The High Relative Safety and Efficacy of Ketamine and Esketamine (Spravato) for Depression in Teenagers
Dr. Danish frequently works with patients using various medications, including ketamine and esketamine (brand name Spravato), to manage major depressive disorder (MDD) and suicidal ideation (SI). These powerful and relatively safe treatments are now being studied more extensively in teenagers, and there are select times when we use them to treat adolescents. Ketamine functions primarily as an NMDA receptor antagonist, stabilizing neurotransmitter levels to alleviate depressive symptoms and reduce suicidal thoughts.
Ketamine and esketamine's effectiveness in treating MDD and SI has been demonstrated in various studies. By targeting neurochemical imbalances, these medications provide valuable tools in the comprehensive treatment plans that Dr. Danish and his team at Philadelphia Integrative Psychiatry develop for their patients. This holistic approach, which combines medication management with therapy, lifestyle adjustments, and other supportive measures, aims to address the multifaceted nature of depression and suicidal ideation.
Study Design and Results
Efficacy in Reducing Suicidal Ideation
A study involving 54 adolescents aged 13-18 with MDD and suicidal ideation found that esketamine significantly reduced suicidal ideation scores. Participants received esketamine or midazolam over three infusions in five days. Esketamine reduced Columbia Suicide Severity Rating Scale (C-SSRS) Ideation scores by -2.6 compared to -1.7 in the midazolam group (p = .007) and intensity scores by -10.6 versus -5.0 (p = .002).
Depression Severity Improvement
The same study showed significant reductions in Montgomery-Åsberg Depression Rating Scale (MADRS) scores for the esketamine group (-15.3) compared to the midazolam group (-8.8, p = .004). Four-week response rates were also higher for esketamine, with 69.2% showing an antisuicidal response and 61.5% showing an antidepressant response compared to 52.5% for midazolam.
Cognitive Effects
Another study assessed the cognitive impacts of esketamine on 51 adolescents with MDD and suicidal ideation. Esketamine significantly improved processing speed from baseline to Days 6 and 12, with effect sizes of 0.566 and 1.032, respectively. Working memory also improved by Day 12, and no significant cognitive impairments were noted, indicating that esketamine is cognitively safe.
Side Effects
The studies reported that the most common side effects of esketamine included nausea, dissociation, dry mouth, sedation, headache, and dizziness. These side effects were generally mild and transient, suggesting that esketamine is well-tolerated in adolescents.
Case Reports and Open-Label Studies
Case reports and open-label studies further support the safety and efficacy of ketamine in adolescents. For instance, a 16-year-old boy with treatment-resistant depression showed rapid and sustained improvement in depressive symptoms and suicidal ideation after IV ketamine infusions. Side effects were mild, including nausea and dissociative symptoms, which were managed effectively.
Randomized Controlled Trials
A clinical trial with 17 adolescents compared ketamine to midazolam, showing that ketamine significantly reduced depressive symptoms within 24 hours, with 76% of participants responding compared to 35% for midazolam. Side effects included transient dissociative symptoms and mild increases in blood pressure and heart rate.
Conclusion
The studies indicate that ketamine and esketamine are effective and well-tolerated treatments for adolescents with MDD and suicidal ideation. They show significant improvements in both depressive symptoms and suicidal thoughts, with minimal and manageable side effects. These findings support the potential of ketamine and esketamine as valuable options in the comprehensive treatment plans at Philadelphia Integrative Psychiatry.
Getting in Touch with Dr. Danish and his Team
At Philadelphia Integrative Psychiatry, we take pride in our ability to practice the most subtle nuances of psychiatry, which is an inherently subjective field full of misdiagnoses and lazy and inaccurate assessment techniques. We want to provide the level of care we would want for our own family members. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for MDD or similar conditions, please text or call 610-999-6414 to learn how we can help.
For more on this topic and related subjects, check out these blogs:
For more blogs discussing the safety and potential side effects of ketamine, visit here.
For more blogs on the robust and long term positive changes that can occur with ketamine treatment, visit here.
Transcranial Magnetic Stimulation (TMS) is another very powerful treatment for depression that is sometimes used in adolescents; read these blogs for more information on TMS.
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