Rapid and long-lasting effects of subcutaneous esketamine on suicidality: An open-label study in patients with treatment-resistant depression.
Eduardo Igor Torquato Cardoso Lopes, Patrícia Cavalcanti-Ribeiro, Fernanda Palhano-Fontes, Kaike Thiê da Costa Gonçalves, Emerson Arcoverde Nunes, Nicole Bezerra de Medeiros Lima, Nestor Caetano Santos, Aldielyson Jorge Cavalcante de Brito, Dráulio Barros de Araújo, Nicole Leite Galvão‐coelho
Journal of Psychiatric Research August 1, 2024 DOI: 10.1016/j.jpsychires.2024.06.020 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Open-label clinical trial Peer reviewed |
|---|---|
| Sample size | 18 |
| Population | Treatment-resistant depressive patients |
| Intervention | Subcutaneous esketamine |
| Duration | 8-week intervention, 6-month follow-up |
| Topics | Depression Esketamine |
| Keywords | Mental health treatment Suicide prevention Esketamine therapy Depression treatment Psychiatric breakthroughs |
| Citations | 9 |
| Key findings | Weekly subcutaneous esketamine injections produced a rapid drop in suicidality within 24 hours that persisted through eight weeks of treatment and remained lower at six-month follow-up, with 61% of patients achieving remission on suicidality. |
Abstract
Therapeutics for suicide management is limited, taking weeks to work. This open-label clinical trial with 18 treatment-resistant depressive patients tested subcutaneous esketamine (8 weekly sessions) for suicidality. We noted a rapid and enduring effect of subcutaneous esketamine, lasting from one week to six months post-treatment, assessed by the Beck Inventory for Suicidality (BSI). There was an immediate drop in suicidality, 24 h following the initial dose, which persisted for seven days throughout the eight-week dosing period. Additionally, this study is the first to examine a six-month follow-up after multiple administrations of subcutaneous esketamine, finding consistently lower levels of suicidality throughout this duration. Conversely, suicidality also was measured along the 8-weeks of treatment by a psychiatrist using the Montgomery-Asberg Depression Rating Scale (MADRS), which showed significant reduction only after two treatment sessions expanding until the last session. Moreover, notably, 61% of patients achieved remission on suicidality (MADRS). These results suggest that weekly subcutaneous esketamine injections offer a cost-effective approach that induces a rapid and sustained response to anti-suicide treatment. This sets the stage for further, more controlled studies to corroborate our initial observations regarding the effects of SC esketamine on suicidality. Registered trial at: https://ensaiosclinicos.gov.br/rg/RBR-1072m6nv.
Comparable studies
Other non-randomized and open-label trials on esketamine for depression, most cited first.
Citations in the library
Cited by 10
- Rapid and sustained antidepressant effects of vaporized N,N-dimethyltryptamine: a phase 2a clinical trial in treatment-resistant depression. Neuropsychopharmacology May 1, 2025
- Repeated subcutaneous esketamine on treatment-resistant depression: An open-label dose titration study. Journal of Affective Disorders January 15, 2025
- Esketamine/Ketamine: Dual‐Action Mechanisms and Clinical Prospects beyond Anesthesia in Psychiatry, Immunology, and Oncology Advanced Science December 14, 2025
- Can ketamine therapy overcome treatment-resistant depression in Alzheimer's disease and older adults? Preclinical and clinical evidence. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie July 1, 2025
- Real-world clinical outcomes under intravenous and subcutaneous esketamine protocols for treatment-resistant depression: a multicenter, retrospective study Frontiers in Psychiatry October 16, 2026
and 5 more in the library
Cites 16
- Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation American Journal of Psychiatry March 17, 2021
- 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 Major Depressive Disorder Symptoms in Patients Who Have Active Suicidal Ideation With Intent The Journal of Clinical Psychiatry May 11, 2020
- Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial Psychological Medicine August 12, 2015
- Psychedelics, Mystical Experience, and Therapeutic Efficacy: A Systematic Review Frontiers in Psychiatry July 12, 2022
and 11 more in the library