Case report: Effectiveness of brexpiprazole and esketamine/ketamine combination: A novel therapeutic strategy in five cases of treatment-resistant depression
Lai Fong Chan, Luke Sy-cherng Woon, Nuur Asyikin Mohd Shukor, Choon Leng Eu, Nurazah Ismail, Song Jie Chin, Nik Ruzyanei Nik Jaafar, Azlin Baharudin
Frontiers in Psychiatry July 22, 2022 Peer reviewed DOI: 10.3389/fpsyt.2022.890099 via DOAJ
Summary
A significant number of patients with treatment-resistant depression do not achieve functional recovery despite various pharmacotherapeutic strategies. Evidence suggests that glutamatergic agents like brexpiprazole and esketamine/ketamine may offer more rapid effects and better outcomes as augmentation therapies. This case series examines five complex cases where standard treatments failed to manage suicidal behavior and achieve recovery, discussing the potential benefits and challenges of combining brexpiprazole with esketamine/ketamine.
Study at a glance
| Design | case study |
|---|---|
| Sample size | 5 |
| Population | patients with unipolar and bipolar treatment-resistant depression |
| Key finding | The combination of brexpiprazole and esketamine/ketamine may improve treatment outcomes for patients with treatment-resistant depression who have not responded to conventional therapies. |
Abstract
A significant proportion of patients with treatment-resistant depression do not attain functional recovery despite administration of multiple steps of pharmacotherapeutic strategies. This highlights the elusiveness of meeting unmet needs in existing pharmacotherapies for treatment-resistant depression. There is accumulating evidence that antidepressant agents involving the glutamatergic system such as brexpiprazole and esketamine/ketamine have more rapid onset of action and potentially improved effectiveness as an augmentation therapy in treatment-resistant depression. This case series aimed to report five complex cases of unipolar and bipolar treatment-resistant depression where conventional treatment strategies were inadequate in managing high risk suicidal behavior and achieving functional recovery. We discussed further the possible synergistic mechanisms of the novel combination strategy of brexpiprazole and esketamine/ketamine, clinical and patient factors that influenced treatment response, challenges with this combination strategy and implications for future practice and research.