Adjunctive short- and long-term combination treatment of esketamine and VNS in difficult to treat depression (DTD)
Erhan Kavakbasi, Bernhard T Baune
European Psychiatry March 1, 2023 DOI: 10.1192/j.eurpsy.2023.572 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Naturalistic observational study Peer reviewed |
|---|---|
| Sample size | 8 |
| Population | Patients with difficult-to-treat depression (DTD), mean age 50.8 years, 50% female |
| Interventions | Esketamine Vagus nerve stimulation (VNS) |
| Duration | Follow-up period 12-24 months (mean 17 months) |
| Measures | MADRS |
| Topics | Depression Esketamine |
| Key findings | Combining esketamine with vagus nerve stimulation was associated with a 38.5% reduction in mean MADRS scores (30.9 to 19) at 12 months and a decrease in hospitalizations per month from 0.17 to 0.11 in 8 patients with difficult-to-treat depression. Among 6 patients offered maintenance esketamine, mean sessions fell from 2.3 at 6 months to 0.96 at 12 months, and 4 discontinued esketamine after a mean of 11.5 months. The authors conclude the combination is safe and effective and reduces the need for esketamine sessions. |
Abstract
IntroductionNMDA-Receptor antagonists have rapid antidepressant and antisuicidal properties. However, the antidepressant effect is short lasting raising the question of best maintenance strategy, which is unanswered so far. Invasive vagus nerve stimulation (VNS) as a treatment option for refractory and chronic major depression was shown to reduce the need of maintenance treatment sessions in electroconvulsive therapy (ECT) patients.ObjectivesThere are no published data on the combination of VNS and esketamine. To determine the impact of the combination of VNS and esketamine in DTD.MethodsIn this naturalistic observational study, we investigated the short- and long-term impact of combination of VNS and esketamine in n=8 patients with difficult-to-treat depression (DTD). Follow-up evaluations were scheduled prospectively pre-surgery at baseline and every 3 months after VNS-implantation (follow-up period 12-24 months, mean 17).ResultsThe mean age of patients was 50,8 years. 50 % of patients (n=4) were female. All patients suffered from severe DTD (mean MADRS at baseline 30,9). Mean number of hospitalizations per months decreased from 0.17 to 0.11 after VNS implantation. 6 of 8 patients were offered maintenance esketamine treatment. Mean MADRS at 12-months was 19 (38.5 % MADRS reduction). The need of mean esketamine treatment sessions decreased from 2.3 at 6-months visit (V6) to 1.37 at V9 and 0.96 at V12 respectively. Termination of maintenance esketamine was possible in 4 cases after a mean of 11.5 months.ConclusionsCombination of esketamine and VNS is a safe and effective treatment option in severely ill DTD patients to relieve disease severity and reduce hospitalizations. Need of esketamine treatment sessions decreases 6 months after VNS implantation.Disclosure of InterestNone Declared
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.