(esketamine)
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Last Updated: 11/28/2023
Martinotti et al (2023)1 presented the results of a retrospective, observational, multicenter study comparing the efficacy, safety, and tolerability of SPRAVATO in patients with unipolar TRD vs patients with B-TRD.
Group, Mean (SD) | MADRS | HAM-A | ||||
---|---|---|---|---|---|---|
Baseline | T1 | T2 | Baseline | T1 | T2 | |
TRD | 34 (9.54) | 21.79 (11.51) | 14.97 (9.99) | 30.9 (11.81) | 21.4 (10.09) | 16.2 (11.17) |
B-TRD | 37.07 (8.11) | 24.04 (11.58) | 12.78 (10.17) | 29.88 (9.39) | 19.8 (12.19) | 11.2 (10.12) |
Abbreviations: B-TRD, bipolar treatment-resistant depression; HAM-A, Hamilton Anxiety Rating Scale; MADRS, Montgomery-Åsberg Depression Rating Scale; SD, standard deviation; T1, end of the first month of treatment; T2, end of the third month of treatment; TRD, treatment-resistant depression. |
de Filippis et al (2023)2 presented a case report of a 39-year-old female patient diagnosed with BD-I and borderline personality disorder who presented to the hospital after a drug ingestion-related suicide attempt. The patient had a long history of alcohol and drug abuse, with prior reports of manic episodes, voluntary and compulsory hospitalizations, drug ingestion-related suicide attempts, and depression. A month after her recent drug ingestion-related suicide attempt, the patient was initiated on SPRAVATO as an adjuvant to the current treatment regimen, including fluoxetine, lithium, lurasidone, and quetiapine. She received a twice-weekly 56 mg SPRAVATO dose for 4 weeks followed by 56 mg once weekly.
After 3 months, a clinical response (50% reduction in the MADRS score) was reported, and at the 12-month follow-up, a clinical remission (MADRS score <10) with improvements in global functioning, sleep cycle, suicidality risk, binge eating, and anxiety symptoms was reported. In the continuation phase, the patient had no clinical relapses or hospitalizations, held a part-time job, and started caring for herself and her daughters.
Skriptshak et al (2021)3 described a case report of a 63-year-old male with a medical history that included BD-I, current episode depression, posttraumatic stress disorder, manic symptoms, and lethargy, with inadequate response to earlier psychotropic therapies, who responded to treatment with SPRAVATO nasal spray.
The patient was diagnosed with bipolar disorder 2 years prior to the initiation of treatment with SPRAVATO. The patient trialed multiple psychotropic medications in the past, including antidepressants with and without active mood stabilizers, and reported partial response to electroconvulsive therapy and transcranial magnetic stimulation. Pharmacogenomic testing did not reveal any significant abnormalities that could account for the patient’s inadequate response to treatment. Laboratory test results were unremarkable, and renal function was stable.
Because of failure to achieve remission with ≥4 antidepressant trials plus 2 augmentation trials, the patient was started on SPRAVATO nasal spray 56 mg twice weekly.
40 mg daily and bupropion 300 mg daily were started prior to and continued throughout the treatment period (1 year). The patient initially responded to treatment until day 7, when depressive symptoms returned. Hence, an increased dose of SPRAVATO 84 mg twice weekly was administered until the end of week 4 (induction phase) and then switched to 84 mg once weekly for the remainder of the treatment period (maintenance phase).
By the end of the induction phase, the self-reported 9-item Patient Health Questionnaire (PHQ-9) scores dropped from 20 (severe depression) at baseline to 0 (absence of depressive symptoms). Although the scores have increased since then, the patient continued to benefit from treatment as evidenced by improved PHQ-9 scores compared with those at baseline, reduced depressive symptoms, and no reported return of manic or hypomanic symptoms. No longterm adverse events were reported. Short-term adverse events included mild blood pressure elevation and subjective reports of dissociation in the first 30 minutes following administration of treatment, which resolved after 1 hour.
A literature search of Ovid MEDLINE®
1 | Martinotti G, Dell’Osso B, Lorenzo GD, et al. Treating bipolar depression with esketamine: safety and effectiveness data from a naturalistic multicentric study on esketamine in bipolar versus unipolar treatment-resistant depression. Bipolar Disord. 2023;25(3):233-244. |
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