Symptom remission with IV ketamine quicker than intranasal esketamine in TRD
Click Here to Manage Email Alerts
For individuals diagnosed with treatment-resistant depression, response and remission rates for IV ketamine and intranasal esketamine were similar, but remission time was quicker with the former compared with the latter.
“Patients with treatment-resistant depression represent a significant proportion of the MDD burden on society,” Balwinder Singh, MD, MS, of the department of psychiatry and psychology at the Mayo Clinic, and colleagues wrote in the Journal of Clinical Psychiatry. “Ketamine ... has been redeveloped as a rapid-acting antidepressant for TRD.”
Singh and fellow researchers sought to compare efficacy and interval until remission or response with repeated ketamine and esketamine treatment in adults diagnosed with TRD.
Their observational study included 62 individuals (median age 50 years; 65% female) who received up to six IV ketamine (0.5 mg/kg over 40 minutes) or up to eight intranasal esketamine (56 or 84 mg) treatments approximately two to three times per week from Aug. 17, 2017, to June 24, 2021. The number of days between each treatment varied by patient. For both treatment groups, symptoms of depression were measured by the 16-item Quick Inventory of Depressive Symptomatology self-report (QIDS-SR) prior to and then 24 hours after treatment. Cox proportional hazard models were used to evaluate associations between time to response (50% change in QIDS-SR score) and remission (QIDS-SR score5).
Results showed that the median number of treatments required to achieve both response (two vs. four) and remission (two vs. seven) was significantly lower among those in the IV ketamine group compared with intranasal esketamine.
When adjusting for age, sex, BMI and baseline QIDS-SR score, and counting time as the overall number of treatments, researchers found faster responses (HR = 2.61; 95% CI, 1-7.1) as well as a faster time to remission (HR = 5; 95% CI, 1-24.3) for IV ketamine.
“These findings need to be investigated in a randomized controlled trial comparing these two treatment interventions,” Singh and colleague wrote.