Rapid infusion of esketamine for unipolar and bipolar depression: a retrospective chart review
This retrospective chart review (n=27) investigates the efficacy and safety of rapid infusion of esketamine in patients with treatment-resistant depression (TRD) and bipolar depression (BD). The study found that rapid infusion of esketamine is not the best choice for treatment-resistant depression due to tolerability issues. Additionally, patients reported dissociative symptoms ranging from mild to severe and found them to be disturbing.
Authors
- Acioly Luiz Tavares Lacerda
- Gustavo Leal
Published
Abstract
Background
This study evaluated efficacy and safety of intravenous subanesthetic doses of esketamine using an administration time of 10 minutes in patients with treatment-resistant depression and bipolar depression.
Methods
A retrospective chart review was conducted to identify patients who met the inclusion criteria for treatment-resistant depression and bipolar depression according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria, and these patients received rapid infusion of esketamine between June 2012 and December 2015. The Montgomery-Åsberg Depression Rating Scale (MADRS) was administered to measure and score depressive symptom severity before infusion and at 24 hours, 72 hours, and 7 days after infusion. In addition, Clinical Global Impression scale was administered before and 7 days after esketamine infusion.
Results
Esketamine was administered to 30 patients. A total of 27 patients met the inclusion criteria and had MADRS evaluation data, which showed that 23 had unipolar and 4 had bipolar depression. Thirteen patients (48.1%) showed therapeutic response (MADRS reduction ≥50%) within 1 week (7 days) of intervention. Remission (MADRS <7) was observed in 10 patients (37.0%) in the same period. Therapeutic response and remission frequencies were seen in 16 (59.3%) and 11 (40.7%) patients, respectively, within 24 hours following drug infusion. The most relevant side effect observed during the esketamine infusion was dissociative symptoms ranging from mild to severe, which was reported by 11.1% of patients as a very disturbing experience.
Limitations
This study was done retrospectively, had a small sample size, and there was no comparative group.
Conclusion
The present study demonstrates that rapid infusion of esketamine is possibly not the optimal choice to administer this drug for treatment-resistant depression due to tolerability reasons. Further controlled studies are required to investigate efficacy, safety, and tolerability profiles among the different types of ketamines and methods of using this drug in depressed patients.
Research Summary of 'Rapid infusion of esketamine for unipolar and bipolar depression: a retrospective chart review'
Introduction
Major depressive disorder causes substantial clinical and socioeconomic burden, and about one third of patients do not achieve remission with available treatments; these individuals are commonly described as having treatment-resistant depression (TRD). Previous trials have shown that subanesthetic doses of ketamine, an NMDA receptor antagonist, can produce rapid antidepressant effects in TRD. Most published clinical work has used the racemic formulation RS-(±)-ketamine and infusion protocols of around 40 minutes; by contrast, clinical experience in anaesthesiology supports faster intravenous administration for higher doses, and relatively little evidence exists on the S-(+)-enantiomer (esketamine), its tolerability, and optimal infusion schedules. S Correia-Melo and colleagues set out to examine the efficacy, safety, and tolerability of a rapid intravenous infusion of esketamine (0.25 mg/kg administered over 10 minutes) in patients with TRD and bipolar depression. Depressive symptoms were assessed with the Montgomery–Åsberg Depression Rating Scale (MADRS) at baseline and at 24 hours, 72 hours, and 7 days after infusion; the Clinical Global Impression (CGI) was also recorded before and 7 days after treatment. The investigation used a retrospective chart-review approach to report clinical outcomes and adverse events associated with this faster infusion rate of esketamine.
Expert Research Summaries
Go Pro to access AI-powered section-by-section summaries, editorial takes, and the full research toolkit.
Full Text PDF
Full Paper PDF
Create a free account to open full-text PDFs.
Study Details
- Study Typemeta
- Journal
- Compounds
- Topics
- Authors
- APA Citation
S Correia-Melo, F., C Argolo, F., Araújo-de-Freitas, L., Carneiro Gomes Leal, G., Kapczinski, F., L Lacerda, A., & C Quarantini, L. (2017). Rapid infusion of esketamine for unipolar and bipolar depression: a retrospective chart review. Neuropsychiatric Disease and Treatment, Volume 13, 1627-1632. https://doi.org/10.2147/NDT.S135623
References (4)
Papers cited by this study that are also in Blossom
Berman, R. M., Cappiello, A., Anand, A. et al. · Biological Psychiatry (2000)
Fond, G., Loundou, A., Macgregor, A. et al. · Psychopharmacology (2014)
Diazgranados, N., Ibrahim, L., Brutsche, N. E. et al. · JAMA Psychiatry (2010)
Luckenbaugh, D. A., Niciu, M. J., Ionescu, D. F. et al. · Journal of Affective Disorders (2014)
Cited By (4)
Papers in Blossom that reference this study
Hartland, H., Mahdavi, K., Jelen, L. A. et al. · Journal of Psychopharmacology (2023)
Cubała, W. J., Szarmach, J., Galuszko-Wegielink, M. et al. · Medicine (2021)
Wilkowska, A., Szałach, L., Cubała, W. J. · Neuropsychiatric Disease And Treatment (2020)
Leal, G. C., Bandeira, I. D., Correia-Melo, F. S. et al. · European Archives of Psychiatry and Clinical Neuroscience (2020)
Your Personal Research Library
Go Pro to save papers, add notes, rate studies, and organize your research into custom shelves.