 Transform Treatment-Resistant Depression? Insights from a Recent Study){kind=link}
Treatment-resistant Depression (TRD) remains one of Psychiatry’s most complex clinical challenges. Standard antidepressants often fail to bring relief to approximately one-third of patients with Major depressive disorder (MDD). In this landscape of unmet needs, the ICEBERG study offers critical insights into the long-term benefits of Spravato (Esketamine) nasal spray, a novel intervention designed to add to traditional treatment paradigms.
The Aim: An Indirect Comparison with Real-World Relevance
The ICEBERG study wasn’t a typical randomized controlled trial. Instead, it used an indirect treatment comparison (ITC) approach to evaluate the long-term effectiveness of Spravato/Esketamine combined with oral antidepressants, measured against routine treatments for TRD in real-world psychiatric settings (Oliveira-Maia et al., 2023). This method is especially useful when direct head-to-head trials are lacking.
To achieve this, researchers used data from two different study populations:
- The SUSTAIN-3 trial, which tracked long-term Spravato/Esketamine outcomes.
- The TRD cohort from the German DGPPN naturalistic study, representing general psychiatry practices.
Key Findings
1. Higher Remission Rates
Patients treated with Spravato were significantly more likely to achieve remission over time compared to those receiving standard treatments in general psychiatry. This was especially noteworthy beyond the short-term window, highlighting Spravato’s sustained efficacy.
2. Faster Onset of Response
Esketamine users saw quicker reductions in depressive symptoms, with improvements emerging in as little as 24 hours for some. In contrast, conventional antidepressants often take at least several weeks to yield noticeable effects.
3. Real-World Applicability
By using routine care data for the control group, the study painted a more authentic picture of typical treatment outcomes, enhancing the generalizability of its findings to day-to-day clinical practice.
4. Long-Term Effectiveness
The ICEBERG analysis showed that Spravato’s benefits aren’t just short-lived. Throughout the study, patients remained in remission longer, suggesting effectiveness not only in acute treatment but also in maintenance phases.
Strengths and Limitations
The strength of this study lies in its comparative approach, filling a major gap in evidence for long-term treatment strategies in TRD. However, as an indirect analysis, it’s limited by potential differences in patient characteristics and settings between the two cohorts.
Still, advanced statistical adjustments were made to ensure the comparison was as fair and robust as possible, accounting for key variables like age, gender, baseline Depression severity, and treatment history.
Why It Matters
For clinicians, the ICEBERG study reinforces the growing evidence base for Spravato as not just a rapid-acting antidepressant, but a durable and effective long-term solution for TRD. For patients, it brings hope, especially those who’ve cycled through multiple treatments without lasting relief.
Spravato is not without its caveats: it requires close medical supervision, comes with potential side effects (like dissociation or elevated blood pressure), and may not be accessible to all due to cost or availability. But in the right clinical setting, it can represent a paradigm shift.
Mid City TMS specializes in both TMS and Spravato treatment, providing patients with treatment options that have shown remarkable success rates, even for treatment-resistant Depression. If you haven’t found relief with traditional treatments, we encourage you to contact us for a consultation. Our experienced team can help determine which advanced treatment option might be right for you, potentially offering a path to remission. Contact us today to learn more about TMS and Spravato treatment options.
Souces:
- Oliveira-Maia, A. J., Morrens, J., Rive, B., Godinov, Y., Cabrieto, J., Perualila, N., Barbreau, S., & Mulhern-Haughey, S. (2023). ICEBERG study: An indirect adjusted comparison estimating the long-term benefit of esketamine nasal spray when compared with routine treatment of treatment-resistant depression in general psychiatry. Frontiers in Psychiatry, 14, 1250980. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1250980/full