Changing the paradigm in treatment-resistant depression: A review of long-term efficacy and tolerability of esketamine nasal spray.
Jesús Herrera-Imbroda
Experimental and Clinical Psychopharmacology May 1, 2023 DOI: 10.1037/pha0000650 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Placebo-controlled Open-label Peer reviewed |
|---|---|
| Interventions | Esketamine nasal spray oral antidepressant |
| Topics | Depression Ketamine Esketamine |
| Keywords | Humans Antidepressive agents Drug therapy, combination Nasal sprays |
| Key findings | The authors report that esketamine nasal spray, combined with an oral antidepressant, demonstrated long-term efficacy and safety for treatment-resistant depression in both placebo-controlled and open-label maintenance studies, with one study reporting high patient satisfaction. They argue it represents a new paradigm in treatment, while cautioning that more studies are needed to consolidate the evidence. |
Abstract
Treatment-resistant depression (TRD) is a major public health problem worldwide. There are currently five strategies for its treatment: optimization, change, combination, augmentation, and somatic therapies. However, many of these therapies are not fully effective, are not accessible, or have a significant number of side effects. Esketamine nasal spray has recently been approved, in combination with another oral antidepressant, for TRD, with excellent results in short-term studies. We consider in this review whether this therapy is also safe and effective in the long-term treatment of patients. A narrative review, using a comprehensive Pubmed search, and other search strategies, of long-term studies evaluating the safety and efficacy of esketamine nasal spray for the treatment of TRD has been conducted. Five studies have been included in the review. Esketamine nasal spray has demonstrated long-term efficacy and safety in both placebo-controlled and open-label studies evaluating maintenance of antidepressant response. In addition, one study has reported a high level of patient satisfaction with treatment. As limitations, a systematic search for studies has not been carried out and these are still scarce, given the short time that has elapsed since the discovery of the molecule. Esketamine nasal spray is the greatest pharmacological novelty in the treatment of major depression in the last 50 years. It constitutes a new paradigm in the treatment of TRD, which should make us rethink the care protocols that we currently follow. However, more studies are still needed to consolidate the data found so far. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Comparable studies
Other narrative reviews on esketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Long-term safety of ketamine and esketamine in treatment of depression | 2022 | Review | |
| Ketamine, Esketamine, and Arketamine: Their Mechanisms of Action and Applications in the Treatment of Depression and Alleviation of Depressive Symptoms. | 2024 | Review | |
| Variations in BDNF and Their Role in the Neurotrophic Antidepressant Mechanisms of Ketamine and Esketamine: A Review. Patients with depression | 2024 | Narrative review | |
| The Possible Application of Ketamine in the Treatment of Depression in Alzheimer’s Disease | 2022 | Review |