A new study from researchers at Mass General Brigham has found that intravenous (IV) ketamine works faster and may be more effective than intranasal (IN) esketamine for people with depression that hasn’t improved after trying other medications.
The research was done at McLean Hospital, where doctors looked at real patient records to see how well each treatment worked.
Depression is a serious condition that affects millions of people. For about 30% of those with major depression, regular antidepressants don’t work, even after trying two or more kinds. These people are said to have treatment-resistant depression.
In recent years, ketamine and its relative esketamine have become new options for treating this tough condition. Esketamine is approved by the FDA and given as a nasal spray, while ketamine is used off-label through an IV.
The study looked at 153 adults who had treatment-resistant depression. Of these, 111 received IV ketamine, and 42 were treated with IN esketamine. Both groups had eight treatments over about a month. The researchers then measured how much the patients’ depression symptoms improved over time.
The results showed that both treatments helped reduce depression, but ketamine worked faster and more strongly. Patients who got IV ketamine had a 49.2% improvement in their depression scores by the end of the treatment.
Those who used the nasal esketamine showed a 39.6% improvement. People treated with IV ketamine often felt better right after the first session, while those using esketamine didn’t notice big changes until after the second session.
The authors of the study say that both treatments are useful, and the choice between them should be based on many things, including the patient’s needs, access to care, and insurance coverage.
They also warn that ketamine use should be handled with care. Because ketamine can be misused and some clinics may not follow safe guidelines, it’s important that doctors use it in a controlled, professional setting.
This study was not a randomized clinical trial, which means people were not randomly chosen to receive one treatment or the other. That makes it hard to say for sure if one is truly better than the other. More research is needed to confirm these results.
Still, this is one of the largest real-world studies comparing the two treatments, and it offers helpful information for patients and doctors looking for options when standard treatments don’t work. As more studies are done, we’ll learn even more about how to safely and effectively use ketamine and esketamine to help people with depression.
The study is published in The Journal of Clinical Psychiatry.
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