Association of intranasal esketamine, a novel ‘standard of care’ treatment and outcomes in the management of patients with treatment-resistant depression: protocol of a prospective cohort observational study of naturalistic clinical practice
Gustavo Vazquez, Gilmar Gutierrez, Joshua D. Rosenblat, Ayal Schaffer, Jennifer Swainson, Ganapathy Karthikeyan, Nisha Ravindran, Raymond W. Lam, André Do, Peter Giacobbe, Emily R. Hawken, Roumen Milev
BMJ Open September 1, 2022 DOI: 10.1136/bmjopen-2022-060967 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Multicentre prospective cohort observational study (protocol) Peer reviewed |
|---|---|
| Sample size | 60 |
| Population | Patients with moderate to severe treatment-resistant major depressive disorder approved to receive intranasal esketamine as part of standard care |
| Intervention | Intranasal esketamine |
| Measures | Montgomery-Åsberg Depression Rating Scale (MADRS), simplified 6-Item Clinician Administered Dissociative Symptom Scale, Likeability and Craving Questionnaire (LCQ) |
| Topics | Depression Esketamine Ketamine |
| Citations | 6 |
| Key findings | The protocol proposes to examine whether adding intranasal esketamine to patients' current pharmacological treatment is associated with reduced depression severity and to characterise its tolerability, including side effects, dissociation, and abuse potential, in 60 patients with treatment-resistant major depressive disorder. No outcomes are reported because the study has not yet been conducted. |
Abstract
Introduction: Esketamine is the S-enantiomer of racemic ketamine and has been approved by the Food and Drug Administration for the management of treatment resistant depression, demonstrating effective and long-lasting benefits. The objective of this observational study is to elucidate the association of intranasal (IN) esketamine with beneficial and negative outcomes in the management of treatment resistant major depressive disorder.
Methods: AND ANALYSIS: This is a multicentre prospective cohort observational study of naturalistic clinical practice. We expect to recruit 10 patients per research centre (6 centres, total 60 subjects). After approval to receive IN esketamine as part of their standard of care management of moderate to severe treatment resistant depression, patients will be invited to participate in this study. Association of esketamine treatment with outcomes in the management of depression will be assessed by measuring the severity of depression symptoms using the Montgomery-Åsberg Depression Rating Scale (MADRS), and tolerability by systematically tracking common side effects of ketamine treatment, dissociation using the simplified 6-Item Clinician Administered Dissociative Symptom Scale and potential for abuse using the Likeability and Craving Questionnaire (LCQ). Change in depressive symptoms (MADRS total scores) over time will be evaluated by within-subject repeated measures analysis of variance. We will calculate the relative risk associated with the beneficial (reduction in total scores for depression) outcomes, and the side effect and dropout rates (tolerability) of adding IN esketamine to patients' current pharmacological treatments. Covariate analysis will assess the impact of site and demographic variables on treatment outcomes. ETHICS AND DISSEMINATION: Approval to perform this study was obtained through the Health Sciences Research Ethics Board at Queen's University. Findings will be shared among collaborators, through departmental meetings, presented on different academic venues and publishing our manuscript.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.