European Archives of Psychiatry and Clinical Neuroscience
February 20, 2020
G. C. Leal, I. D. Bandeira, F. S. Correia-Melo et al.
257 citations
A single intravenous infusion of arketamine (0.5 mg/kg) rapidly reduced depression severity in seven people with treatment-resistant depression. The Montgomery–Åsberg Depression Rating Scale score fell from an average of 30.7 before infusion to 10.4 after one day, a mean drop of 20.3 points. Dissociative side effects were nearly absent. The findings suggest arketamine may produce fast-onset and sustained antidepressant effects with a favorable safety profile, as previously observed in animals, but controlled trials are needed to confirm.
Journal of Affective Disorders
November 14, 2019
F. S. Correia-Melo, G. C. Leal, F. Vieira et al.
188 citations
In adults with treatment-resistant depression, a single intravenous infusion of esketamine (0.25 mg/kg) was non-inferior to ketamine (0.5 mg/kg) for achieving remission 24 hours later. Among 63 participants, 29.4% in the esketamine group and 24.1% in the ketamine group showed remission, a difference of 5.3% that fell within the predefined non-inferiority margin. Depression scores on the Montgomery-Åsberg Depression Rating Scale improved similarly in both groups, and side effects were mild and comparable. The findings suggest that esketamine at half the dose of ketamine offers equivalent short-term efficacy and safety.
Frontiers in Psychiatry
May 28, 2021
V. B. Cavenaghi, Leandro Paulino da Costa, A. Lacerda et al.
41 citations
Subcutaneous (SC) ketamine shows promise as a rapid and effective antidepressant for unipolar and bipolar depression, with response and remission rates ranging from 50 to 100% after single or multiple doses. Doses of 0.1 to 0.5 mg/kg of racemic ketamine and 0.5 to 1 mg/kg of esketamine were used, administered weekly or twice-weekly, often with dose titration. Side effects were temporary. This systematic review of 12 studies (two randomized trials, five case reports, and five retrospective studies) found SC ketamine to be a convenient and cost-effective route, particularly relevant for developing countries, though a meta-analysis was not possible due to heterogeneity. Further research comparing SC with intravenous and intranasal protocols is needed.
Human psychopharmacology
February 18, 2022
A. P. Jesus-Nunes, G. C. Leal, F. S. Correia-Melo et al.
39 citations
Most people with major depressive disorder do not achieve symptom remission, and treatment-resistant depression is defined by the failure of at least one adequate antidepressant trial. This study investigated clinical predictors of depressive symptom remission and response 24 hours and 7 days after infusions of racemic ketamine and esketamine.
Journal of Psychiatric Research
May 8, 2021
R. Mello, Mariana V F Echegaray, A. P. Jesus-Nunes et al.
22 citations
Dissociative symptoms are common side effects of ketamine and esketamine used for depression. In adults with treatment-resistant depression randomly assigned to a single 40-minute infusion of either esketamine 0.25 mg/kg or ketamine 0.5 mg/kg, those with higher trait dissociation (measured by the Dissociative Experience Scale) had a greater risk of experiencing induced dissociation (measured by the Clinician-Administered Dissociative States Scale). Every 5-point increase in trait dissociation was associated with a 10.9% increase in induced dissociation. Subjects with high trait dissociation had a 1.41 times higher risk of induced dissociation and a 3.05 times higher risk of very high induced dissociation. Induced dissociation was not a serious adverse effect. The findings suggest screening for trait dissociation and counseling patients on risks.