Among US adults with treatment-resistant depression, those who started esketamine nasal spray had fewer mental-health-related disability days and lower associated costs six months later compared with the month before starting treatment. In the esketamine group, disability days fell by an average of 0.4 days and costs dropped by $312 per patient per month. Trends for other therapies varied: transcranial magnetic stimulation showed a $123 cost reduction with no change in disability days, second-generation antipsychotic augmentation showed little change, and electroconvulsive therapy was linked to increases in both disability days and costs. The findings suggest esketamine may reduce disability burden, but the study was descriptive and lacked statistical comparisons.
Combining six ketamine infusions with a brief exposure-based psychotherapy, written exposure therapy (WET), produced large and durable reductions in PTSD symptoms for patients with chronic, severe PTSD. In an open-label trial, 13 of 14 patients completed treatment. PTSD symptom severity, measured by the CAPS-5, dropped from an average of 41.6 before treatment to 20.8 at 12 weeks, a large-magnitude improvement. Nine patients (69%) were treatment responders, and eight (61.5%) maintained improvement up to six months. The authors suggest the combined treatment may be effective but call for larger randomized controlled trials to confirm efficacy and synergy.