Phenomenology and therapeutic potential of patient experiences during oral esketamine treatment for treatment-resistant depression: an interpretative phenomenological study

Breeksema, Joost J.; Niemeijer, Alistair; Kuin, Bouwe; Veraart, Jolien K E; Vermetten, Eric; Kamphuis, Jeanine; Brink, Wim van den; Schoevers, Robert A.

doi:10.1007/s00213-023-06388-6

Cited by 14 publications

(2 citation statements)

References 69 publications

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“…They include several effects like perceptual (auditory, visual, proprioceptive), detachment from body or from self or the external world, tranquility and openness feeling peace and calm, mystical-type-effects feeling unity and relativeness or spiritual. Although fear and anxiety could appear during the session (25). Analyses of the Transform-2 study did not show any correlation between dissociative and antidepressant effects (11).…”

Section: Adverse Events Of Intranasal Esketaminementioning

confidence: 78%

Overcoming the myths of esketamine administration: different and not difficult

Buchmayer,

Kasper

2023

Front. Psychiatry

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Intranasal esketamine for treatment-resistant depression has been introduced and approved by the FDA and EMA in 2019 and 2020, respectively. Since then, the administration practices were found different among countries. Major depression has a high impact on many humans lives worldwide and more than a third of treated people are not responding after several treatment attempts. Additional administration with esketamine closed this gap for more than the half of these non-responders. Guidelines for the treatment of major depression recommend starting with add-on esketamine after 2–4 serious attempts of treatment with standard antidepressants (SSRI/SNRI) irrespective of augmentation with others, e.g., second generation antipsychotics or lithium. Thus, intranasal esketamine became an important role in the evidence-based treatment of major depression. The authors review and critically evaluated published articles focusing on preparation, management and observation of intranasal esketamine treatment. There exists a clear recommendation for administrating intranasal esketamine in a medical environment, not limited to a clinical setting for selecting the dose, monitoring the improvements and managing adverse events. The administration of intranasal esketamine is considered as safe during the application itself and long-lasting or severe adverse events during long-term treatment are very rare. Since this is a new approach for treatment application psychiatrists face new different but not difficult treatment procedures compared to prescribing only a medication.

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Section: Adverse Events Of Intranasal Esketaminementioning

confidence: 78%

Overcoming the myths of esketamine administration: different and not difficult

Buchmayer,

Kasper

2023

Front. Psychiatry

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“…Preliminary data focusing on clinician-rated specific symptoms and psychopathological dimensions reported beneficial effects of ESK-NS on anxiety, cognition, and physical correlates, as well as on anhedonia and suicidality in TRD patients [2,[16][17][18]. However, little evidence is available on the viewpoint of patients with TRD receiving esketamine, and it has been investigated through audio interviews [19] and self-administered questionnaires assessing cognition, quality of life, and functional outcomes [18,20,21].…”

Section: Introductionmentioning

confidence: 99%

The Patient’s Perspective on the Effects of Intranasal Esketamine in Treatment-Resistant Depression

Pepe,

Bartolucci,

Marcelli

et al. 2023

Brain Sciences

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The effectiveness of the esketamine nasal spray (ESK-NS) for treatment-resistant depression (TRD) has been confirmed by real-world studies. Available evidence derived from clinician-rated assessments might differ from patients’ perceptions about the helpfulness of treatments. We aimed to verify the effect of ESK-NS from patients’ view in 25 TRD patients (56% males, 55.1 ± 10.9 years) treated with ESK-NS (mean dose: 78.4 ± 11.43 mg) for three months and evaluated at different time-points through clinician-rated and self-administered scales, assessing changes in depression, anhedonia, sleep, cognition, suicidality, and anxiety. We observed an overall early improvement that lasted over time (endpoint total score reduction in Montgomery-Åsberg Depression Rating Scale, p < 0.001, Beck Depression Inventory, p = 0.003). Patients reported a significant self-rated decrease in anhedonia at two months (Snaith–Hamilton Pleasure Scale, p = 0.04) and in suicide ideation at endpoint (BDI subitem 9, p = 0.039) vs. earlier improvements detected by clinicians (one-month reduction in MADRS subitem 8, p = 0.005, and subitem 10, p = 0.007). These findings confirm the effectiveness of a three-month treatment with ESK-NS in TRD patients, highlighting an overall overlapping response from patients’ and clinicians’ perspectives, although with some differential effects on specific symptoms at given time-points. Including patients’ viewpoints in routine assessments could inform clinical practice, ensuring a better characterization of clinical phenotypes to deliver personalized interventions.

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