Does BMI matter when treating depression with esketamine? A retrospective analysis of real-world data.
Mina Ansari, Taeho Greg Rhee, Mia C Santucci, Sina Nikayin
Journal of Affective Disorders July 15, 2025 DOI: 10.1016/j.jad.2025.03.198 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective analysis Peer reviewed |
|---|---|
| Sample size | 190 |
| Population | Patients treated with intranasal esketamine at the Yale Interventional Psychiatry Service between January 2015 and May 2023 |
| Intervention | Intranasal esketamine |
| Topics | Depression Esketamine |
| Keywords | Psychiatric treatment Depression treatment Psychiatric medication Obesity therapy Bmi research Mental health breakthrough |
| Citations | 4 |
| Key points | Obese patients were significantly more likely to respond to intranasal esketamine treatment for depression compared to non-obese patients. |
Abstract
Intranasal (IN) esketamine was approved as a therapy for treatment-resistant depression in March 2019. There continues to be interest in the field to better understand factors associated with response to treatment. The aim of the current study is to assess the association between BMI and response to esketamine. A retrospective analysis was conducted on all patients treated with intranasal esketamine at the Yale Interventional Psychiatry Service between January 2015 and May 2023. The primary outcome was the association between BMI (ctegorized as obese vs. non-obese) and response to treatment (≥50 % improvement) by Montgomery-Åsberg Depression Rating Scale (MADRS). Statistical models, including generalized linear mixed-effects models were employed. A total of 190 patients met criteria for inclusion in the study, out of which 34.2 % were categorized as obese. Patients with obesity were significantly more likely to respond to esketamine treatment (RR = 1.63; p = 0.033) compared to non-obese patients. No linear association between BMI and treatment response was observed when BMI was treated as a continuous variable (RR = 1.02, p = 0.163). Obesity appears to be associated with a higher response rate to intranasal esketamine treatment for depression. Although the underlying mechanisms of this association are still unknown, increased body fat may prolong the presence of lipid-soluble compounds such as ketamine/esketamine or their active metabolites.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.
Citations in the library
Cited by 2
- Ketamine Infusions and Rapid Reduction of Suicidal and Depressive Symptoms in Major Depressive Episode: A Systematic Review and Meta-Analysis. JAMA Psychiatry July 1, 2026
- Clinical Predictors of Antidepressant Effects of Ketamine and Esketamine in Treatment-Resistant Unipolar and Bipolar Depression: A Systematic Review CNS Drugs July 1, 2026
Cites 15
- mTOR-Dependent Synapse Formation Underlies the Rapid Antidepressant Effects of NMDA Antagonists Science August 19, 2010
- Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression JAMA Psychiatry December 27, 2017
- Side-effects associated with ketamine use in depression: a systematic review. The Lancet Psychiatry 2018
- Comparative efficacy of racemic ketamine and esketamine for depression: a systematic review and meta-analysis Journal of Affective Disorders September 23, 2020
- Efficacy and safety of adjunctive therapy using esketamine or racemic ketamine for adult treatment-resistant depression: A randomized, double-blind, non-inferiority study. Journal of Affective Disorders November 14, 2019
and 10 more in the library