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Esketamine: new hope for the treatment of treatment-resistant depression? A narrative review


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Salahudeen, MS ORCID: 0000-0001-9131-7465, Wright, CM and Peterson, GM ORCID: 0000-0002-6764-3882 2020 , 'Esketamine: new hope for the treatment of treatment-resistant depression? A narrative review' , Therapeutic Advances in Drug Safety, vol. 11 , pp. 1-23 , doi: 10.1177/2042098620937899.

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This narrative review aims to provide an overview of the current literature on thepharmacology, safety, efficacy and tolerability of intranasal esketamine, the S-enantiomerof ketamine, for the treatment of treatment-resistant depression (TRD). A literature searchusing Medline, Embase, PsycINFO and Cochrane Central was conducted (January 2000 toJuly 2019). Product information and were also reviewed. The literaturesearch was limited to human studies published in English. PhaseI, II, and III studies ofintranasal esketamine for TRD were reviewed. About a third of patients with major depressivedisorder fail to achieve remission despite treatment with multiple antidepressants. Thisarticle examines the trials that led to the approval of esketamine in the United States, aswell as other recent studies of esketamine for TRD. The findings from limited phaseIII trialsillustrate that intranasal esketamine is effective and safe in reducing depressive symptomsand achieving clinical response in patients with TRD. The optimum duration and frequency ofuse are not fully understood. Although the nasal spray is a convenient dosage form, its use inpractice may be limited by cost and administrative regulation. While it may prove beneficialto many patients who suffer from TRD, further long-term data are required, along withcomparative trials with the R-isomer (arketamine). In the interim, care and monitoring shouldbe exercised in its use in clinical practice.

Item Type: Article
Authors/Creators:Salahudeen, MS and Wright, CM and Peterson, GM
Keywords: antidepressant, esketamine, intranasal, major depressive disorder, R-ketamine, S-ketamine, TRD, treatment resistant depression
Journal or Publication Title: Therapeutic Advances in Drug Safety
Publisher: Sage Publications Ltd.
ISSN: 2042-0986
DOI / ID Number: 10.1177/2042098620937899
Copyright Information:

Copyright The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License( which permits non-commercial use, reproduction and distribution of the work without further permissionprovided the original work is attributed as specified on the SAGE and Open Access pages (

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