Evidence map›Paper›PMID 37961848›Full record

ReviewAustralasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists2023

What clinicians need to know about intranasal esketamine for treatment-resistant depression?

Judy Hope, David Copolov, John Tiller, Megan Galbally, Malcolm Hopwood, Richard Newton, Nicholas A Keks

Open access · hybridAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 2 pooled it
2.2field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 2 syntheses or guidelines pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Research progress in brain-targeted nasal drug delivery.Frontiers in aging neuroscience · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 6 institutions in 1 country.

Judy HopeMental Health Program, Eastern Health, Box Hill, VIC, Australia; Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia; Centre of Mental Health Education and Research, Delmont Private Hospital, Burwood, VIC, Australia.ORCID 0000-0001-8119-6815
David CopolovDepartment of Psychiatry, Monash University, Clayton, VIC, Australia.
John TillerDepartment of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.
Megan GalballyDepartment of Psychiatry, Monash University, Clayton, VIC, Australia; Mental Health Program Monash Health, Clayton, VIC, Australia; Centre of Women's and Children's Mental Health, Melbourne, VIC, Australia.ORCID 0000-0003-3909-1918
Malcolm HopwoodDepartment of Psychiatry, University of Melbourne, VIC, Australia.
Richard NewtonPeninsula Health, Frankston, VIC, Australia; Monash University, Clayton, VIC, Australia.ORCID 0000-0003-1160-171X
Nicholas A KeksMonash Medical Centre, Clayton, VIC, Australia; Centre of Mental Health Education and Research, Delmont Private Hospital, Burwood, VIC, Australia.ORCID 0000-0002-5981-3706
The University of Melbourne · AUEastern Health · AUMonash Health · AUMonash Medical Centre · AUMonash University · AUPeninsula Health · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo review the usefulness of esketamine for treatment-resistant depression.

methodPivotal trials of intranasal esketamine in treatment-resistant depression were synthesized as a narrative review.

resultsEsketamine is postulated to act through antagonism of N-methyl-D-aspartate (NMDA) glutamate receptors, but opioidergic effects may also be involved. Unlike intravenous ketamine, esketamine is given intranasally (under clinical observation), usually in addition to an oral antidepressant. Trials compared esketamine plus antidepressant versus placebo plus antidepressant. At 4 weeks, remission was 37% higher with esketamine/antidepressant than placebo/antidepressant. Speed of response and improvement in suicidality were comparable. In stable remitters on esketamine/antidepressant, 45% relapsed when esketamine was withdrawn over the following 6 months (whereas 25% relapsed on esketamine/antidepressant). Response appears less likely in patients with multiple antidepressant failures. Adverse effects include dissociation, dizziness, nausea, sedation, and headache but no psychosis. Hypertension affected 13%, especially older patients. Dose frequency is twice-weekly for 4 weeks, then weekly/fortnightly thereafter. No abuse has been reported. Unsubsidised cost may be beyond the reach of many Australians.

conclusionIntranasal esketamine plus antidepressant has been approved by regulators as moderately effective and acceptably tolerable for treatment-resistant depression. Cost is a drawback. Use often needs to be long-term and vigilance for abuse is essential.

Indexed as

Depressive Disorder, Treatment-ResistantKetamineAntidepressive AgentsAustralasian PeopleAustraliaDepressionHumansAntidepressive AgentsEsketamineKetamineantidepressantsintranasal esketamineN-methyl-D-aspartate antagonisttreatment resistant depression

Identifiers

PMID37961848
PMCPMC10725109
OpenAlexW4388659384

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.