Impact of Repeated Doses of Subcutaneous Esketamine on Acute Dissociative Symptoms in Treatment-Resistant Depression.
Lorena Catarina Del Sant, Luciana Maria Sarin, Ana Cecília Lucchese, Eduardo Jorge Muniz Magalhães, Marco Aurélio Tuena, Carolina Nakahira, José Alberto Del Porto, Acioly Luiz Tavares De Lacerda, Jair de Jesus Mari
Pharmaceuticals (Basel, Switzerland) December 26, 2022 DOI: 10.3390/ph16010031 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective analysis Peer reviewed |
|---|---|
| Sample size | 70 |
| Population | Patients with treatment-resistant depression (TRD) |
| Interventions | Esketamine oral antidepressant therapy |
| Dose | 0.5 to 1.0 mg/kg |
| Duration | Six-week trial with weekly injections |
| Measures | Clinician-Administered Dissociative States Scale (CADSS) |
| Topics | Esketamine Depression |
| Keywords | Dissociation Treatment resistant depression |
| Key points | Repeated subcutaneous esketamine injections over six weeks were reported as safe and well-tolerated regarding acute dissociative and psychotomimetic symptoms. Dissociative symptoms peaked at 30 minutes, decreased by 60 minutes, and returned to pretreatment levels by 120 minutes. No correlation was found between dissociative symptoms and antidepressant response. |
Abstract
Esketamine has been approved by the US Food and Drug Administration (FDA) as an adjunctive treatment for use in conjunction with an oral antidepressant for patients with treatment-resistant depression (TRD), but dissociative symptoms are common adverse effects. A retrospective analysis of 394 subcutaneous esketamine injections given to 70 patients with TRD that were administered once a week during a six-week trial in conjunction with oral antidepressant therapy. Doses between 0.5 to 1.0 mg/kg were administered according to the patient's response. Dissociative symptoms were assessed using the Clinician-Administered Dissociative States Scale (CADSS) 30 and 60 min after every weekly treatment (day 1, 8, 15, 22, 29 and 36). Seventy patients received a total of 394 subcutaneous esketamine injections over six weeks. Over time, the evolution of CADSS scores demonstrated a significant mean difference of CADSS at 60 min post-injection (p = 0.010) throughout the six infusions. The mean CADSS scores at 60 min on day 22, 29 and 36 were similar. There were no differences between mean CADSS scores 30 min after the injections, no clinical correlation between response and dissociative symptoms, no correlation between time and demographic and clinical characteristics and no interactions between time and combined medication. Our results suggest that repeated subcutaneous esketamine doses are safe and well-tolerated regarding their acute dissociative and psychotomimetic symptoms. Symptoms usually peak at 30 min and decrease at 60 min post-injection, returning to their pretreatment levels at 120 min. Dissociative symptoms do not correlate with antidepressant response.