The anesthetic ketamine nasal spray apparently enhances the effects of conventional medications in people with difficult-to-treat depression. This is evident from a clinical study at the Vienna University Hospital (AKH), which was published last Thursday in the ‘New England Journal of Medicine’.
The results of the scientific research led by Andreas Reif, director of the Clinic for Psychiatry in Frankfurt, and co-authored by the Viennese psychiatrist Richard Frey (University Clinic for Psychiatry/MedUni Vienna, AKH) are also currently being presented at the annual meeting of the European College of Neuropsychopharmacology presented in Barcelona.
In Austria, about 8% of the population is depressed
The background: probably about 320 million people worldwide are depressed. In Austria, the frequency is reported to be just under eight percent of the population. The number of unreported cases is high. The conventional antidepressants – especially the so-called serotonin and/or norepinephrine reuptake inhibitors (SSRI or SNRI) – which increase the concentration of the nerve messengers serotonin and/or norepinephrine in the synaptic gap between nerve cells in the brain, only develop after about two hours. weeks Effect.
But the biggest shortcoming is that about two-thirds of all patients with major depression do not respond to the first attempt at conventional drug treatment. In a third, a second treatment attempt with the drug remains unsuccessful. Until recently, the main treatment option for these people was the additional administration of an atypical antipsychotic (e.g. quetiapine). Since 2019, esketamine, derived from the anesthetic ketamine, has also been approved in the EU as a nasal spray for the treatment of “resistant” depression.
The psychiatrists involved in the scientific study from 171 hospitals in 24 countries conducted an initial comparative study between the two strategies. The patients were between 18 and 74 years old. On average, they had been in their current depressive episode for more than 60 weeks. Symptoms were not significantly improved after treatment with an SSRI or SNRI.
“For two-thirds of the patients it was already the third attempt at treatment,” the German Medical Journal wrote about the scientific research. The third third of the total 676 subjects had already made up to six different treatment attempts. The patients were between 18 and 74 years old and had been suffering from major depression for at least 60 weeks.
Esketamine from nasal spray showed the best effect
In a one-to-one ratio, patients continued to take conventional medications over the course of the study and also used the antipsychotic quetiapine (340 subjects) or esketamine nasal spray (336 subjects). According to the scientists, the results speak in favor of the nasal spray. “More patients in the esketamine group than in the quetiapine group showed remission (disappearance of symptoms; note) after eight weeks (91 of 336 patients or 27.1 percent versus 60 of 340 patients or 17.6 percent),” says the New England Journal of Medicine (DOI: 10.1056/NEJMoa2304145).
The effect apparently increased with the duration of treatment. “At week 32, 49 percent of patients in the esketamine group and 33 percent in the quetiapine group were in remission,” the German medical journal wrote. A possible problem with treatment with esketamine is that patients who usually take it once a week may need to come to the hospital. a clinic.
Source: Krone
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