Intranasal esketamine safe, effective with psychotropics to treat depression
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DENVER – Use of intranasal esketamine with psychotropic medications did not counteract safety and efficacy in treatment for depression, a presenter said at the Anxiety and Depression Association of America annual conference.
“The research is clinically based, reporting a case in which a patient was diagnosed with major depressive disorder and treatment resistant depression and was already on a complex medication list and we’d introduced him to something new,” Mubeena Hanif, MBBS, of the department of psychiatry and behavioral neurosciences at Wayne State University in Detroit, said during the presentation.
Researchers sought to determine if prescribing intranasal esketamine would produce any ameliorating effects on a 51-year-old male with major depressive disorder and treatment-resistant depression who saw no improvement on a combination of at least three other medications.
The case study was conducted through a series of 14 sessions of esketamine administration used concurrently with a rotating series of psychotropic medication, whose dosing schedules were altered to mitigate cardiovascular response. Progress of depressive symptoms was measured by the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) scale. Safety profile for esketamine was determined through a self-reported adverse reaction checklist, while hemodynamics were logged by a noninvasive finger cuff.
Hanif and colleagues found the patient’s depression decreased significantly, from a baseline QIDS-SR score of 27 to 7 near the conclusion of treatment, which indicated mild depression. In addition, the patient’s blood pressure and heart rate peaked within the first 30 minutes after esketamine dose before returning to baseline level, indicating both safety and efficacy of the drug.
“(Esketamine is) safe to use, even in patients with complex medication history, and a history of hypertension, hypertensive crisis or history,” Hanif said. “Literature has reported that the more response it has on the cardiovascular system, it means there is a significant response on depression severity as well.”