Intranasal esketamine significantly alleviates depression severity and suicidal ideations in electroconvulsive therapy (ECT) non-responders

European Archives of Psychiatry and Clinical Neuroscience, vol. 275, pp. 2379–2387

Abstract

INTRODUCTION: Intranasal esketamine (ESK) is a novel therapy option in patients with treatment-resistant depression (TRD). Patients with a history of electroconvulsive therapy (ECT) non-response (ECT+) in the current episode have usually been excluded from previous studies. Data on the effectiveness of ESK in ECT non-responders are sparse. METHODS: In this retrospective study, we investigated the effectiveness of intranasal ESK in real-world inpatients with (ECT+, n = 39) history of ECT non-response compared to patients who have not received an adequate course of ECT in their current episode (ECT-, n = 57). A factorial analysis of variance (ANOVA) has been used to determine the impact of ECT non-response on treatment outcome. RESULTS: A total of n = 96 patients (mean age 47.0; 52.1% women) with TRD were included in this study. There was a significant main effect of history of ECT non-response on MADRS score in the ANOVA (F = 10.386, p = 0.002). However, there was no significant interaction effect of time (pre-treatment, post-treatment)*history of ECT non-response in current episode (F = 2.166, p = 0.143). The response (34.9% vs. 21.9%, χ2 = 1.498, p = 0.167) and remission rates (24.4% vs. 12.1%, χ2 = 1.861, p = 0.141) were none significantly lower in the ECT + group than in the ECT- group. There was significant improvement in MADRS and BDI-II in the ECT + group. No major safety concerns occurred during the study. CONCLUSION: There was no significant impact of ECT non-response on esketamine treatment outcome. Our results support the approach to offer esketamine to ECT non-responders given that the array of treatment alternatives is limited for these patients.

Authors 3

1. Erhan Kavakbasi corresponding Aachen Department of Psychiatry, Psychotherapy and Psychosomatics

   RWTH Aachen University · University of Münster · University Hospital Münster

   Affiliation as printed

   Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany. erhan.kavakbasi@uni-muenster.de

   Department of Psychiatry, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany. erhan.kavakbasi@uni-muenster.de

2. Kevin Rosemann

   University of Münster · University Hospital Münster

   Affiliation as printed

   Department of Psychiatry, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany

3. Bernhard Theodor Baune

   University of Münster · The University of Melbourne · University Hospital Münster · Florey Institute of Neuroscience and Mental Health

   Affiliation as printed

   Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia

   Department of Psychiatry, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany

   The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia