Rapid and long-lasting effects of subcutaneous esketamine on suicidality: An open-label study in patients with treatment-resistant depression.
Eduardo Igor Torquato Cardoso Lopes, Patrícia Cavalcanti-Ribeiro, Fernanda Palhano-Fontes, Kaike Thiê da Costa Gonçalves, Emerson Arcoverde Nunes, Nicole Bezerra de Medeiros Lima, Nestor Caetano Santos, Aldielyson Jorge Cavalcante de Brito, Draulio Barros de Araujo, Nicole Leite Galvão-Coelho
Journal of psychiatric research August 1, 2024 DOI: 10.1016/j.jpsychires.2024.06.020 via PubMed
Summary
AI-generated from the abstractSubcutaneous esketamine injections given weekly for eight weeks produced a rapid and lasting reduction in suicidality among 18 adults with treatment-resistant depression. Suicidal thoughts dropped within 24 hours after the first dose and remained low throughout the eight-week treatment period. At six months after treatment ended, suicidality was still consistently lower. Clinician ratings showed significant improvement only after two sessions, and 61% of patients achieved remission from suicidal ideation. The findings suggest that weekly subcutaneous esketamine may be a cost-effective way to achieve fast and sustained anti-suicide effects, but controlled studies are needed to confirm these initial observations.
Study at a glance
| Characteristics | Open-label clinical trial Peer reviewed |
|---|---|
| Sample size | 18 |
| Population | Treatment-resistant depressive patients |
| Intervention | Subcutaneous esketamine |
| Duration | 8-week intervention, 6-month follow-up |
| Topics | Depression Esketamine |
| Keywords | Mental health treatment Suicide prevention Esketamine therapy Depression treatment |
| Citations | 9 |
| Key finding | Weekly subcutaneous esketamine injections produced a rapid drop in suicidality within 24 hours that persisted through eight weeks of treatment and remained lower at six-month follow-up, with 61% of patients achieving remission on suicidality. |
Abstract
Therapeutics for suicide management is limited, taking weeks to work. This open-label clinical trial with 18 treatment-resistant depressive patients tested subcutaneous esketamine (8 weekly sessions) for suicidality. We noted a rapid and enduring effect of subcutaneous esketamine, lasting from one week to six months post-treatment, assessed by the Beck Inventory for Suicidality (BSI). There was an immediate drop in suicidality, 24 h following the initial dose, which persisted for seven days throughout the eight-week dosing period. Additionally, this study is the first to examine a six-month follow-up after multiple administrations of subcutaneous esketamine, finding consistently lower levels of suicidality throughout this duration. Conversely, suicidality also was measured along the 8-weeks of treatment by a psychiatrist using the Montgomery-Asberg Depression Rating Scale (MADRS), which showed significant reduction only after two treatment sessions expanding until the last session. Moreover, notably, 61% of patients achieved remission on suicidality (MADRS). These results suggest that weekly subcutaneous esketamine injections offer a cost-effective approach that induces a rapid and sustained response to anti-suicide treatment. This sets the stage for further, more controlled studies to corroborate our initial observations regarding the effects of SC esketamine on suicidality. Registered trial at: https://ensaiosclinicos.gov.br/rg/RBR-1072m6nv.