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 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.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.
Citations in the library
Cited by 7
- The Antidepressant Actions of Ketamine and its Enantiomers Pharmacology & Therapeutics May 1, 2023
- Beyond NMDA Receptors: A Narrative Review of Ketamine's Rapid and Multifaceted Mechanisms in Depression Treatment. International Journal of Molecular Sciences December 20, 2024
- Ketamine-induced altered states of consciousness: a systematic review of implications for therapeutic outcomes in psychiatric practices. European Archives of Psychiatry and Clinical Neuroscience October 28, 2024
- Subcutaneous ketamine reduces suicide risk and improves functioning in depression: A proof-of-concept study. Psychiatry Research July 1, 2024
- Dissociation and Antidepressant Response to Subcutaneous Esketamine: A Clinical Study Journal of Psychiatric Research July 1, 2026
and 2 more in the library
Cites 19
- Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study American Journal of Psychiatry May 21, 2019
- Measurement of dissociative states with the Clinician‐Administered Dissociative States Scale (CADSS) Journal of Traumatic Stress 1998
- Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression JAMA Psychiatry June 5, 2019
- Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression JAMA Psychiatry December 27, 2017
- 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
and 14 more in the library