Background: Major depressive disorder (MDD) is highly prevalent and associated with significant disability and mortality. Treatment-resistant depression (TRD), defined as inadequate response to ⩾2 antidepressant lines, remains a major therapeutic challenge. Esketamine nasal spray, approved in 2019 for TRD, demonstrated efficacy and safety in randomized trials, but real-world evidence remains...
This study evaluated the long-term comparative effectiveness and safety of esketamine versus injectable ketamine and esketamine versus oral antidepressants for major depressive disorder (MDD). This emulated target trial utilized observational data from a cohort of U.S. adults with MDD between 2018 and 2024. Patients were categorized into those receiving esketamine, injectable R,S-ketamine, and...
Ketamine and esketamine have been increasingly used as adjunctive treatments for treatment-resistant depression (TRD), yet evidence on pharmacological interactions with commonly prescribed psychotropic medications remains limited. This study evaluated the association between concomitant lamotrigine, lithium, and benzodiazepine use and antidepressant outcomes during subcutaneous esketamine...
Patients with serious illnesses and short prognoses often experience depression and suicidal ideation. Traditional antidepressants are limited by delayed onset, creating a need for rapidly acting therapies. In this Palliative Care Rounds, we examine the evidence for ketamine/esketamine's efficacy as antidepressants, including evidence specific to people with serious illnesses. In psychiatric...
Intravenous ketamine has emerged as a rapid-acting antidepressant intervention that has shown promising effects in patients with treatment-resistant depression, although evidence remains heterogeneous and less well established across diagnostic subtypes. Nevertheless, real-world data comparing diagnostic subtypes and sex-related differences remain limited. This observational study examined the...
Ketamine may alleviate treatment-resistant depression (TRD) primarily through glutamatergic modulation, with downstream dopaminergic activation. Iron plays an important role in monoaminergic metabolism, that is also implicated in the pathophysiology of TRD. Both Quantitative Susceptibility Mapping (QSM) and Effective Transverse Relaxation Rate (R2*) mapping can determine the extent of iron...
BACKGROUND: Major depressive disorder (MDD) is one of the leading causes of disability globally, and conventional monoaminergic antidepressants often have a slow onset and limited efficacy. About onethird of patients suffer from treatment-resistant depression (TRD), which emphasizes the urgent need for alternative therapies. This review aims to systematically evaluate the available data about...
This is a case report of a 52 year old female with ECT-refractory bipolar depression who was treated with esketamine nasal spray, leading to a noticeable improvement in her depressive symptoms. She experienced a relapse after a reduction in her maintenance treatment in conjunction with psychosocial stressors, but improved once again after returning to her induction regimen. She tolerated the...
Background Depression remains a leading cause of disability and suicide worldwide, with treatment-resistant depression (TRD) affecting nearly 30% of individuals diagnosed with major depressive disorder. Esketamine nasal spray (NS) and quetiapine extended-release (XR) are both approved as adjunctive therapies for TRD; however, direct head-to-head comparisons are limited. Method A systematic...
Treatment-resistant depression (TRD) is a heterogeneous condition in which symptoms such as anhedonia, rumination, and anxiety contribute to persistent disability. Esketamine nasal spray (ESK-NS), accelerated repetitive transcranial magnetic stimulation (arTMS), and adjunctive brexpiprazole represent novel therapeutic options with distinct mechanisms, though their domain-specific effects in...