Intranasal racemic ketamine in treatment-resistant depression: Efficacy and tolerability in outpatient treatment
Background and aim: Intranasal racemic ketamine is an off-label alternative for treatment-resistant depression (TRD), offering a non-invasive and compared to esketamine less expensive option. However, its efficacy and safety in outpatient settings remain underexplored. This study aimed to assess the...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
|
| Series: | Journal of Affective Disorders Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666915325000848 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Background and aim: Intranasal racemic ketamine is an off-label alternative for treatment-resistant depression (TRD), offering a non-invasive and compared to esketamine less expensive option. However, its efficacy and safety in outpatient settings remain underexplored. This study aimed to assess the safety, tolerability, and efficacy of intranasal racemic ketamine in patients with TRD. Methods: This retrospective analysis included 45 patients (mean age 50.7 years, 21 women) who completed an induction phase of eight treatments with intranasal racemic ketamine over four weeks. Symptom severity was measured using the Montgomery-Åsberg Depression Rating Scale (MADRS). A complete response was defined as a ≥ 50 % reduction in MADRS scores from baseline, and a partial response as a 25–50 % reduction. Results: The mean racemic ketamine dose was 114.0 mg, the mean MADRS score reduction after four weeks was 34.5 %. The mean increase in blood pressure was 7.4 mmHg systolic and 6.9 mmHg diastolic. A paired t-test comparing baseline and week 8 MADRS scores revealed a statistically significant reduction in scores, with a mean difference of 10.04. Cohen’s d for MADRS reduction was 1.30, indicating a large effect. A total of 31.1 % of patients achieved a complete response, and 33.3 % had a partial response. Euphoria was a significant predictor of treatment response (p < 0.001). Adverse events requiring medical intervention occurred in four patients, and the drop-out rate due to adverse effects was 4.2 %. Conclusions: Intranasal racemic ketamine is an effective, well-tolerated treatment for TRD, with favorable safety outcomes and substantial antidepressant effects. |
|---|---|
| ISSN: | 2666-9153 |