Risk of manic switch and suicidal outcomes in bipolar depression treated with esketamine: A one-year retrospective cohort study of 2126 patients.
European Neuropsychopharmacology August 6, 2025 Tingting Liu, Jheng-Yan Wu, Po-Yu Huang et al. 6 citations
Esketamine, when added to a mood stabilizer, is associated with a lower risk of suicide-related events in adults with bipolar depression and does not increase the risk of manic switch. In a matched analysis of 2,126 patients, those receiving esketamine had a significantly lower hazard of suicide-related outcomes across intervals from 1–7 days (HR = 0.439) through 1–365 days (HR = 0.754). The risk of manic switch was also lower at 1–180 days (HR = 0.643) and 1–365 days (HR = 0.673). Suicide risk reduction was consistent across age, sex, and racial subgroups, while the lower manic switch risk was significant only in female patients at longer intervals.