Esketamine ‘effective and well-tolerated’ for adolescents with MDD, suicidal ideation

Key takeaways:

• The esketamine group had significantly improved C-SSRS and MADRS scores compared with those receiving midazolam.
• The esketamine group had 69.2% antisuicidal responses and 61.5% antidepressant responses.

Esketamine is an effective and well-tolerated treatment option for adolescents with major depressive disorder and suicidal ideation, according to a study published in the Journal of the American Academy of Child & Adolescent Psychiatry.

“Suicide is a major cause of death in adolescents with limited treatment options,” Yanling Zhou, PhD, from the Affiliated Brain Hospital of Guangzhou Medical University, Hong Kong, China, and colleagues wrote. “Ketamine and its enantiomers have shown rapid antisuicidal effects in adults with major depressive disorder (MDD), but their efficacy in adolescents is unknown. We conducted an active, placebo-controlled trial of intravenous esketamine’s safety and efficacy in this population.”

In a study of 54 adolescents aged 13 to 18 years with MDD and suicidal ideation, participants were randomized to receive three infusions of 0.25 mg/kg esketamine or 0.045 mg/kg midazolam.

Using the Columbia Suicide Severity Rating Scale (C-SSRS) and the Montgomery–Åsberg Depression Rating Scale (MADRS), the researchers analyzed the outcomes of each group after 5 days of treatment.

Zhou and colleagues found that those in the esketamine group experienced significantly greater C-SSRS Ideation and Intensity scores as well as significantly greater changes in MADRS scores from baseline compared with the midazolam group.

At 4 weeks, the esketamine group had a rate of 69.2% antisuicidal responses and 61.5% antidepressant responses, while the midazolam group had 52.5% antisuicidal responses and 52.5% antidepressant responses. “These preliminary findings indicate that three-dose intravenous esketamine, added to routine inpatient care and treatment, was an effective and well-tolerated therapy for treating adolescents with MDD and suicidal ideation,” Zhou and colleagues wrote.