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...
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Elsevier
2025-07-01
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| Series: | Journal of Affective Disorders Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666915325000848 |
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| author | Jan Sarlon Timur Liwinski Annette Beatrix Bruehl Deanne Thomi Undine Emmi Lang |
| author_facet | Jan Sarlon Timur Liwinski Annette Beatrix Bruehl Deanne Thomi Undine Emmi Lang |
| author_sort | Jan Sarlon |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-ebe89851310d4004adc6e25026bdcb6a |
| institution | Kabale University |
| issn | 2666-9153 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Affective Disorders Reports |
| spelling | doaj-art-ebe89851310d4004adc6e25026bdcb6a2025-08-20T03:55:53ZengElsevierJournal of Affective Disorders Reports2666-91532025-07-012110095410.1016/j.jadr.2025.100954Intranasal racemic ketamine in treatment-resistant depression: Efficacy and tolerability in outpatient treatmentJan Sarlon0Timur Liwinski1Annette Beatrix Bruehl2Deanne Thomi3Undine Emmi Lang4University Psychiatric Clinics (UPK) Basel, Switzerland; University of Basel, Switzerland; Corresponding author at: Centre of Affective, Stress- and Sleep Disorders (ZASS), University Psychiatric Clinics (UPK) Basel, Switzerland.University Psychiatric Clinics (UPK) Basel, Switzerland; University of Basel, SwitzerlandUniversity Psychiatric Clinics (UPK) Basel, Switzerland; University of Basel, SwitzerlandUniversity Psychiatric Clinics (UPK) Basel, Switzerland; University of Basel, SwitzerlandUniversity Psychiatric Clinics (UPK) Basel, Switzerland; University of Basel, SwitzerlandBackground 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.http://www.sciencedirect.com/science/article/pii/S2666915325000848DepressionNasal racemic ketamineResponseTolerabilityCost-effectiveness |
| spellingShingle | Jan Sarlon Timur Liwinski Annette Beatrix Bruehl Deanne Thomi Undine Emmi Lang Intranasal racemic ketamine in treatment-resistant depression: Efficacy and tolerability in outpatient treatment Journal of Affective Disorders Reports Depression Nasal racemic ketamine Response Tolerability Cost-effectiveness |
| title | Intranasal racemic ketamine in treatment-resistant depression: Efficacy and tolerability in outpatient treatment |
| title_full | Intranasal racemic ketamine in treatment-resistant depression: Efficacy and tolerability in outpatient treatment |
| title_fullStr | Intranasal racemic ketamine in treatment-resistant depression: Efficacy and tolerability in outpatient treatment |
| title_full_unstemmed | Intranasal racemic ketamine in treatment-resistant depression: Efficacy and tolerability in outpatient treatment |
| title_short | Intranasal racemic ketamine in treatment-resistant depression: Efficacy and tolerability in outpatient treatment |
| title_sort | intranasal racemic ketamine in treatment resistant depression efficacy and tolerability in outpatient treatment |
| topic | Depression Nasal racemic ketamine Response Tolerability Cost-effectiveness |
| url | http://www.sciencedirect.com/science/article/pii/S2666915325000848 |
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