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

IF 3.5 3区医学 Q1 CLINICAL NEUROLOGY

European Archives of Psychiatry and Clinical Neuroscience Pub Date : 2025-07-01 DOI:10.1007/s00406-025-02041-9

Erhan Kavakbasi, Kevin Rosemann, Mert Yilmaz, Helmut Berndt, Bernhard T Baune

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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.

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鼻内艾氯胺酮可显著减轻电休克治疗无反应患者的抑郁严重程度和自杀意念。

鼻内艾氯胺酮（ESK）是治疗难治性抑郁症（TRD）患者的一种新的治疗选择。既往有电痉挛治疗（ECT）无反应（ECT+）病史的患者通常被排除在既往研究之外。关于ESK在ECT无应答者中的有效性的数据很少。方法：在这项回顾性研究中，我们调查了鼻内ESK在现实世界中有ECT+无反应住院患者（n = 39）与在当前发作中未接受足够ECT疗程的患者（n = 57）的有效性。方差的因子分析（ANOVA）已被用于确定电痉挛治疗无反应对治疗结果的影响。结果：共n = 96例患者(平均年龄47.0；52.1%的女性TRD患者被纳入本研究。方差分析显示，电痉挛无反应史对MADRS评分有显著的主影响（F = 10.386, p = 0.002）。然而，时间（治疗前、治疗后）与当前发作ECT无反应史的交互作用不显著（F = 2.166, p = 0.143）。ECT +组的缓解率（34.9%比21.9%,χ2 = 1.498, p = 0.167）和缓解率（24.4%比12.1%,χ2 = 1.861, p = 0.141）均低于ECT-组。ECT +组的MADRS和BDI-II有显著改善。研究期间未发生重大安全问题。结论：电痉挛无反应对艾氯胺酮治疗效果无显著影响。我们的研究结果支持为ECT无反应患者提供艾氯胺酮的方法，因为这些患者的治疗选择有限。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Archives of Psychiatry and Clinical Neuroscience 医学-精神病学

CiteScore

8.80

自引率

4.30%

发文量

154

审稿时长

6-12 weeks

期刊介绍： The original papers published in the European Archives of Psychiatry and Clinical Neuroscience deal with all aspects of psychiatry and related clinical neuroscience. Clinical psychiatry, psychopathology, epidemiology as well as brain imaging, neuropathological, neurophysiological, neurochemical and moleculargenetic studies of psychiatric disorders are among the topics covered. Thus both the clinician and the neuroscientist are provided with a handy source of information on important scientific developments.