(#21) Esketamine Following Failure of Transcranial Magnetic Stimulation in Patients with Treatment Resistant Depression

Abstract: Major depressive disorder is the leading cause of disability worldwide. Almost a third of patients with major depression failed to achieve remission despite treatment with multiple antidepressants. Treatment resistant depression (TRD) is defined as non-responsiveness to at adequate treatment with at least two antidepressants. The modalities available to treat patients with treatment resistant depression include transcranial magnetic stimulation (TMS) and esketamine (SPRAVATO). Clinical trials of esketamine have shown response and remission rates 69% & 52% respectively (4). We conducted a retrospective chart review of patients with TRD who did not respond to treatment with TMS. Our database included 35 patients with treatment resistant depression (> 2 antidepressants history) and recent non-response to TMS therapy who received Esketamine intranasal spray treatment. This analysis includes results from treatment after one dose, eight doses (induction period of 4 weeks) and twelve doses (end of 2 months). Primary outcomes were the PHQ-9. We also analyzed results on the GAD-7. Results: Mean baseline PHQ-9 scores were 22, indicating a severe level of depression. Mean PHQ-9 score after a single treatment was 18 (Mean difference), after eight treatments was 12 (Mean difference: 10), and after twelve treatments was 9 (Mean difference: 13). At week 4, 51% of patients achieved treatment response and 20% of patients achieved remission. At week 8, 63% of patients were responders and 34% were remitters. Conclusions: Esketamine is an effective treatment option for patients with TRD who fail to respond to TMS.Short Description: We analyzed data from 35 patients with TRD who failed a course of TMS and were treated esketamine (Spravato). At week 4, 51% of patients were responders and 20% were remitters. At week 8, 63% were responders and 34% were remitters. Treatment with esketamine could be a useful treatment strategy in patients who have failed TMS. Continued treatment beyond the induction period may also be effective in additional patients getting to response and remission.Name of Sponsoring Organization(s):