Comparing Esketamine and Quetiapine in Treating Treatment-Resistant Depression
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on October 23rd, 2023
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Between 10% and 30% of all cases of major depressive disorder are resistant to common treatments in the form of selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI). Esketamine and Quetiapine are two other alternative treatments. A study was conducted to investigate the effectiveness of using Esketamine with SSRI and SNRI in treating depression.
The trial included 676 patients between the age of 18 and 74 years old who had been diagnosed with treatment resistant depression according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. These patients had previously been treated with SSRI and SNRI; however, there was little significant clinical response. The participants were randomly assigned to be treated with 1) the combination of Esketamine with a SSRI or an SNRI, or 2) the combination of Quetiapine with a SSRI or an SNRI. Esketamine was administered in the form of a nasal spray, and Quetiapine was administered orally. The study failed to state the dosage and frequency used in the trial. However, further analysis of the record registered with the government agency revealed that Esketamine was given in 3 levels (28 mg, 56 mg, and 84 mg), and Quetiapine was also administered in 3 doses (50 mg, 100 mg, and 150 mg). Efficacy of treatment was assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS). After 8 weeks of treatment, the researchers found that the Esketamine plus SSRI/SNRI combination was superior to the combination using Quetiapine in treating depression. This trend was sustainable, as the superiority was also observable at the 36th week. To further quantify the difference in effectiveness, the MADRS score of the Esketamine group was 2.2 points lower than the Quetiapine group at the 36th week, which indicated better clinical outcomes. Esketamine was also well tolerated, as the rate of serious adverse events were similar between the two groups.
The trial included 676 patients between the age of 18 and 74 years old who had been diagnosed with treatment resistant depression according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. These patients had previously been treated with SSRI and SNRI; however, there was little significant clinical response. The participants were randomly assigned to be treated with 1) the combination of Esketamine with a SSRI or an SNRI, or 2) the combination of Quetiapine with a SSRI or an SNRI. Esketamine was administered in the form of a nasal spray, and Quetiapine was administered orally. The study failed to state the dosage and frequency used in the trial. However, further analysis of the record registered with the government agency revealed that Esketamine was given in 3 levels (28 mg, 56 mg, and 84 mg), and Quetiapine was also administered in 3 doses (50 mg, 100 mg, and 150 mg). Efficacy of treatment was assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS). After 8 weeks of treatment, the researchers found that the Esketamine plus SSRI/SNRI combination was superior to the combination using Quetiapine in treating depression. This trend was sustainable, as the superiority was also observable at the 36th week. To further quantify the difference in effectiveness, the MADRS score of the Esketamine group was 2.2 points lower than the Quetiapine group at the 36th week, which indicated better clinical outcomes. Esketamine was also well tolerated, as the rate of serious adverse events were similar between the two groups.