Shrinks In Sneakers

Tag: oral ketamine

🧠 Esketamine + Antidepressants in TRD: Does the Combo Matter?
📢 New data from a real-world study of 50,000+ patients with treatment-resistant depression (TRD) published in JAMA Psychiatry:

📌 Study Question:
Does combining esketamine with an SSRI or SNRI affect long-term outcomes in TRD?

📊 Key Findings (5-Year Follow-Up):
- ✅ Esketamine + SNRI:
  ↘️ Lower all-cause mortality
  ↘️ Fewer hospitalizations
  ↘️ Reduced depressive relapse
- ✅ Esketamine + SSRI:
  ↘️ Lower incidence of suicide attempts
- 🔒 Overall: Low rates of adverse outcomes in all groups
💡 Clinical Implications:
- Not all combinations are equal—pairing matters.
- Esketamine + SNRI may be preferred for reducing relapse/mortality
- Esketamine + SSRI may be considered in patients at risk for suicide
- Personalized treatment decisions can enhance outcomes in TRD
🔍 More than symptom relief—it’s about survival, stability, and safety.
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April 9, 2025
FDA warns patients and health care providers about potential risks associated with compounded ketamine
The FDA has issued a warning to patients and healthcare providers regarding the potential risks of compounded ketamine products, including oral formulations, used for psychiatric disorders. These products, often compounded outside of FDA oversight, can pose serious safety concerns such as inconsistent dosing, contamination, and lack of proven efficacy. The FDA emphasizes that while ketamine is approved for anesthesia and certain treatments, compounded versions may not meet the same quality standards, leading to unpredictable outcomes. Patients are urged to consult with their healthcare providers to explore safer, FDA-approved treatment options for psychiatric conditions.

Link to FDA press release: https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine
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October 4, 2024
Oral Extended-Release Ketamine: Beyond the Hype or Just Another Hope?
Psychiatry’s fascination with ketamine continues, despite growing evidence that it may not be the miracle treatment some once hoped for. It’s clear that ketamine is not disease-modifying, meaning patients treated for depression with ketamine can still experience relapses. Even more concerning is that ketamine’s effects are short-lived, with the average time to relapse being just 2-4 weeks.

This brings us to recent studies on oral extended-release ketamine for treatment-resistant depression (TRD). In a proof-of-concept study, twice-weekly dosing of extended-release ketamine showed statistically significant and clinically meaningful improvements in depressive symptoms. The treatment was generally well-tolerated, with a side effect profile that included reduced dissociation and sedation, though there were increases in blood pressure. Having a tablet form of ketamine could make the treatment more accessible, but it also raises concerns about potential abuse and diversion.

In my view, this is another symptom management tool for patients with TRD. However, the challenge remains that patients will likely need to continue ketamine treatment long-term without a clear dosing regimen. Nonetheless, the results were promising enough to lead to a phase-3 trial using 180 mg doses twice daily.

Link to article: https://www.nature.com/articles/s41591-024-03063-x
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August 27, 2024