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Depression (Mood disorder)

Comparative Efficacy of Ketamine Infusions and Esketamine Nasal Spray in Treatment-Resistant Depression

Strategic Insights

— 2 min read

A new study by Mass General Brigham investigators has compared the effects of repeated intravenous (IV) ketamine and intranasal (IN) esketamine in patients with treatment-resistant depression. The results, published in the Journal of Clinical Psychiatry, may help inform conversations between clinicians and patients about treatment decisions. Both treatments reduced depression severity, but IV ketamine led to relatively faster and greater improvements in symptoms. The study suggests both IN esketamine and IV ketamine are important tools in the evolving neuropsychiatric toolkit, but their differences are contingent on a holistic set of clinical and logistical factors.

Key Takeaways:

  • The study evaluated 153 adult patients with treatment-resistant depression who received either IV ketamine or IN esketamine, administered twice weekly over 4 to 5 weeks for a total of eight treatments during the induction treatment phase.
  • IV ketamine showed greater overall efficacy, with a 49.22% reduction in depression scores by the final dose, while IN esketamine resulted in a 39.55% reduction in the same period.
  • IV ketamine was associated with faster responses, with patients exhibiting improved symptoms immediately after the first treatment, whereas IN esketamine led to significant improvements after the second treatment.
  • The authors emphasize the importance of careful integration of clinical and logistical factors when considering IV ketamine and esketamine treatment options.
  • Future randomized clinical trials are needed to confirm comparative efficacy and to eliminate confounding factors such as socioeconomic status, differences in dose and effects due to other psychiatric treatments.
  • The study highlights the need for rigorous studies like these to inform treatment decisions and mitigate the risks of ketamine misuse and abuse.

Statistics:

  • 153 adult patients were included in the study, with 111 patients receiving IV ketamine and 42 patients receiving IN esketamine.
  • IV ketamine showed a 49.22% reduction in depression scores by the final dose, while IN esketamine resulted in a 39.55% reduction in the same period.
  • Patients receiving IV ketamine exhibited improved symptoms immediately after the first treatment, whereas IN esketamine led to significant improvements after the second treatment.
  • The study was conducted over a period of 4 to 5 weeks, with patients receiving a total of eight treatments during the induction treatment phase.

Sources:

  • Meisner R et al. (2023). "Comparative Effects of Repeated Ketamine Infusion Versus Intranasal Esketamine in Patients With Treatment-Resistant Depression: A Retrospective Chart Review" J Clin Psych DOI: 10.4088/JCP.25m15789
  • Mass General Brigham. (2023). "Comparative Efficacy of Ketamine Infusions and Esketamine Nasal Spray in Treatment-Resistant Depression". Press Release.

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