Esketamine Treatment for Depression in Adults: A PRISMA Systematic Review and Meta-Analysis

Summary & key facts

Researchers pooled results from several clinical trials that tested esketamine added to standard antidepressants for adults whose depression did not get better with usual treatment. They found that esketamine gave only a small extra benefit for depressive symptoms, did not reduce suicidal thoughts or behavior, and raised safety questions because of possible misuse, some worrying events during trials, and unknown long-term effects. This means esketamine might help some people a little, but its risks and unclear long-term safety matter when deciding if it should be used.

Key facts:

• The study combined results from multiple clinical trials of esketamine used alongside antidepressants in adults with depression that resisted usual treatment.
• Esketamine produced only modest improvement in depressive symptoms compared with antidepressants alone, similar to the small gains seen when some antipsychotic drugs are added.
• Esketamine showed no benefit for suicidality; it did not reduce suicidal thoughts or behavior in the analyzed trials.
• The review flagged esketamine's potential for abuse or misuse as an important safety concern.
• Long-term effects of esketamine are still not well known because there is limited long-term data.
• The authors reported some alarming signs during testing, including deaths and cases of new or increased suicidal behavior, which raised regulatory and safety questions.

Abstract

The study findings suggest that esketamine's efficacy as an add-on to antidepressants is modest in treatment-resistant depression (similar to augmentation strategies with atypical antipsychotics) and is absent against suicidality itself. These findings need to be considered in light of esketamine's abuse potential and the fact that long-term effects are still not fully known. Some alarming signs concerning deaths and emerging suicidality during the testing phase are discussed, along with other regulatory issues.

Topics

Functional Brain Connectivity Studies Mental Health Research Topics Treatment of Major Depression

Categories

Health Sciences Medicine Pharmacology

Tags

Clinical psychology Depression (economics) Economics Internal medicine Law Macroeconomics Medicine MEDLINE Meta-analysis Political science Psychiatry Psychology Systematic review

Substances

Ketamine

Conditions & symptoms

Depression Addiction or harmful habbits Sadness or low mood