Is there an independant anti-suicidal effect of esketamine in treatment resistant depression?

Abstract

<h4>Background</h4>Regulatory approvals for intranasal esketamine in treatment-resistant depression (TRD) differ with respect to its indication for suicidal ideation. While rapid antidepressant effects are well documented, whether esketamine exerts an anti-suicidal effect independent of mood improvement remains unclear.<h4>Methods</h4>In this two-center observational study, 261 adults with moderate-to-severe TRD at Sainte-Anne Hospital, Paris, France, received eight esketamine sessions over four weeks. MADRS-D (items 1-9) and MADRS-S (item 10) were rated before each session.<h4>Results</h4>Both MADRS-D (all p < .001) and MADRS-S (all p < .001) improved during esketamine treatment. In multivariate analysis, depressive improvement remained significant after adjusting for MADRS-S (all p < .001), whereas the reduction in suicidal ideation lost significance when adjusting for MADRS-D (all p > .949) in both samples.<h4>Conclusions</h4>Our results suggest that the anti-suicidal effect of esketamine does not persist once its antidepressant effect is taken into account.

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