Repeated, low-dose oral esketamine in patients with treatment-resistant depression: pilot study

Sanne Y Smith-Apeldoorn*, Jolien K E Veraart, Henricus G Ruhé, Marije Aan Het Rot, Jeanine Kamphuis, Marrit K de Boer, Robert A Schoevers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND: Intravenous infusion of ketamine can produce rapid and large symptom reduction in patients with treatment-resistant depression (TRD) but presents major obstacles to clinical applicability, especially in community settings. Oral esketamine may be a promising addition to our TRD treatment armamentarium.

AIMS: To explore the safety, tolerability and potential clinical effectiveness of a 3-week treatment with repeated, low-dose oral esketamine.

METHOD: Seven patients with chronic and severe TRD received 1.25 mg/kg generic oral esketamine daily, over 21 consecutive days. Scores on the Systematic Assessment for Treatment Emergent Events (SAFTEE), Community Assessment of Psychic Experiences (CAPE), Clinician Administered Dissociative States Scale (CADSS) and Hamilton Rating Scale for Depression (HRSD) instruments, as well as blood pressure and heart rate, were repeatedly assessed.

RESULTS: Treatment with oral esketamine was well-tolerated. No serious side-effects occurred, and none of the participants discontinued treatment prematurely. Psychotomimetic effects were the most frequently reported adverse events. Mean HDRS score decreased by 16.5%, from 23.6 to 19.7. Three participants showed reductions in HDRS scores above the minimum clinically important difference (eight-point change), of whom two showed partial response. No participants showed full response or remission.

CONCLUSIONS: These results strengthen the idea that oral esketamine is a safe and well-tolerated treatment for patients with chronic and severe TRD, but therapeutic effects were modest. Results were used to design a randomised controlled trial that is currently in progress.

Original languageEnglish
Article number4
Number of pages6
JournalBJPsych Open
Volume8
Issue number1
Early online date6-Dec-2021
DOIs
Publication statusPublished - Jan-2022

Keywords

  • Esketamine
  • oral administration
  • treatment-resistant depression
  • tolerability
  • safety
  • ELECTROCONVULSIVE-THERAPY
  • BIPOLAR DEPRESSION
  • DOUBLE-BLIND
  • KETAMINE USE
  • S-KETAMINE
  • UNIPOLAR
  • EFFICACY
  • ANTIDEPRESSANT
  • METAANALYSIS
  • NORKETAMINE

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