Patients who took esketamine improved their depression and fibromyalgia.

Treatment-resistant depression treated with intranasal esketamine was associated with symptom improvement. Major depressive disorder (MDD) Symptoms and pain of fibromyalgia were demonstrated in patient cases.¹

In 2019, the U.S. Food and Drug Administration approved esketamine (Supravat) for treatment-resistant depression and depressive symptoms in adults with MDD who have acute suicidal ideation.²

“Ketamine/esketamine is not just a replacement drug, it's a treatment that works within a day and can actually help people with treatment-resistant depression,” said Professor of Psychiatry and Pharmacology. says Roger S. McIntreier, MD, of from the University of Toronto told HCPLive at the American Psychiatric Association (APA) 2022 Annual Meeting.³

Since then, the FDA has warned that using compound ketamine nasal sprays to treat mental illnesses puts patients at risk.² Although esketamine may be derived from racemic ketamine, it is safe for treating mental illnesses. Esketamine is approved for treatment-resistant depression, but research suggests it may be effective for other conditions as well.

After administration of intranasal esketamine, a 40-year-old woman receiving intranasal esketamine showed incidental improvement in both MDD and chronic fibromyalgia pain.¹

She was not the first patient to experience pain relief after receiving esketamine. Another patient with treatment-resistant depression the researchers studied had his chronic migraine headaches go into remission after six months of treatment. Other patients with treatment-resistant depression with esketamine experienced pain relief for pain syndromes such as diabetic peripheral neuropathy, low back pain, and sciatica on the day of administration.

A study earlier this year found that low doses of esketamine improved acute postoperative pain in patients undergoing thoracoscopic surgery without increasing adverse events. Researchers in this study suggest that the underlying mechanism may be related to postoperative inflammation. In this study, depression scores did not decrease after surgery in the esketamine group.

However, for fibromyalgia pain, intranasal esketamine has been shown to reduce discomfort, as demonstrated in a patient case presented at a conference. Annual American Psychiatric Association (APA) 2024 Conference. The patient suffered from treatment-resistant depression, as well as anxiety, irritable bowel syndrome (IBS), paresthesias, difficulty concentrating, low energy, and weight gain.

She tried many oral antidepressants and enhancers to alleviate her depression symptoms. Antidepressants helped my symptoms a little, but it wasn't enough.

Prior to esketamine treatment, she was taking extended-release bupropion 450 mg and extended-release venlafaxine 225 mg daily. Her esketamine therapy began with her first 56 mg dose on the first day to establish tolerability. Thereafter, she received esketamine 84 mg intranasally twice weekly for 4 weeks, followed by once weekly for 4 weeks.

The patient's depressive symptoms improved within a few days of starting esketamine. This treatment also improved my sleep. After switching to biweekly dosing, her depressive symptoms returned, so she returned to weekly dosing.

In addition to reducing depression symptoms, esketamine also reduced fibromyalgia pain. She rated her daily baseline pain as a 7-8 on her 10-point scale, and as it worsened she would get a 9 or 10.

After administering esketamine, she rated her pain as a 2-3. However, her day 6 score was her 4 and her 1 week dosing interval score was her 7. Responses were sustained over a 10-month treatment period. If the dose was on her 11th or 9th, the patient rated the breakthrough pain as her 6-7.

“This case and the observations of the migraine patient described above raise the question of whether it might be better to use esketamine early in cases where certain pain syndromes are present. [treatment-resistant depression] Patients,” the presenters wrote on the poster.

References

1. ^{Fichtner, Christopher. Incident analgesia with esketamine for depression: Durable effects in fibromyalgia and migraine. Paper presented at the American Psychiatric Association (APA) 2024 Annual Meeting. New York, New York. May 4-8, 2024.}
2. ^{Zhang, Qw., Wang, X., Wang, Zy. and others. Low-dose esketamine improves acute postoperative pain in patients undergoing thoracoscopic surgery. APS 25 (2024). https://doi.org/10.1007/s44254-023-00039-x}
3. ^{FDA warns medical professionals about potential risks associated with combination ketamine nasal spray. U.S. Food and Drug Administration. February 16, 2024. https://www.fda.gov/drugs/human-drug-compounding/fda-alerts-health-care-professionals-potential-risks-associated-compounded-ketamin-nasal-spray. Accessed May 5, 2024.}