Esketamine nasal spray shows promise in treatment-resistant depression

In the realm of treatment-resistant depression, where conventional therapies often fall short, a recent study has shed light on a potential breakthrough. The research published in NEJM showed that esketamine nasal spray, combined with SSRIs or SNRIs, demonstrates superior efficacy in achieving remission in treatment-resistant depression compared to extended-release quetiapine augmentation therapy..

This phase 3b, randomized, active-controlled trial, conducted as an open-label, single-blind study with raters unaware of group assignments, sought to address the pressing need for effective treatments for patients who do not respond to multiple consecutive therapies during their current depressive episode.

A total of 676 patients were assigned to two groups in a 1:1 ratio, with one group receiving flexible doses of esketamine nasal spray and the other extended-release quetiapine. Both groups continued their ongoing treatment with an SSRI or SNRI.

At week 8, significantly more patients in the esketamine group achieved remission compared to the quetiapine group (27.1% vs. 17.6%, respectively). Moreover, the esketamine group demonstrated a lower relapse rate through week 32 after remission (21.7% vs. 14.1%). Over the 32 weeks of follow-up, various measures of treatment success, including remission rates and treatment response, favored esketamine nasal spray.

Importantly, the study found that the adverse events associated with both treatments were consistent with their established safety profiles.

Reference: Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression, Andreas Reif et al,N Engl J Med 2023; 389:1298-1309, DOI: 10.1056/NEJMoa2304145