For adults with treatment-resistant depression, adding mindfulness-based cognitive therapy (MBCT) to usual pharmacotherapy produced a significantly greater reduction in depression severity (36.6% vs. 25.3% on the Hamilton Depression Rating Scale) and a higher rate of treatment responders (30.3% vs. 15.3%) after eight weeks, compared with an active control program of physical fitness, music therapy, and nutritional education. Remission rates did not differ significantly between groups (22.4% vs. 13.9%). Higher state anxiety, perceived stress, and personality disorder were associated with worse outcomes. MBCT appears to be a viable adjunctive treatment for treatment-resistant depression.
For patients with treatment-resistant depression who did not show a response within the first week of treatment, a full four-week induction course of esketamine nasal spray plus an oral antidepressant may still provide benefit. In a pooled analysis of two phase 3 trials, among those not meeting early response criteria at day 2 or days 2 and 8, the odds of a response by day 28 were about 1.6 times higher with esketamine plus antidepressant compared to antidepressant plus placebo. The findings suggest that lack of early improvement does not preclude later benefit from the full induction course.
A post hoc analysis of two pooled 4-week phase 3 trials examined predictors of response and remission in patients with treatment-resistant depression receiving esketamine nasal spray plus a new oral antidepressant compared to a new oral antidepressant plus placebo nasal spray. Younger age, being employed, having fewer failed antidepressants in the current episode, and early reduction in Clinical Global Impression-Severity score at day 8 predicted better outcomes. Those on esketamine had 68% higher odds of response and 55% higher odds of remission. In the esketamine group, response was more likely in employed patients, those without baseline anxiety, and those with early symptom improvement.