The international journal of neuropsychopharmacology
December 1, 2024
Craig Chepke, Richard Shelton, Gerard Sanacora et al.
7 citations
Esketamine nasal spray, approved for treatment-resistant depression and major depressive disorder with suicidal thoughts, rarely causes respiratory depression after marketing. Analysis of 47 months of postapproval safety data found 50 cases of respiratory depression among patients, with 8 strongly linked to the drug. The estimated incidence is 1 case per 20,000 treatment sessions. Symptoms are manageable and resolve with minor support. Monitoring, including pulse oximetry, is recommended during postdose observation.
The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry
June 1, 2026
Chittaranjan Behera, Srishti Gupta, Richard Shelton et al.
2 citations
Inflammation and immune dysregulation are linked to suicidal behavior. People with suicidal behavior show elevated levels of pro-inflammatory cytokines (interleukin-6, interleukin-1β, tumor necrosis factor-α), C-reactive protein, and chemokines in blood, cerebrospinal fluid, and brain tissue. These markers disrupt the hypothalamic-pituitary-adrenal axis, monoamine systems, and glutamatergic signaling. Inflammatory activation of indoleamine 2,3-dioxygenase shifts tryptophan metabolism toward neurotoxic kynurenine metabolites, reducing serotonin and promoting excitotoxicity, potentially increasing impulsivity and acute suicidal ideation. Several immunomodulatory treatments—including lithium, ketamine, COX-2 inhibitors, cytokine antagonists, and kynurenine-pathway modulators—show promise in reducing inflammation-linked suicidal risk. Precision-based approaches integrating biomarkers, genetics, and clinical profiles may help identify individuals likely to benefit from these therapies.