Personalizing ketamine therapy: Real-world predictors of response to IV ketamine and intranasal esketamine in treatment-resistant depression.
Psychiatry research December 1, 2025 Ahmed Z Elmaadawi, Imane Naha, Shruti Prabhudesai et al. 2 citations
Both intravenous (IV) ketamine and intranasal esketamine significantly reduce depressive symptoms in adults with treatment-resistant depression (TRD). IV ketamine produced a greater reduction on the Montgomery-Åsberg Depression Rating Scale (MADRS) than esketamine (mean difference about 5 points), especially in highly treatment-resistant patients. Comorbid psychiatric conditions strongly moderated outcomes: patients without comorbidities improved the most (MADRS change -22.0), while those with borderline personality disorder showed minimal response (MADRS change -3.7). Males improved more than females on the MADRS, but no sex difference appeared on the patient-rated PHQ-9. Age had no effect. Personalized approaches considering comorbidity profiles are critical for optimizing outcomes.