Repeated, low-dose oral esketamine in patients with treatment-resistant depression: pilot study
Background Intravenous infusion of ketamine can produce rapid and large symptom reduction in patients with treatment-resistant depression (TRD) but presents major obstacles to clinical applicability, especially in community settings. Oral esketamine may be a promising addition to our TRD treatment...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-01-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472421010590/type/journal_article |
| _version_ | 1811156921083756544 |
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| author | Sanne Y. Smith-Apeldoorn Jolien K. E. Veraart Henricus G. Ruhé Marije aan het Rot Jeanine Kamphuis Marrit K. de Boer Robert A. Schoevers |
| author_facet | Sanne Y. Smith-Apeldoorn Jolien K. E. Veraart Henricus G. Ruhé Marije aan het Rot Jeanine Kamphuis Marrit K. de Boer Robert A. Schoevers |
| author_sort | Sanne Y. Smith-Apeldoorn |
| collection | DOAJ |
| description |
Background
Intravenous infusion of ketamine can produce rapid and large symptom reduction in patients with treatment-resistant depression (TRD) but presents major obstacles to clinical applicability, especially in community settings. Oral esketamine may be a promising addition to our TRD treatment armamentarium.
Aims
To explore the safety, tolerability and potential clinical effectiveness of a 3-week treatment with repeated, low-dose oral esketamine.
Method
Seven patients with chronic and severe TRD received 1.25 mg/kg generic oral esketamine daily, over 21 consecutive days. Scores on the Systematic Assessment for Treatment Emergent Events (SAFTEE), Community Assessment of Psychic Experiences (CAPE), Clinician Administered Dissociative States Scale (CADSS) and Hamilton Rating Scale for Depression (HRSD) instruments, as well as blood pressure and heart rate, were repeatedly assessed.
Results
Treatment with oral esketamine was well-tolerated. No serious side-effects occurred, and none of the participants discontinued treatment prematurely. Psychotomimetic effects were the most frequently reported adverse events. Mean HDRS score decreased by 16.5%, from 23.6 to 19.7. Three participants showed reductions in HDRS scores above the minimum clinically important difference (eight-point change), of whom two showed partial response. No participants showed full response or remission.
Conclusions
These results strengthen the idea that oral esketamine is a safe and well-tolerated treatment for patients with chronic and severe TRD, but therapeutic effects were modest. Results were used to design a randomised controlled trial that is currently in progress.
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| first_indexed | 2024-04-10T04:59:14Z |
| format | Article |
| id | doaj.art-7368b2f76c9c4de29a4e976f861824ea |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T04:59:14Z |
| publishDate | 2022-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-7368b2f76c9c4de29a4e976f861824ea2023-03-09T12:29:18ZengCambridge University PressBJPsych Open2056-47242022-01-01810.1192/bjo.2021.1059Repeated, low-dose oral esketamine in patients with treatment-resistant depression: pilot studySanne Y. Smith-Apeldoorn0https://orcid.org/0000-0002-9133-262XJolien K. E. Veraart1Henricus G. Ruhé2https://orcid.org/0000-0001-6072-0358Marije aan het Rot3Jeanine Kamphuis4Marrit K. de Boer5Robert A. Schoevers6https://orcid.org/0000-0003-0760-9866Department of Psychiatry, University of Groningen, University Medical Center Groningen, The NetherlandsDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands; and Department of Mood Disorders, PsyQ Haaglanden, Parnassia Psychiatric Institute, The NetherlandsDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands; and Department of Psychiatry, Radboud University Medical Center, The NetherlandsDepartment of Psychology, University of Groningen, The NetherlandsDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, The NetherlandsDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, The NetherlandsDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands Background Intravenous infusion of ketamine can produce rapid and large symptom reduction in patients with treatment-resistant depression (TRD) but presents major obstacles to clinical applicability, especially in community settings. Oral esketamine may be a promising addition to our TRD treatment armamentarium. Aims To explore the safety, tolerability and potential clinical effectiveness of a 3-week treatment with repeated, low-dose oral esketamine. Method Seven patients with chronic and severe TRD received 1.25 mg/kg generic oral esketamine daily, over 21 consecutive days. Scores on the Systematic Assessment for Treatment Emergent Events (SAFTEE), Community Assessment of Psychic Experiences (CAPE), Clinician Administered Dissociative States Scale (CADSS) and Hamilton Rating Scale for Depression (HRSD) instruments, as well as blood pressure and heart rate, were repeatedly assessed. Results Treatment with oral esketamine was well-tolerated. No serious side-effects occurred, and none of the participants discontinued treatment prematurely. Psychotomimetic effects were the most frequently reported adverse events. Mean HDRS score decreased by 16.5%, from 23.6 to 19.7. Three participants showed reductions in HDRS scores above the minimum clinically important difference (eight-point change), of whom two showed partial response. No participants showed full response or remission. Conclusions These results strengthen the idea that oral esketamine is a safe and well-tolerated treatment for patients with chronic and severe TRD, but therapeutic effects were modest. Results were used to design a randomised controlled trial that is currently in progress. https://www.cambridge.org/core/product/identifier/S2056472421010590/type/journal_articleEsketamineoral administrationtreatment-resistant depressiontolerabilitysafety |
| spellingShingle | Sanne Y. Smith-Apeldoorn Jolien K. E. Veraart Henricus G. Ruhé Marije aan het Rot Jeanine Kamphuis Marrit K. de Boer Robert A. Schoevers Repeated, low-dose oral esketamine in patients with treatment-resistant depression: pilot study BJPsych Open Esketamine oral administration treatment-resistant depression tolerability safety |
| title | Repeated, low-dose oral esketamine in patients with treatment-resistant depression: pilot study |
| title_full | Repeated, low-dose oral esketamine in patients with treatment-resistant depression: pilot study |
| title_fullStr | Repeated, low-dose oral esketamine in patients with treatment-resistant depression: pilot study |
| title_full_unstemmed | Repeated, low-dose oral esketamine in patients with treatment-resistant depression: pilot study |
| title_short | Repeated, low-dose oral esketamine in patients with treatment-resistant depression: pilot study |
| title_sort | repeated low dose oral esketamine in patients with treatment resistant depression pilot study |
| topic | Esketamine oral administration treatment-resistant depression tolerability safety |
| url | https://www.cambridge.org/core/product/identifier/S2056472421010590/type/journal_article |
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