Efficacy and Safety of Esketamine Combined with Antidepressants for Treatment-Resistant Depression: A Meta-Analysis
Peng Liu, Shanshan Zhang, Yun Liang, Zijun Gao, Wei Gao, Buhuai Dong
Neuropsychiatric Disease and Treatment December 1, 2022 Peer reviewed DOI: 10.2147/ndt.s388764 via OpenAlex
Summary
Esketamine combined with an antidepressant significantly improves symptoms in patients with treatment-resistant depression. In a meta-analysis of seven studies involving 701 patients receiving esketamine plus an antidepressant and 551 receiving a placebo, results indicated a reduction in Montgomery-Asberg Depression Rating Scale scores by 2.68 points and self-rating depression scale scores by 2.9 points. The treatment also increased response rates by 28% and remission rates by 39%, although some minor adverse reactions were noted.
Study at a glance
| Design | meta-analysis |
|---|---|
| Sample size | 1,252 |
| Population | patients with treatment-resistant depression |
| Key finding | Esketamine + antidepressant significantly improves depression symptoms and quality of life in treatment-resistant depression. |
Abstract
Objective: To evaluate the efficacy and safety of esketamine + antidepressant in treatment-resistant depression. Methods: We searched PubMed, Web of Science, Embase, CNKI, and Wanfang databases to obtain published information on esketamine + antidepressant from inception to July 2022. We searched for randomized controlled studies on the treatment of depression with a double-blind induction phase. Outcome indicators included changes in Montgomery-Asberg Depression Rating Scale (MADRS) scores before and after treatment, effective response rate, remission rate, and changes in self-rating depression scale (SDS). We analyzed data using Review Manager 5.4 and assessed the quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) analysis. Results: A total of seven articles were included, including 701 patients in the esketamine + antidepressant group and 551 in the placebo group. Meta-analysis results showed that esketamine + antidepressant could improve the MADRS score in patients with treatment-resistant depression (MD = -2.68, 95% CI -3.98 to -1.37, P < 0.0001), SDS (MD = -2.9, 95% CI -4.01 to -1.79, P < 0.00001), response rate at the end of the double-blind induction period (RR = 1.28, 95% CI 1.12 to 1.46, P = 0.0002), remission rate at the end of the double-blind induction period (RR = 1.39, 95% CI 1.18 to 1.63, P < 0.0001), Five-Dimensional Health Scale (EQ-5D-5L) (MD = 0.05, 95% CI 0.02 to 0.08, P = 0.00009), Visual Analogue Scale of Health Status (EQ-VAS) (MD = 5.54, 95% CI 2.37 to 8.71, P = 0.0006). Conclusion: Esketamine + antidepressant has an obvious curative effect in treatment-resistant depression and can rapidly improve depression in patients, quality of life and satisfaction, but minor adverse reactions can occur.