Effect of Esketamine on Depressive Symptoms in Adolescents With Major Depressive Disorder at Imminent Suicide Risk: A Randomized Psychoactive-Controlled Study.
Colette Kosik-Gonzalez, Dong-Jing Fu, Li Nancy Chen, Rosanne Lane, Michael H. Bloch, Melissa P. DelBello, Carmen Moreno, Wayne C. Drevets, Carla M. Canuso
Journal of the American Academy of Child & Adolescent Psychiatry March 7, 2025 DOI: 10.1016/j.jaac.2025.02.015 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Double-blind Peer reviewed |
|---|---|
| Sample size | 147 |
| Population | Adolescents (12 to <18 years old) with major depressive disorder at imminent risk for suicide |
| Interventions | Esketamine Midazolam |
| Dose | 28, 56, or 84 mg |
| Duration | 4-week intervention |
| Topics | Depression Esketamine |
| Keywords | #mentalhealth mental illness Psychiatric care Behavioral health #esketamine ketamine therapy Intranasal esketamine Rct Suicide Clinical depression |
| Citations | 14 |
| Registration | NCT03185819 |
| Key findings | Pooled esketamine doses (56 and 84 mg) showed superiority over midazolam in reducing depressive symptoms at 24 hours post first dose. |
Abstract
To evaluate the efficacy, safety, and tolerability of esketamine nasal spray vs psychoactive placebo (oral midazolam) in rapidly reducing depressive symptoms in adolescents with major depressive disorder at imminent risk for suicide. This double-blind, double-dummy, phase 2b study randomized (1:1:1:2) 147 adolescents (12 to <18 years old) to esketamine (28, 56, or 84 mg) or midazolam twice weekly for 4 weeks. Participants concomitantly received comprehensive standard of care, including initial hospitalization, oral antidepressant, and evidenced-based psychotherapy. The primary efficacy end point-change in Children's Depression Rating Scale-Revised (CDRS-R) total score from baseline to 24 hours post first dose-was analyzed using analysis of covariance, according to a pooled sequential multiple testing procedure. All participants were moderately to severely depressed at enrollment; approximately 95% were moderately to extremely suicidal. Pooled esketamine doses (56 and 84 mg) showed superiority over midazolam in reducing CDRS-R total score at 24 hours post first dose (between-group difference of least squares means [95% CI]: -5.8 [-11.19, -0.35], p = .037). The between-group differences for individual esketamine 84 mg and 56 mg doses vs midazolam were -5.7 ([-12.91, 1.55], p = .123) and -5.9 ([-12.25, 0.53], p = .072), respectively. Severity of suicidality, per Clinical Global Impression of Severity of Suicidality-revised (CGI-SS-R), improved in all 4 groups (between-group difference of least squares means [95% CI]: -0.2 [-0.90, 0.41], -0.3 [-0.93, 0.31], 0.0 [-0.69, 0.72] for esketamine 28, 56, and 84 mg, respectively, at 24 hours post first dose). Common adverse events (incidence ≥20%) reported for esketamine were dizziness, nausea, dissociation, headache, dysgeusia, somnolence, vomiting, hypoesthesia, and intentional self-injury. The primary efficacy end point of the study was met for the pooled esketamine doses (56 and 84 mg). Esketamine in conjunction with comprehensive standard of care rapidly improved depressive symptoms among adolescents at imminent risk for suicide. Study to Evaluate the Efficacy and Safety of 3 Fixed Doses of Intranasal Esketamine in Addition to Comprehensive Standard of Care for the Rapid Reduction of the Symptoms of Major Depressive Disorder, Including Suicidal Ideation, in Pediatric Participants Assessed to Be at Imminent Risk for Suicide; https://clinicaltrials.gov/study/NCT03185819.
Comparable studies
Other randomized controlled trials on esketamine for depression, most cited first.
Citations in the library
Cited by 12
- Blinding Integrity in Psychedelic Randomized Clinical Trials JAMA Psychiatry April 15, 2026
- Psychedelic therapeutics in psychiatric conditions Neuropsychopharmacology January 16, 2026
- Esketamine’s therapeutic effect on anhedonia in adolescents: a post-hoc of a randomized controlled trial BMC Psychiatry October 7, 2026
- Case report of S-ketamine as treatment option for suicidal ideation and treatment-resistant depression in adolescents with early-onset psychosis Neuropsychiatrie August 25, 2026
- A pilot randomized trial of ketamine for suicidal ideation in a pediatric emergency department. CJEM June 3, 2026
and 7 more in the library
Cites 6
- Measurement of dissociative states with the Clinician‐Administered Dissociative States Scale (CADSS) Journal of Traumatic Stress 1998
- Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study American Journal of Psychiatry April 16, 2018
- Esketamine Nasal Spray for Rapid Reduction of Depressive Symptoms in Patients With Major Depressive Disorder Who Have Active Suicide Ideation With Intent: Results of a Phase 3, Double-Blind, Randomized Study (ASPIRE II) The International Journal of Neuropsychopharmacology August 26, 2020
- Esketamine Nasal Spray for Rapid Reduction of Major Depressive Disorder Symptoms in Patients Who Have Active Suicidal Ideation With Intent The Journal of Clinical Psychiatry May 11, 2020
- Efficacy of Intravenous Ketamine in Adolescent Treatment-Resistant Depression: A Randomized Midazolam-Controlled Trial. American Journal of Psychiatry March 3, 2021
and 1 more in the library