Efficacy of repeated intravenous esketamine in adolescents with anxious versus non-anxious depression.
Xiaofeng Lan, Chengyu Wang, Fan Zhang, Haiyan Liu, Ling Fu, Weicheng Li, Yanxiang Ye, Zhibo Hu, Siming Mai, Yuping Ning, Yanling Zhou
General Psychiatry June 21, 2023 DOI: 10.1136/gpsych-2023-101007 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 54 |
| Population | Adolescents with major depressive disorder and suicidal ideation, classified as anxious (n=33) or non-anxious (n=21) |
| Interventions | Esketamine midazolam |
| Dose | Esketamine 0.25 mg/kg; midazolam 0.045 mg/kg |
| Duration | Three infusions over 5 days, with assessments through 4 weeks post-treatment (days 12, 19, and 33) |
| Measures | Columbia Suicide Severity Rating Scale, Montgomery-Åsberg Depression Rating Scale |
| Topics | Anxiety Depression Esketamine |
| Keywords | Suicidal ideation Adolescent psychiatry Depressive disorder, major |
| Key findings | Among adolescents with MDD and suicidal ideation receiving esketamine, the non-anxious group had higher antisuicidal remission than the anxious group on day 6 (72.7% vs 18.8%) and day 12 (90.9% vs 43.8%), and higher antidepressant remission on day 33 (72.7% vs 26.7%). The authors report the antisuicidal advantage was temporary and not maintained at other time points. |
Abstract
Background: Patients with anxious major depressive disorder (MDD) are more likely to have poorer outcomes than those with non-anxious MDD. However, the effect of esketamine on adolescents with anxious versus non-anxious MDD has remained unknown.
Aims: We compared the efficacy of esketamine in adolescents with MDD and suicidal ideation, both anxious and non-anxious.
Methods: Fifty-four adolescents with anxious (n=33) and non-anxious (n=21) MDD received three infusions of esketamine 0.25 mg/kg or active-placebo (midazolam 0.045 mg/kg) over 5 days, with routine inpatient care and treatment. Suicidal ideation and depressive symptoms were assessed using the Columbia Suicide Severity Rating Scale and the Montgomery-Åsberg Depression Rating Scale. Multiple-sample proportional tests were used to compare the differences between groups on treatment outcomes 24 hours after the final infusion (day 6, primacy efficacy endpoint) and throughout the 4-week post-treatment (days 12, 19 and 33).
Results: In subjects who received esketamine, a greater number of patients in the non-anxious group than the anxious group achieved antisuicidal remission on day 6 (72.7% vs 18.8%, p=0.015) and day 12 (90.9% vs 43.8%, p=0.013), and the non-anxious group had a higher antidepressant remission rate compared with the anxious group on day 33 (72.7% vs 26.7%, p=0.045). No significant differences in treatment outcomes were observed between the anxious and non-anxious groups at other time points.
Conclusions: Three infusions of esketamine as an adjunct to routine inpatient care and treatment had a greater immediate post-treatment antisuicidal effect in adolescents with non-anxious MDD than in those with anxious MDD; however, this benefit was temporary and was not maintained over time. Trial registration number: ChiCTR2000041232.
Comparable studies
Other randomized controlled trials on esketamine for anxiety, most cited first.