Esketamine nasal spray effective, fast-acting antidepressant: Study

A new study has supported the effectiveness and safety of esketamine nasal spray that helps treat depression in people who do not respond to other depression treatments. The research was published in the 'American Journal of Psychiatry'.

This study is one of the key studies that led to the recent Food and Drug Administration (FDA) approval of esketamine nasal spray, in conjunction with an oral antidepressant, for use in people with treatment-resistant depression. Depression is common, and as many as one-third of people with depression are considered treatment resistant--not finding relief from symptoms even after trying several antidepressants. Esketamine offers a new fast-acting treatment for people that have not responded to other depression treatments.

"The trial of esketamine was one of the pivotal trials in the FDA's review of this treatment for patients with treatment-resistant depression. Not only was adjunctive esketamine therapy effective, but the improvement was also evident within the first 24 hours," said, Michael Thase, one of the authors of the study. "The novel mechanism of action of esketamine, coupled with the rapidity of benefit, underpins just how important this development is for patients with difficult to treat depression," Thase added.

The study was conducted at 39 outpatient centres from August 2015 to June 2017 and involved nearly 200 adults with moderate to severe depression and a history of not responding to at least two antidepressants. Participants were randomly assigned to one of two groups. One group was switched from their current treatment to esketamine nasal spray (56 or 84 mg twice weekly) plus a newly initiated antidepressant. The other group was switched from their current treatment to a placebo nasal spray in combination with a new antidepressant.

The improvement in depression among those in the esketamine group was significantly greater than the placebo group on day 28. Similar improvements were seen at earlier points in time. Adverse events in the esketamine group generally appeared shortly after taking the medication and resolved by 1.5 hours later while patients were in the clinic. The most common side effects included dissociation, nausea, vertigo, dysgeusia (distortion of the sense of taste) and dizziness. Seven per cent of patients in the esketamine group discontinued the study due to side effects.

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