The results showed significant improvement in the MADRS score of patients that took Ketamine compared to patients in the placebo group four hours after the first treatment. Patients in one group received the standard treatment along with ketamine in the form of a nasal spray known as esketamine. The researchers then analysed its effects four hours, 24 hours and 25 days after first treatment.
Ketamine tolerance varied from one person to the next, with half of the group experiencing adverse side effects such as high blood pressure, psychotic-like effects and motor incoordination, which left some participants unable to continue to self-administer the spray.
The results of the study support nasal spray esketamine as a possible effective rapid treatment for depressive symptoms in patients assessed to be at imminent risk for suicide, according to the authors. Patients who received esketamine showed significantly greater improvement in suicidal thoughts at 4 hours (effect size = 0.67), but not at 24 hours after the first dose (effect size = 0.35) or at day 25 (effect size = 0.29).
The researchers measured a patient's score depending on the Montgomery-Asberg Depression Rating Scale, a psychological rating scale to measure the severity of depression symptoms as well as the Suicide Ideation and Behavior Assessment Tool. The most common events among those receiving esketamine were nausea, dizziness, dissociation, unpleasant taste and headache. All of the participants also took standard anti-depressants throughout this period.
This study was a proof-of-concept, phase 2, study for esketamine; it must still go through a phase 3 study before possible FDA approval.
However, the researchers, as well as members of the AJP Editorial Board, acknowledged the risky potential for abuse that surrounds the drug. "Protection of the public's health is part of our responsibility as well, and, as physicians, we are responsible for preventing new drug epidemics", said Dr. Robert Freedman, the current editor in chief for the AJP.
If approved for use on the NHS, Stone said, the spray "would be aimed at people with severe depression as a second or third line of treatment if other drugs haven't worked", including as a potential alternative to electroconvulsive therapy.
However, AJP gave caution to the drug's potential for abuse and the need for effective controls.
The researchers looked at 68 people deemed at imminent risk of suicide, all of whom were treated with anti-depressants or admitted to the hospital.
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