Effectiveness of Two Forms of Ketamine Therapy in Treating Resistant Depression

A recent study conducted by researchers at Mass General Brigham compared the therapeutic effects of repeated intravenous (IV) ketamine and intranasal (IN) esketamine in patients suffering from treatment-resistant depression. Analyzing data from 153 adult patients treated at McLean Hospital, the study found that both treatments contributed to reductions in depression severity. Notably, IV ketamine demonstrated a faster onset and greater overall improvement in symptoms compared to intranasal esketamine.

The study, published in the Journal of Clinical Psychiatry, provides valuable insights for clinicians and patients in selecting appropriate treatment options. Dr. Robert Meisner, the study's lead author, emphasized that both IN esketamine and IV ketamine are important tools in managing depression, with the choice depending on individual clinical and logistical considerations.

Approximately 30% of individuals with major depressive disorder do not respond to at least two antidepressant treatments, prompting the need for alternative therapies. FDA-approved for adults, intranasal esketamine is a newer option that has shown promise. Meanwhile, IV ketamine, originally approved as an anesthetic, has accumulated clinical evidence supporting its off-label use for depression.

The study evaluated the efficacy of these treatments over a 4-5 week period, with patients receiving up to eight doses. Results indicated that both groups experienced significant symptom reduction, with IV ketamine leading to a 49.22% decrease in depression scores by the end, compared to 39.55% with esketamine. Additionally, patients treated with IV ketamine showed immediate improvements after the first dose, whereas esketamine effects became significant after the second dose.

Factors such as insurance coverage, treatment accessibility, and risks associated with misuse influence the treatment decision. The authors stress the importance of further randomized clinical trials to validate these findings and explore confounding variables like socioeconomic status and dosing differences.

Dr. Meisner highlighted the necessity of safe, evidence-based approaches in using ketamine therapies, stressing vigilance against potential misuse while recognizing their potential benefits in tailored treatment settings.