Oral Esketamine as Alternative for Maintenance Electroconvulsive Therapy in Patients With Treatment-Resistant Depression: A Case Series.
Daniël T Coerts, Jolien K E Veraart, Jeanine Kamphuis, Sanne Y Smith-Apeldoorn, Robert A Schoevers, Sjoerd M van Belkum
The Journal of ECT January 21, 2025 DOI: 10.1097/YCT.0000000000001103 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational study Case report Peer reviewed |
|---|---|
| Sample size | 8 |
| Population | Patients with treatment-resistant depression |
| Intervention | oral esketamine |
| Dose | 0.5 or 1.0 mg/kg titrated to maximum 3.0 mg/kg twice weekly |
| Duration | 6-week dosing phase |
| Topics | Depression Esketamine |
| Keywords | Depression treatment Esketamine therapy Mental health breakthrough Psychiatric medicine Treatment alternatives |
| Citations | 1 |
| Key findings | Repeated oral esketamine maintained or improved depression severity in five of eight patients with treatment-resistant depression, suggesting it may be a viable alternative to maintenance electroconvulsive therapy. |
Abstract
This study investigates repeated oral esketamine as a substitution strategy for maintenance electroconvulsive therapy (M-ECT) in eight patients with treatment-resistant depression (TRD). In a 6-week dosing phase, esketamine was titrated from 0.5 or 1.0 mg/kg to a maximum of 3.0 mg/kg twice weekly. Outcomes included 6-week change in Inventory of Depressive Symptomatology - Self-rated (IDS-SR), Hamilton Depression Rating Scale - 17 items (HDRS17), and Outcome Questionnaire 45 (OQ-45), along with esketamine treatmentcontinuation. Depression severity remained stable or improved in five patients, whereas three experienced worsening symptoms and resumed M-ECT. OQ-45 scores were available for five patients, all of whom showed improvement. Currently, four patients are still receiving oral esketamine. Repeated oral esketamine may be a suitable and patient-friendly alternative to M-ECT. We recommend controlled trials to compare long-term safety and efficacy.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.
Citations in the library
Cites 12
- Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. New England Journal of Medicine May 24, 2023
- Maintenance ketamine treatment for depression: a systematic review of efficacy, safety, and tolerability. The Lancet Psychiatry November 1, 2022
- Efficacy and Safety of Ketamine vs Electroconvulsive Therapy Among Patients With Major Depressive Episode: A Systematic Review and Meta-analysis. JAMA Psychiatry October 19, 2022
- Long-Term Safety and Maintenance of Response With Esketamine Nasal Spray in Participants With Treatment-Resistant Depression: Interim Results of the SUSTAIN-3 Study Neuropsychopharmacology May 12, 2023
- Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT) The International Journal of Neuropsychopharmacology December 4, 2021
and 7 more in the library