Although intravenous racemic ketamine has rapid antidepressant properties, it is not approved for depression treatment. However, the US Food and Drug Administration has approved intranasal esketamine for treatment-resistant depression. Correia-Melo et al. treated 63 participants with intravenous ketamine or esketamine and observed that esketamine was noninferior to ketamine. A recent meta-analysis suggested that intravenous ketamine was more effective,3 but the only head-to-head trial included was from Correia-Melo et al., rendering interpretation difficult. To our knowledge, no multidose, head-to-head comparisons of these treatments have been reported.
"The most important finding of our study is that both esketamine and [intravenous] ketamine can help alleviate symptoms in patients suffering from treatment-resistant depression, as long as they are provided in an evidence-based manner and with rigorous clinical standards," Sina Nikayin, MD, assistant professor of psychology at Yale University School of Medicine, told Healio.
Nikayin and colleagues reviewed retrospective data for all Yale Interventional Psychiatry Service patients who received IV ketamine or intranasal esketamine from September 2016 through April 2021.
Of the 210 patients included in the analysis, 126 (61.4%) received IV ketamine, and 81 received intranasal esketamine.
Favouring IV ketamine, the estimated group difference in the Montgomery-Asberg Depression Rating Scale (MADRS) score by treatment end was 2.15 (95% CI, –0.06 to 4.37). Group differences in Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) scores after full treatment also favored ketamine (1.59; 95% CI, 0.24-2.94).
After six full treatments, differences in MADRS scores (2.49; 95% CI, 0.01-4.98) and QIDS-SF scores (1.64; 95% CI, 0.08-3.19) favored ketamine. "The findings suggest there might be some differences between these treatments, which require further studies to clarify," Nikayin said. "These studies, in turn, can provide us with the knowledge to better fine-tune our treatment methods and choose the most appropriate treatment modality for each individual patient."
Reference:
Evaluation of the Trajectory of Depression Severity With Ketamine and Esketamine Treatment in a Clinical Setting by Sina Nikayin et al. published in the JAMA Psychiatry
doi:10.1001/jamapsychiatry.2022.1074
Keywords:
Evaluation, Trajectory, Depression, Severity, Ketamine, Esketamine, Treatment, Clinical Setting, Sina Nikayin, Taeho Greg Rhee, Maria Elena Cunningham, Christina A. de Fontnouvelle, Robert B. Ostroff, Gerard Sanacora, Samuel T. Wilkinson, JAMA Psychiatry
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