 for Depression: An Update){kind=link}
Research on the efficacy and safety of intranasal esketamine (Spravato) as a treatment for Depression continues. In particular, three recent analyses provide additional background for patients interested in learning more about this treatment option for Depression, serving as updates to our prior discussions about esketamine.
Meta-Analysis of Esketamine Augmentation
George I. Papakostas, M.D., et al. conducted a meta-analysis of studies of Major Depressive Disorder (MDD) treatment using esketamine nasal spray. The analysis combined the results of five trials with a total of 774 patients whose response was measured on the MADRS scale at baseline, with measurements taken (depending on the study) at 4 hours after administration, on the 8th day and on the 28th day. Regarding the efficacy and safety of intranasal esketamine (versus placebo) as an augmentation of treatment for MDD that featured either treatment resistance or suicidality, the authors found it to be a significantly effective treatment strategy.
REAL-ESK Study
A 2022 study by Giovanni Martinotti, et. al. aimed to evaluate the efficacy and safety of intranasal esketamine for Treatment-Resistant Depression in a real-world setting. Their study of 116 patients included patients whose psychiatric comorbidities would tend to cause them to be excluded from randomized clinical trials. The authors wrote that their “observational data support the safety and tolerability of esketamine” in the real world, as well as its “clinical effectiveness.” Their study illustrated this by a comparison of Depression symptoms as two time points (T1 and T2) to the baseline (T0), finding that they dropped significantly at T1 (one month after initiation) and T2 (3 months after initiation). Furthermore, a dramatic increase in clinical response (64.2 %) and remission rates (40.6 %) was detected at T2 compared to T1. They also did not find that psychiatric comorbidities affected the efficacy of esketamine.
The study’s findings also support the safety and tolerability of esketamine. There was no evidence of abuse, misuse, withdrawal, gateway activity, and no long term cognitive or urogenital or hepatic toxicity. Less than 3% of subjects dropped out due to side effects.
The authors did note limitations of their study, including the lack of a placebo group. However, this study adds valuable information to the body of scientific evidence for esketamine, especially in real world (vs research) settings.
International Expert Opinion on The Efficacy and Safety of Intranasal Esketamine
A 2021 article in The American Journal of Psychiatry by Roger S. McIntyre, et al. contained an international expert option that summarized the existing evidence on the efficacy and safety of intranasal esketamine, as well as various delivery methods of ketamine for Treatment-Resistant Depression.
In the conclusion of the article, these authors express optimism and emphasize the importance of closely monitoring patients receiving these treatments. The authors state that esketamine should be provided at specialized practices that are set up to handle these risks and whose practitioners have expertise in the treatment of refractory Depression..
Esketamine (Spravato) is a Safe and Effective Depression Treatment When Administered by Expert Practitioners
Synthesizing the information contained in these three analyses, we can see that when esketamine is administered in an appropriate setting and with the care and attention it can provide an effective option for Depression treatment. Esketamine (Spravato) nasal spray received FDA approval for the treatment of Depression in 2019. For patients who have tried other treatments for their Depression without adequate relief, the availability of esketamine treatment can be a literal lifesaver, particularly because it works quickly.
Learn more about Depression treatment options at Mid City TMS
Mid City TMS provides our patients with proven and safe treatments for Depression, including Spravato and transcranial magnetic stimulation (TMS). Your treatment provider will listen to you and create a treatment plan that takes into account your needs, preferences, and treatment history. Learn more about our services by contacting us today.