Ketamine as Add-On Treatment in Psychotic Treatment-Resistant Depression

Gałuszko-Węgielnik, Maria; Chmielewska, Zuzanna; Jakuszkowiak-Wojten, Katarzyna; Wiglusz, Mariusz S.; Cubała, Wiesław Jerzy

doi:10.3390/brainsci13010142

Cited by 9 publications

(7 citation statements)

References 34 publications

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“…46 Wegielnik included patients with MDD and psychiatric illness or bipolar disorder and found that ketamine had good safety and efficacy for TRD patients with major depressive disorder and psychiatric comorbidity. 11 TRD with psychotic comorbidities was safe and well tolerated, consistent with previous results. 47 Based on the above studies, the safety of using ketamine for depression in specific populations also seems reasonable.…”

Section: Discussionsupporting

confidence: 89%

“…Consequently, esketamine was recently approved by the US Food and Drug Administration (FDA) for the acute management of MDD, depressive symptoms in adults with MDD with acute SI or behavior (MDSI), and as an adjunctive psychiatric indication for the treatment of MDD with a psychiatric emergency (MDD-PE). 10,11 Several RCTs and meta-analysis have reported that ketamine and esketamine have a good safety and tolerability profile in MDD or TRD, with rapid and effective antidepressant and anti-SI effects. [12][13][14] Given the findings of the above mentioned studies, there is growing interest in exploring whether ketamine and esketamine can be used to rescue patients with acute SI.…”

Section: Introductionmentioning

confidence: 99%

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Acute Effects of Intravenous Sub-Anesthetic Doses of Ketamine and Intranasal Inhaled Esketamine on Suicidal Ideation: A Systematic Review and Meta-Analysis

Chen¹,

Zhou²,

Hu³

et al. 2023

NDT

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Suicide is a major public health concern with currently no validated and efficacious treatments approved. Preliminary evidence suggests that intravenous ketamine has rapid and sustained antidepressant effects, making it a candidate with therapeutic potential for depressed patients at risk for suicide. We conducted a meta-analysis to evaluate the efficacy of ketamine and esketamine in reducing suicidal ideation (SI), as well as their respective onset and duration of action. Data Sources: We searched PubMed, Embase, Ovid, Cochrane, and Web of Science databases for studies published from inception to September 29, 2022. Study Eligibility Criteria: We conducted a systematic review of all parallel randomized controlled trials (RCTs) examining the effect and duration of ketamine or esketamine on SI. Our primary outcome measure was the Suicide Scale score, which was measured using the Scale for Suicidal Ideation (SSI), Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory (BDI), or Modified Scale for Suicidal Ideation (MSSI). To obtain effect sizes (Cohen's d), we calculated the difference in Suicide Scale scores before and after administration in each group. Results: Our study showed that intravenous sub-anesthetic doses of ketamine and intranasal inhaled esketamine had a significant anti-SI effect. Specifically, ketamine produced a large degree of anti-SI effect within the 4-6 hours (Cohen's d = 1.16, 95% CI: 0.50, 1.81) and a medium-large degree in the 24 hours (Cohen's d = 0.95, 95% CI: 0.48, 1.41). Esketamine, on the other hand, produced a small-medium degree of anti-SI effect within the 4-6 hours timeframe (Cohen's d = 0.26, 95% CI: 0.09, 0.44) and the 24 hours (Cohen's d = 0.30, 95% CI: 0.17, 0.47). Conclusion: Intravenous sub-anesthetic doses of ketamine and intranasal inhaled esketamine could reduce SI within 4 hours and last for 24 hours.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Acute Effects of Intravenous Sub-Anesthetic Doses of Ketamine and Intranasal Inhaled Esketamine on Suicidal Ideation: A Systematic Review and Meta-Analysis

Chen¹,

Zhou²,

Hu³

et al. 2023

NDT

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“…In our earlier study involving four patients with TRD-MDD-P who received ketamine as an adjunctive therapy, we demonstrated favorable safety and tolerance in terms of depressive and psychotic symptoms. We did not observe any exacerbation of psychotic symptoms during short- or long-term follow-up ( Gałuszko-Wȩgielnik et al, 2023 ).…”

Section: Discussionmentioning

confidence: 68%

“…Nevertheless, several studies have demonstrated that ketamine not only improves mood, but also reduces psychotic symptoms in patients with TRD who experience psychosis. The treatment shows good safety and tolerability ( da Frota Ribeiro et al, 2016 ; Pennybaker et al, 2017 ; Ajub and Lacerda, 2018 ; Kim et al, 2021 ; Veraart et al, 2021 ; Gałuszko-Wȩgielnik et al, 2023 ).…”

Section: Introductionmentioning

confidence: 99%

Central nervous system-related safety and tolerability of add-on ketamine to standard of care treatment in treatment-resistant psychotic depression in patients with major depressive disorder and bipolar disorder

et al. 2023

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BackgroundPsychotic treatment-resistant depression represents a complex and challenging form of mood disorder in clinical practice. Despite its severity, psychotic depression is frequently underdiagnosed and inadequately treated. Ketamine has demonstrated rapid and potent antidepressant effects in clinical studies, while exhibiting a favorable safety and tolerability profile. Although there is limited literature available on the use of ketamine in psychotic TRD, reports on its efficacy, safety, and tolerability profile are of great interest to clinicians. The aim of this study is to investigate the relationship between dissociative symptomatology and psychomimetic effects in inpatients with treatment-resistant major psychotic depression and treatment-resistant bipolar psychotic depression, who receive intravenous ketamine treatment alongside psychotropic medication, both during and after treatment.Materials and methodsA total of 36 patients diagnosed with treatment-resistant unipolar (17 patients) or bipolar (18 patients) depression with psychotic features were treated with eight intravenous infusions of 0.5 mg/kg ketamine twice a week over 4 weeks. Ketamine was given in addition to their standard of care treatment. The severity of depressive symptoms was evaluated using the MADRS, while dissociative and psychomimetic symptoms were assessed using the CADSS and BPRS, respectively.ResultsThere were no statistically significant changes observed in MADRS, CADSS, and BPRS scores within the study group during ketamine infusions. However, significant improvements in MADRS, CADSS, and BPRS scores were observed during ketamine infusions in both the unipolar and bipolar depression groups.ConclusionThis study provides support for the lack of exacerbation of psychotic symptoms in both unipolar and bipolar depression.

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“…A recent systematic review ( 26 ) found that ketamine has a substantial antidepressant effect, although its effectiveness varies significantly across patients. Moreover, a recent study by Gałuszko-Węgielnik et al ( 108 ) found that ketamine is an effective add-on treatment to standard of care for people with treatment-resistant depression presenting psychotic features. Ketamine is administered as intravenous infusion and the subsequent monitoring revealed no exacerbation of psychotic symptoms in short and long-term observation, while stable remission and fast antisuicidal effect was found.…”

Section: Discussionmentioning

confidence: 99%

Facts and myths about use of esketamine for treatment-resistant depression: a narrative clinical review

Di Vincenzo,

Martiadis,

Della Rocca

et al. 2024

Front. Psychiatry

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Introduction and aimsTreatment-resistant depression (TRD) occurs when at least two different antidepressants, taken at the right dosage, for adequate period of time and with continuity, fail to give positive clinical effects. Esketamine, the S-enantiomer of ketamine, was recently approved for TRD treatment from U.S. Food and Drug Administration and European Medicine Agency. Despite proved clinical efficacy, many misconceptions by clinicians and patients accompany this medication. We aimed to review the most common “false myths” regarding TRD and esketemine, counterarguing with evidence-based facts.MethodsThe keywords “esketamine”, “treatment resistance depression”, “depression”, “myth”, “mythology”, “pharmacological treatment”, and “misunderstanding” were entered in the main databases and combined through Boolean operators.ResultsMisconceptions regarding the TRD prevalence, clinical features and predictors have been found. With respect of esketamine, criteria to start treatment, dissociative symptoms, potential addiction and aspects of administration and monitoring, were found to be affected by false beliefs by clinicians and patients.Discussion and conclusionTRD represents a challenging condition, requiring precise diagnosis in order to achieve patient’s full recovery. Esketamine has been proved as an effective medication to treat TRD, although it requires precautions. Evidence can inform clinical practice, in order to offer this innovative treatment to all patients with TRD.

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Ketamine as Add-On Treatment in Psychotic Treatment-Resistant Depression

Cited by 9 publications

References 34 publications

Acute Effects of Intravenous Sub-Anesthetic Doses of Ketamine and Intranasal Inhaled Esketamine on Suicidal Ideation: A Systematic Review and Meta-Analysis

Acute Effects of Intravenous Sub-Anesthetic Doses of Ketamine and Intranasal Inhaled Esketamine on Suicidal Ideation: A Systematic Review and Meta-Analysis

Central nervous system-related safety and tolerability of add-on ketamine to standard of care treatment in treatment-resistant psychotic depression in patients with major depressive disorder and bipolar disorder

Facts and myths about use of esketamine for treatment-resistant depression: a narrative clinical review

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