The British journal of psychiatry : the journal of mental science
January 7, 2025
Natalie T Mills, Stevan Nikolin, Nick Glozier et al.
3 citations
Anxiety disorders and treatment-resistant major depressive disorder (TRD) often occur together. In a randomized controlled trial comparing subcutaneous ketamine to midazolam in 174 people with TRD, ketamine reduced anxiety only when given at flexible, response-guided doses (0.5-0.9 mg/kg). At a fixed low dose (0.5 mg/kg), the reduction in anxiety was not statistically significant. The anxiety-reducing effect was linked to overall depression improvement and was not sustained four weeks after treatment ended. The findings suggest that adequate dosing is necessary for ketamine's anxiolytic effect in this population.
Journal of affective disorders
October 15, 2025
Mary Lou Chatterton, Johana Kevin Perez, Thao Thai et al.
2 citations
Subcutaneous ketamine appears cost-effective for treatment-resistant depression from a health sector perspective when the costs of the control treatment (midazolam) are included, but not from a societal perspective. A cost-utility analysis alongside a randomized controlled trial with 174 participants compared ketamine to midazolam given twice weekly for four weeks. At the end of the trial, quality of life scores were significantly higher for ketamine. When control arm costs were included, ketamine was less costly and more effective, with an 89% probability of being cost-effective at a $50,000 per quality-adjusted life year threshold. Excluding those costs made ketamine not cost-effective, highlighting the importance of comparator choice.
European archives of psychiatry and clinical neuroscience
July 1, 2025
Erhan Kavakbasi, Kevin Rosemann, Mert Yilmaz et al.
2 citations
In patients with treatment-resistant depression, a history of not responding to electroconvulsive therapy does not significantly affect the outcome of subsequent treatment with intranasal esketamine. Among 96 inpatients, those who had previously not responded to ECT showed similar improvements in depression scores compared to those who had not received an adequate ECT course. Response and remission rates were numerically lower in the ECT non-response group, but the differences were not statistically significant. The findings support offering esketamine to ECT non-responders, given limited alternative treatments.
Der Nervenarzt
May 1, 2024
Bernhard T Baune, Sarah E Fromme, Maximilian Kiebs et al.
1 citation
Treatment-resistant depression lacks a standardized definition, but several promising pharmacological and neuromodulatory options exist. Current research emphasizes fast-acting, well-tolerated treatments beyond the monoamine hypothesis. Esketamine is an established fast-acting and well-tolerated therapy, while psychedelics and esmethadone remain in clinical trials. Off-label compounds like dextromethorphan and anti-inflammatory strategies are also discussed. Pharmacological approaches modulating the glutamatergic system or belonging to the psychedelic class are particularly important for current research, especially those with rapid clinical effects and favorable side-effect profiles.