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The rapid antidepressant effectiveness of repeated dose of intravenous ketamine and intranasal esketamine: A post-hoc analy sis of pooled real-world data.
Abstract
Intravenous ketamine (KET-IV) and intranasal esketamine (ESK-NS) are effective in the acute treatment of Treatment-Resistant Depression (TRD). Studies comparing KET-IV and ESK-NS concerning their action, safety, and tolerability are currently lacking. We combined patients' data from two unipolar TRD cohorts that received KET-IV (n = 171) at the Canadian Rapid Treatment Center of Excellence in Toronto, Canada, or ESK-NS (n = 140) at several TRD clinics in Italy. The Quick Inventory for Depression Symptomatology-Self-Report-16/QIDS-SR16 in the KET-IV group and Montgomery-Åsberg Depression Rating Scale/MADRS in the ESK-NS group measured depressive symptoms at baseline (T0) and after the acute treatment phase (T1) (i.e., four infusions of KET-IV and eight administrations of ESK-NS). As different scales were used, the primary outcome was to compare the improvement in depression severity in the two cohorts by measuring effect sizes, response and remission rates. Finally, we c ompare side effects and discontinuation rates. At T1, KET-IV and ESK-NS significantly reduced depressive symptoms (respectively: QIDS-SR16 mean reduction = 5.65, p < 0.001; MADRS mean reduction = 11.41, p = 0.025). KET-IV showed larger effect sizes compared to ESK-NS (1.666 vs. 1.244). KET-IV had higher response rates (36 % vs. 25 %; p = 0.042) but not superior remission rates (13 % vs. 12 %; p = 0.845) than ESK-NS at T1. Despite more reported side effects, KET-IV did not cause more discontinuations for adverse events (4.6 % vs. 2.12 %; p = 0.228) than ESK-NS. KET-IV showed a higher short-term antidepressant effect, whereas ESK-NS exhibited lower side effects. Both were generally well tolerated. Future head-to-head studies should consider the long-term efficacy of these treatments.
Authors (19) : Giacomo d'Andrea, Mauro Pettorruso, Giorgio Di Lorenzo, Taeho Greg Rhee, Stefania Chiappini, Rosalba Carullo, Stefano Barlati, Raffaella Zanardi, Gianluca Rosso, Marco Di Nicola, Ileana Andriola, Matteo Marcatili, Massimo Clerici, Bernardo Maria Dell'Osso, Stefano L Sensi, Rodrigo B Mansur, Joshua D Rosenblat, Giovanni Martinotti, Roger S McIntyre
Source : Journal of affective disorders
Article Information
| Year | 2023 |
| Type | Journal Article |
| DOI | 10.1016/j.jad.2023.12.038 |
| ISSN | 1573-2517 |
| Volume |
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