Trauma re-experiencing episodes during esketamine treatment in patients with treatment-resistant depression and comorbid PTSD: a retrospective case series.
In patients with treatment-resistant depression and comorbid PTSD, trauma re-experiencing episodes during esketamine treatment may not prevent clinical improvement, with a depression response rate of 45.5%.
Where it sits
this study against the rest of the igf-1 des (des(1-3) igf-1) corpusSummary and findings
This study examined trauma re-experiencing episodes in patients with treatment-resistant depression (TRD) and comorbid PTSD receiving esketamine treatment. A total of 22 adult patients were included, with 72.7% experiencing a disappearance of trauma re-experiencing episodes as treatment progressed. Clinical outcomes showed a depression response rate of 45.5% and a PTSD improvement rate of 45.5%.
Abstract
<b>Background:</b> Posttraumatic stress disorder (PTSD) is a severe and frequent affection that is highly comorbid to major depressive disorder. Comorbid PTSD and depression increase the risk of treatment-resistant depression (TRD), with a high risk of functional impairment and suicide. Esketamine nasal spray is a recent validated treatment for TRD, but its efficacy on comorbid TRD-PTSD remains insufficiently documented. In particular, it is unknown whether traumatic re-experiencing may occur during esketamine treatment and if so, how it influences clinical outcomes.<b>Objectives:</b> Our objective was to describe trauma re-experiencing episodes during esketamine sessions and their impact on clinical trajectories within an ecological sample of patients with comorbid TRD-PTSD.<b>Methods:</b> We retrospectively collected clinical data of patients receiving esketamine nasal spray for TRD for whom at least one trauma re-experiencing episodes had been identified by clinicians during esketamine sessions across 11 psychiatric departments.<b>Results:</b> Between February 2020 and March 2023, 22 adult patients with TRD met inclusion criteria. In sixteen patients (72.7%) trauma re-experiencing episodesdisappeared as the sessions progressed. In six patients (27.3%), esketamine treatment was stopped because of trauma re-experiencing episodes. When esketamine was continued, favourable clinical outcomes were observed both for depression and PTSD (depression response rate: 45.5% and remission rate: 22.7%; PTSD improvement rate: 45.5% and remission: 18.2%).<b>Limitations:</b> The retrospective design of the study and the absence of a comparator group are the main limitations of our study.<b>Conclusions:</b> Our results suggest that esketamine can be safely administered to patients with comorbid PTSD and TRD, and that the occurrence of trauma re-experiencing episodes does not hinder clinical response.
Background
The paper addresses the relationship between esketamine treatment and trauma re-experiencing episodes in patients with treatment-resistant depression and PTSD. Prior studies have indicated that esketamine may have effects on mood disorders, but the interaction with PTSD symptoms remains underexplored. Understanding this relationship is crucial for optimizing treatment strategies in this patient population.
Methods
This study utilized a retrospective case series design, focusing on patients diagnosed with treatment-resistant depression and comorbid PTSD. The sample size and specific dosages of esketamine administered were not reported in the abstract. The primary outcome measured was the occurrence of trauma re-experiencing episodes during treatment.
Results
Not reported in abstract.
Interpretation
The findings from this study could provide insights into the safety and tolerability of esketamine in patients with PTSD. However, without specific numeric results or effect sizes, it is difficult to assess the clinical significance of the observations. The retrospective nature of the study and lack of control group may confound the conclusions drawn.
Key findings
- Not reported in abstract.
Limitations
- Retrospective case series design
- Sample size not reported
- No control group for comparison
- Specific effects of IGF-1 DES not reported