Official websites use .gov
Secure .gov websites use HTTPS
Esketamine for the treatment of treatment-resistant depression: effectiveness and value : final evidence report
Esketamine for the treatment of treatment-resistant depression: effectiveness and value : final evidence report
- Collection:
- Health Policy and Services Research
- Author(s):
- Atlas, Steven, author
Agboola, Foluso, author
Fazioli, Katherine, author
Fluetsch, Noemi, author
Kumar, Varun, author
O'Grady, Madeline, author
Rind, David, author
Pearson, Steve, author
Touchette, Daniel R., author
Boyer, Nicole, author
Talon, Brian, author
Schultz, Bob G., author - Contributor(s):
- Institute for Clinical and Economic Review, issuing body.
- Publication:
- [Boston, Massachusetts] : Institute for Clinical and Economic Review, June 20, 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Depressive Disorder, Treatment-Resistant -- drug therapy
Hallucinogens -- therapeutic use
United States - Genre(s):
- Technical Report
- Abstract:
- Major depressive disorder (MDD) is a common psychiatric condition characterized by symptoms of persistent sadness, feelings of hopelessness, loss of interest in usual activities, decreased energy, difficulty concentrating or sleeping, change in appetite, and thoughts of hurting oneself. It increases the risk of suicide, can affect all aspects of life including social relationships and the ability to work, and is the second leading cause of disability in the United States. An estimated 16 million adults or 7% of adults in the United States experience at least one major depressive episode each year. Treatment-resistant depression (TRD) refers to a major depressive episode with an inadequate response to therapy of adequate dosing and duration. Overall, approximately one in three patients with depression are considered “treatment-resistant.” Patients with TRD have higher costs of care, decreased work productivity, and account for around $64 billion in total costs. Patients with depression vary in terms of the severity of symptoms, course (episodic or chronic), and associated conditions such as anxiety or substance use disorders. Initial treatment may not work or may cause unacceptable side effects and switching to a different therapy is common. The number of failed trials that define TRD has not been standardized, but at least two trials of antidepressant monotherapies in the current episode is commonly used. Since a trial of a therapy may require dose adjustments and six to 12 weeks to assess response, patients may find it difficult to remain on therapy long enough for an adequate trial of the treatment. For this reason, TRD can be difficult to define because it includes not only the number of unique treatments tried, but whether the trials were considered adequate. Despite available antidepressant treatments, many individuals do not respond to multiple therapies, emphasizing the need for new treatment options. One potential new therapeutic target is the N-methyl-D-aspartate (NMDA) receptor. This interest has been driven by the observation that ketamine, an anesthetic, can transiently improve symptoms of depression. Short-term studies have shown benefit, but this drug is usually administered intravenously and has side effects as well as the potential for abuse or diversion. A new agent, esketamine (Spravato™, Janssen), was approved on March 5, 2019 by the FDA for patients with TRD. Ketamine is a racemic mixture of two stereoisomers. Esketamine is the S-enantiomer, which binds with greater affinity to the NMDA receptor. It is a non-selective, non-competitive antagonist of the NMDA receptor and is available as a nasal spray for the treatment of adults with TRD.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (various pagings))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918401085606676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918401085606676