Bipolar Disorders
January 13, 2023
Giovanni Martinotti, Bernardo Dell’osso, Giorgio Di Lorenzo et al.
72 citations
Esketamine nasal spray reduced depressive symptoms in people with treatment-resistant bipolar depression as effectively as in those with unipolar treatment-resistant depression, with no significant differences in response or remission rates after one and three months. The treatment also showed greater anxiety-reducing effects in the bipolar group. No treatment-emergent affective switch occurred, supporting the safety and tolerability of esketamine for bipolar treatment-resistant depression.
Psychiatry Research
July 29, 2023
Mauro Pettorruso, Roberto Guidotti, Giacomo D’andrea et al.
56 citations
Machine learning models predicted which patients with treatment-resistant depression would respond to esketamine nasal spray. In a retrospective study of 149 patients, three random forest classifiers achieved 68.53% accuracy for response at one month and 66.26% at three months, and 68.60% accuracy for remission at three months. Features such as severe anhedonia, anxious distress, mixed symptoms, and bipolarity positively predicted response and remission, while benzodiazepine use and depression severity were linked to delayed responses. The findings suggest machine learning may aid personalized treatment decisions for treatment-resistant depression.
American Journal of Geriatric Psychiatry
July 8, 2023
Giacomo D’andrea, Stefania Chiappini, Roger S. McIntyre et al.
36 citations
Esketamine nasal spray (ESK-NS) shows preliminary effectiveness for treatment-resistant depression in adults aged 65 and older, with 53.3% of participants responding (MADRS score reduced by at least 50%) and 33.33% achieving remission (MADRS below 10) after three months. Common adverse effects included dizziness (50%), dissociation (33.3%), sedation (30%), and hypertension (13.33%). Twenty percent of participants discontinued treatment. These findings, from a post-hoc analysis of 30 older adults, suggest ESK-NS can be effective but is associated with high rates of treatment-emergent adverse events, most of which did not require stopping treatment.
International clinical psychopharmacology
May 1, 2025
Vincenzo Cardaci, Matteo Carminati, Mattia Tondello et al.
7 citations
Postpartum depression is increasingly recognized as distinct from major depressive disorder, with unique causal factors including hormone fluctuations (estrogen, progesterone, allopregnolone), pathway imbalances (oxytocin, kynurenine), chronobiological factors, and brain imaging alterations. Treatment approaches are expanding beyond traditional antidepressants like sertraline to include newly approved neurosteroids brexanolone and zuranolone, with others under development. Esketamine, psychedelics, brain stimulation, and light therapy also show benefit. Individualized pharmacological and non-pharmacological therapies are being introduced into routine clinical practice.
Journal of psychiatric practice
September 1, 2025
Matteo Carminati, Mattia Tondello, Barbara Barbini et al.
2 citations
In a case series of five patients with treatment-resistant depression who received both intravenous ketamine and later intranasal esketamine, four responded to ketamine but only one responded to esketamine. A better response to ketamine did not predict a good response to esketamine; the one patient who did not respond to ketamine showed a good response to esketamine. All patients had significant reductions in depressive symptoms after both treatments, but none achieved remission. The findings suggest both treatments reduce symptoms, with a generally better response to ketamine, possibly due to the R-ketamine component or the inpatient versus outpatient setting.
Journal of clinical psychopharmacology
May 1, 2026
Matteo Carminati, Mattia Tondello, Chiara Morana et al.
In a small retrospective study of 16 patients with treatment-resistant depression treated with intranasal esketamine, those who responded to treatment after 7 months had higher baseline neutrophil-to-lymphocyte ratios (NLR) than non-responders (1.81 vs. 1.23). The difference remained significant after adjusting for age. The findings suggest that a patient's inflammatory status before treatment may influence their response to esketamine, but the small sample and retrospective design limit confidence. Larger prospective studies are needed to clarify whether inflammatory markers can predict esketamine response.