Oral Esketamine as Alternative for Maintenance Electroconvulsive Therapy in Patients With Treatment-Resistant Depression: A Case Series.
Daniël T Coerts, Jolien K E Veraart, Jeanine Kamphuis, Sanne Y Smith-Apeldoorn, Robert A Schoevers, Sjoerd M van Belkum
The journal of ECT January 21, 2025 DOI: 10.1097/YCT.0000000000001103 via PubMed
Summary
AI-generated from the abstractIn eight patients with treatment-resistant depression, repeated oral esketamine was tested as a replacement for maintenance electroconvulsive therapy (M-ECT). Over six weeks, esketamine doses were gradually increased up to 3.0 mg/kg twice weekly. Depression severity remained stable or improved in five patients, while three worsened and resumed M-ECT. Among five patients with available scores, all showed improvement on the Outcome Questionnaire 45. Four patients continue to receive oral esketamine. Oral esketamine may offer a suitable, patient-friendly alternative to M-ECT, though controlled trials are needed to confirm long-term safety and efficacy.
Study at a glance
| Characteristics | Observational study Case report Peer reviewed |
|---|---|
| Sample size | 8 |
| Population | Patients with treatment-resistant depression |
| Intervention | oral esketamine |
| Dose | 0.5 or 1.0 mg/kg titrated to maximum 3.0 mg/kg twice weekly |
| Duration | 6-week dosing phase |
| Keywords | Depression treatment Esketamine therapy Mental health breakthrough Psychiatric medicine Treatment alternatives |
| Citations | 1 |
| Key finding | Repeated oral esketamine maintained or improved depression severity in five of eight patients with treatment-resistant depression, suggesting it may be a viable alternative to maintenance electroconvulsive therapy. |
Abstract
This study investigates repeated oral esketamine as a substitution strategy for maintenance electroconvulsive therapy (M-ECT) in eight patients with treatment-resistant depression (TRD). In a 6-week dosing phase, esketamine was titrated from 0.5 or 1.0 mg/kg to a maximum of 3.0 mg/kg twice weekly. Outcomes included 6-week change in Inventory of Depressive Symptomatology - Self-rated (IDS-SR), Hamilton Depression Rating Scale - 17 items (HDRS17), and Outcome Questionnaire 45 (OQ-45), along with esketamine treatmentcontinuation. Depression severity remained stable or improved in five patients, whereas three experienced worsening symptoms and resumed M-ECT. OQ-45 scores were available for five patients, all of whom showed improvement. Currently, four patients are still receiving oral esketamine. Repeated oral esketamine may be a suitable and patient-friendly alternative to M-ECT. We recommend controlled trials to compare long-term safety and efficacy.