differences among the psychotherapies in any of the measures. Sensitivity analyses showed improvement in suicidal ideation in both psychotherapies compared to TAU. What is new and conclusion This is one of the few studies that evaluated the effect of BA and TBCT in lowering suicidal ideation. Adding these therapies to ADs seems to decrease suicidal ideation. We suggest the possible beneficial effects of BA and TBCT in the management of suicidal ideation in patients with recurrent MDD. Our findings need further studies to confirm these results.

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Ketamine and Esketamine augmentation for suicidal ideation: A randomized, double-blinded clinical trial

Cited by 16 publications

References 9 publications

The antidepressant effect and safety of non-intranasal esketamine: A systematic review

The antidepressant effect and safety of non-intranasal esketamine: A systematic review

Suizidpräventive Effekte von Ketamin und Esketamin

Behavioural activation and trial‐based cognitive therapy may be beneficial to reduce suicidal ideation in major depressive disorder: A post hoc study from a clinical trial

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