The American journal of psychiatry

Esketamine treatment for depression in adults: a systematic review and combined analysis

Updated

Abstract

Of 1,115 articles initially identified, 87 were included for analysis and discussion.

  • Randomized controlled trials at weeks 2-4 mostly showed negative or failed outcomes.
  • A meta-analysis indicated a weak but significant positive effect for depression (effect size range, 0.15-0.23).
  • The effect size related to suicidality was not significant at any time point.
  • Esketamine's efficacy as an add-on to antidepressants is modest when compared to augmentation strategies with atypical antipsychotics.
  • Concerns regarding esketamine's abuse potential and unknown long-term effects were noted, along with alarming signs of deaths and emerging suicidality during testing.

Simplified

Funding

Competing interests

Dr. Saitis has received support to participate in congresses from Innovis Pharma and Ricordatti. Dr. Schatzberg has served as a consultant for Alto Neurosciences, ANeurotech, Delpor, Douglas Pharmaceuticals, Galen, HMNC, Johnson & Johnson, Magnus, Mindful Health Solutions, NeuraWell, Owl Insights, Sage, Skyland Trail, Soneira, and Tris; and he has equity in Alto Neurosciences, ANeurotech, Corcept, Madrigal, Magnus, Mindful Health Solutions, NeuraWell, Seattle Genetics, Soneira, and Titan. Dr. Fountoulakis reports no financial relationships with commercial interests.
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