Treatment-resistant depression and intranasal esketamine

Background: Pharmacological management of major depressive disorder has traditionally relied on antidepressants targeting the monoaminergic pathway. Treatment-resistant depression (TRD) patients have been frequently excluded from registrational trials, resulting in a lack of clear clinical recommend...

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Autores: Ramos-Quiroga, Josep Antoni|||0000-0003-1622-0350, Mora, Fernando|||0000-0003-4698-1679, Arostegui, Silvia|||0000-0002-2026-9387, Cardoner, Narcís|||0000-0001-9633-0888, Gómez-Revuelta, M.|||0000-0002-3749-3801, Montes, José Manuel|||0000-0002-2030-5253, Vieta, Eduard|||0000-0002-0548-0053, Etxeandia-Pradera, Jon Iñaki, Gómez Juanes, Rocío
Tipo de documento: artigo
Data de publicação:2025
País:España
Recursos:Universitat Autònoma de Barcelona
Repositório:Dipòsit Digital de Documents de la UAB
Idioma:inglês
OAI Identifier:oai:dnet:uabarcelona_::31dcdf1604f105d11aefac3e7a533ad9
Acesso em linha:https://ddd.uab.cat/record/325983
https://dx.doi.org/urn:doi:10.1016/j.ejpsy.2025.100313
Access Level:Acceso aberto
Palavra-chave:Intranasal esketamine
Spain
Consensus
Psychiatric comorbidities
Treatment algorithm
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spelling Treatment-resistant depression and intranasal esketamineSpanish clinical consensus on practical aspectsRamos-Quiroga, Josep Antoni|||0000-0003-1622-0350Mora, Fernando|||0000-0003-4698-1679Arostegui, Silvia|||0000-0002-2026-9387Cardoner, Narcís|||0000-0001-9633-0888Gómez-Revuelta, M.|||0000-0002-3749-3801Montes, José Manuel|||0000-0002-2030-5253Vieta, Eduard|||0000-0002-0548-0053Etxeandia-Pradera, Jon IñakiGómez Juanes, RocíoIntranasal esketamineSpainConsensusPsychiatric comorbiditiesTreatment algorithmBackground: Pharmacological management of major depressive disorder has traditionally relied on antidepressants targeting the monoaminergic pathway. Treatment-resistant depression (TRD) patients have been frequently excluded from registrational trials, resulting in a lack of clear clinical recommendations for an optimised management. In recent years, treatments based on other mechanisms of action have been developed and approved. Intranasal esketamine is a novel non-monoaminergic treatment directed to improve neuroplasticity through the modulation of the glutamatergic system. In this clinical consensus we aimed to provide expert guidance on the use of intranasal esketamine for TRD patients based in our clinical practice in Spain. Methods: A scientific committee of nine psychiatrists, experts in TRD in Spain, reviewed the literature (grey literature and articles/scientific communications published in English or Spanish between January 2014 and January 2024 in PubMed). Statements on practical aspects of TRD management with intranasal esketamine were developed in a first meeting following a discussion group approach, refined in a second meeting with a nominal group technique, and finally drafted after consensus in a third meeting. Results: We recommend a treatment algorithm for the management of TRD with intranasal esketamine. Recommendations were made for specific clinical profiles with other psychiatric comorbidities, which are not contraindications, and for patients who do not have at least a 50 % reduction in symptoms during the first induction phase (partial responders at the end of an induction phase). Treatment should be given in the same health centre where the patient normally receives mental care. The patient's clinical progress will determine early optimisation of intranasal esketamine dose during the induction phase, the need for flexible doses/repeating the induction treatment phase, customisation of management, and treatment duration. We described factors impacting the use of intranasal esketamine and made recommendations on the characteristics of the ideal setting for its administration. Socio-economic aspects of intranasal esketamine were reviewed. Conclusions: This is the first consensus developed in Spain regarding practical aspects of TRD management with intranasal esketamine, with a treatment algorithm for patients who are only partial responders at the end of the induction phase.Universitat Autònoma de Barcelona. Departament de Medicina 22025-01-0120252025-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/325983https://dx.doi.org/urn:doi:10.1016/j.ejpsy.2025.100313reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:dnet:uabarcelona_::31dcdf1604f105d11aefac3e7a533ad92026-06-06T12:50:31Z
dc.title.none.fl_str_mv Treatment-resistant depression and intranasal esketamine
Spanish clinical consensus on practical aspects
title Treatment-resistant depression and intranasal esketamine
spellingShingle Treatment-resistant depression and intranasal esketamine
Ramos-Quiroga, Josep Antoni|||0000-0003-1622-0350
Intranasal esketamine
Spain
Consensus
Psychiatric comorbidities
Treatment algorithm
title_short Treatment-resistant depression and intranasal esketamine
title_full Treatment-resistant depression and intranasal esketamine
title_fullStr Treatment-resistant depression and intranasal esketamine
title_full_unstemmed Treatment-resistant depression and intranasal esketamine
title_sort Treatment-resistant depression and intranasal esketamine
dc.creator.none.fl_str_mv Ramos-Quiroga, Josep Antoni|||0000-0003-1622-0350
Mora, Fernando|||0000-0003-4698-1679
Arostegui, Silvia|||0000-0002-2026-9387
Cardoner, Narcís|||0000-0001-9633-0888
Gómez-Revuelta, M.|||0000-0002-3749-3801
Montes, José Manuel|||0000-0002-2030-5253
Vieta, Eduard|||0000-0002-0548-0053
Etxeandia-Pradera, Jon Iñaki
Gómez Juanes, Rocío
author Ramos-Quiroga, Josep Antoni|||0000-0003-1622-0350
author_facet Ramos-Quiroga, Josep Antoni|||0000-0003-1622-0350
Mora, Fernando|||0000-0003-4698-1679
Arostegui, Silvia|||0000-0002-2026-9387
Cardoner, Narcís|||0000-0001-9633-0888
Gómez-Revuelta, M.|||0000-0002-3749-3801
Montes, José Manuel|||0000-0002-2030-5253
Vieta, Eduard|||0000-0002-0548-0053
Etxeandia-Pradera, Jon Iñaki
Gómez Juanes, Rocío
author_role author
author2 Mora, Fernando|||0000-0003-4698-1679
Arostegui, Silvia|||0000-0002-2026-9387
Cardoner, Narcís|||0000-0001-9633-0888
Gómez-Revuelta, M.|||0000-0002-3749-3801
Montes, José Manuel|||0000-0002-2030-5253
Vieta, Eduard|||0000-0002-0548-0053
Etxeandia-Pradera, Jon Iñaki
Gómez Juanes, Rocío
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universitat Autònoma de Barcelona. Departament de Medicina
dc.subject.none.fl_str_mv Intranasal esketamine
Spain
Consensus
Psychiatric comorbidities
Treatment algorithm
topic Intranasal esketamine
Spain
Consensus
Psychiatric comorbidities
Treatment algorithm
description Background: Pharmacological management of major depressive disorder has traditionally relied on antidepressants targeting the monoaminergic pathway. Treatment-resistant depression (TRD) patients have been frequently excluded from registrational trials, resulting in a lack of clear clinical recommendations for an optimised management. In recent years, treatments based on other mechanisms of action have been developed and approved. Intranasal esketamine is a novel non-monoaminergic treatment directed to improve neuroplasticity through the modulation of the glutamatergic system. In this clinical consensus we aimed to provide expert guidance on the use of intranasal esketamine for TRD patients based in our clinical practice in Spain. Methods: A scientific committee of nine psychiatrists, experts in TRD in Spain, reviewed the literature (grey literature and articles/scientific communications published in English or Spanish between January 2014 and January 2024 in PubMed). Statements on practical aspects of TRD management with intranasal esketamine were developed in a first meeting following a discussion group approach, refined in a second meeting with a nominal group technique, and finally drafted after consensus in a third meeting. Results: We recommend a treatment algorithm for the management of TRD with intranasal esketamine. Recommendations were made for specific clinical profiles with other psychiatric comorbidities, which are not contraindications, and for patients who do not have at least a 50 % reduction in symptoms during the first induction phase (partial responders at the end of an induction phase). Treatment should be given in the same health centre where the patient normally receives mental care. The patient's clinical progress will determine early optimisation of intranasal esketamine dose during the induction phase, the need for flexible doses/repeating the induction treatment phase, customisation of management, and treatment duration. We described factors impacting the use of intranasal esketamine and made recommendations on the characteristics of the ideal setting for its administration. Socio-economic aspects of intranasal esketamine were reviewed. Conclusions: This is the first consensus developed in Spain regarding practical aspects of TRD management with intranasal esketamine, with a treatment algorithm for patients who are only partial responders at the end of the induction phase.
publishDate 2025
dc.date.none.fl_str_mv 2
2025-01-01
2025
2025-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/325983
https://dx.doi.org/urn:doi:10.1016/j.ejpsy.2025.100313
url https://ddd.uab.cat/record/325983
https://dx.doi.org/urn:doi:10.1016/j.ejpsy.2025.100313
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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