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Efficacy of esketamine for depression not linked to dissociation

The Brown University Psychopharmacology Update May 3, 2023 DOI: 10.1002/pu.31025 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Randomized controlled trial Placebo-controlled Double-blind Peer reviewed
Sample size 22
Population Adults with borderline personality disorder (BPD)
Interventions Ketamine Midazolam
Duration Follow-up to 2 weeks
Topics Depression Esketamine Ketamine
Key findings Ketamine infusions were well tolerated and produced greater reductions than midazolam in depressive symptoms, suicidal ideation, and socio-occupational functioning, though most findings were suggestive rather than statistically significant. The authors suggest ketamine may help improve depressive symptoms and promote functional recovery in adults with borderline personality disorder.

Abstract

symptoms of depression and anxiety and evaluated socio-occupational functioning. Twenty-two participants were randomized to treatment. The infusions were well-tolerated, with no serious adverse events. Most of the findings were suggestive but not statistically significant. Post-infusion scores on the primary outcome decreased more in the ketamine group than in the midazolam group. The greatest magnitude of change in suicidal ideation occurred on day 1, with greater change in the ketamine group. The ketamine group also experienced greater change in depressive symptoms by day 3 of follow-up, and improvements in socio-occupational functioning were significantly correlated with reductions in depression at 2 weeks in the ketamine group. The study’s authors wrote that “this first randomized double-blind placebo-controlled clinical trial of ketamine for adults with BPD provides initial safety data and suggests that ketamine may help to improve depressive symptoms and promote functional recovery in this underserved clinical group.” [Fineberg, S., et al. (2023). Neuropsychopharmacol. https:// doi.org/10.1038/s41386-023-01540-4]

Comparable studies

Other randomized controlled trials on esketamine for depression, most cited first.

Study Year Design Participants
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 Adults with moderate to severe nonpsychotic depression and a history of nonresponse to... 2019 Phase 3, double-blind, active-controlled, multicenter randomized controlled trial n = 227
Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression Adults with treatment-resistant depression who achieved stable remission or stable... 2019 Phase 3, multicenter, double-blind, randomized withdrawal study n = 297
Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression Adults with DSM-IV-TR diagnosis of major depressive disorder and history of inadequate... 2017 Phase 2, double-blind, doubly randomized, delayed-start, placebo-controlled study n = 67
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 Depressed patients at imminent risk for suicide 2018 Randomized controlled trial n = 68
Efficacy and Safety of Fixed-Dose Esketamine Nasal Spray Combined With a New Oral Antidepressant in Treatment-Resistant Depression: Results of a Randomized, Double-Blind, Active-Controlled Study (TRANSFORM-1) Adults with moderate-to-severe depression and nonresponse to at least two... 2019 Randomized controlled trial n = 346

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