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Case report: Effectiveness of brexpiprazole and esketamine/ketamine combination: A novel therapeutic strategy in five cases of treatment-resistant depression

Lai Fong Chan, Luke Sy-Cherng Woon, Nuur Asyikin Mohd Shukor, Choon Leng Eu, Nurazah Ismail, Song Jie Chin, Nik Ruzyanei Nik Jaafar, Azlin Baharudin

Frontiers in Psychiatry July 22, 2022 DOI: 10.3389/fpsyt.2022.890099 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case series Case report Peer reviewed
Sample size 5
Population Patients with unipolar or bipolar treatment-resistant depression and high-risk suicidal behavior
Interventions Brexpiprazole Esketamine Ketamine
Topics Depression Esketamine Ketamine
Keywords Effectiveness Brexpiprazole
Citations 2
Key findings Combining brexpiprazole with esketamine/ketamine may improve effectiveness and speed of response in treatment-resistant depression where conventional strategies have failed.

Abstract

A significant proportion of patients with treatment-resistant depression do not attain functional recovery despite administration of multiple steps of pharmacotherapeutic strategies. This highlights the elusiveness of meeting unmet needs in existing pharmacotherapies for treatment-resistant depression. There is accumulating evidence that antidepressant agents involving the glutamatergic system such as brexpiprazole and esketamine/ketamine have more rapid onset of action and potentially improved effectiveness as an augmentation therapy in treatment-resistant depression. This case series aimed to report five complex cases of unipolar and bipolar treatment-resistant depression where conventional treatment strategies were inadequate in managing high risk suicidal behavior and achieving functional recovery. We discussed further the possible synergistic mechanisms of the novel combination strategy of brexpiprazole and esketamine/ketamine, clinical and patient factors that influenced treatment response, challenges with this combination strategy and implications for future practice and research.

Comparable studies

Other case reports and case series on esketamine for depression, most cited first.

Study Year Design Participants
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety... 2025 Case report n = 1
Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD 2022 Retrospective case series n = 35
Case report: Intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa Patients with anorexia nervosa and a comorbid depressive disorder treated at a private... 2023 Case report n = 4
Repeated oral esketamine in patients with treatment resistant depression and comorbid posttraumatic stress disorder Patients with treatment-resistant depression and comorbid PTSD 2023 Case series n = 5
Disembodiment and Affective Resonances in Esketamine Treatment of Depersonalized Depression Subtype: Two Case Studies. Patients with treatment resistant depression and depersonalized depression symptoms 2024 Case study n = 2

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