A nasal spray formulation of ketamine has shown promise for the rapid treatment of symptoms of major depression and suicidal thoughts, according to findings from a new US study.
Researchers found a significant improvement in depression scores and decreased suicidal ideation in a small group of patients given the drug, compared to a placebo after both four hours and 24 hours.
“Preliminary findings indicate that intranasal esketamine… may result in significantly rapid improvement in depressive symptoms”
Their study compared standard treatment plus an intranasal formulation of esketamine – part of the ketamine molecule – to standard treatment plus a placebo.
They used the double-blinded study to test esketamine as a rapid treatment of symptoms of major depression, including suicidality, among individuals at imminent suicide risk.
The study involved 68 participants randomly assigned to one of two groups – either receiving esketamine or placebo twice a week for four weeks.
All participants continued to receive treatment with antidepressants throughout. The researchers looked at effects at four hours after first treatment, at 24 hours and at 25 days.
The study, published in The American Journal of Psychiatry, was conducted by researchers at pharmaceutical company Janssen and the Yale School of Medicine.
It found a significant improvement in depression scores and decreased suicidal ideation in the esketamine group compared to the placebo group at four hours and at 24 hours.
However, the esketamine effects were not greater than the placebo for either outcome at 25 days. The measurement of suicide risk took into consideration both patient and clinician perspectives.
Specifically, a significantly greater improvement in depression scores was observed in the esketamine group compared with placebo at four hours and at 24 hours, but not at day 25.
Meanwhile, significantly greater improvement was also observed in the esketamine group on suicidal thoughts item score at four hours, but not at 24 hours or at day 25.
The study authors said their results supported nasal spray esketamine as a possible effective rapid treatment for depressive symptoms in patients assessed to be at imminent risk for suicide.
They noted that esketamine could be an important treatment to bridge the gap due the delayed effect of most common antidepressants, which need four to six weeks to become fully effective.
The authors caution that more research is needed on the potential for abuse of ketamine.
They stated: “These preliminary findings indicate that intranasal esketamine compared with placebo, given in addition to comprehensive standard-of-care treatment, may result in significantly rapid improvement in depressive symptoms, including some measures of suicidal ideation, among depressed patients at imminent risk for suicide.”