{"id":1485,"date":"2023-04-06T17:51:31","date_gmt":"2023-04-06T17:51:31","guid":{"rendered":"https:\/\/news.psva.org\/?p=1485"},"modified":"2023-04-14T15:06:04","modified_gmt":"2023-04-14T15:06:04","slug":"spring-meeting-recap-es-ketamine-for-treatment-resistant-depression","status":"publish","type":"post","link":"https:\/\/news.psva.org\/?p=1485","title":{"rendered":"Es\/ketamine for Treatment-Resistant Depression"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>By Mark J. Niciu, MD, PhD<\/strong><br><em>Assistant Professor of Psychiatry\/Iowa Neuroscience Institute<br>University of Iowa Health Care<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Dr. Niciu\u2019s lecture was entitled \u201cEs\/ketamine for Treatment-Resistant Depression.\u201d After briefly reviewing his potential conflicts of interest and CME objectives, he provided an outline of the talk. The first segment was a brief discussion of the putative mechanisms of action and functional brain response to the N-methyl-D-aspartate receptor antagonist and glutamate modulator ketamine in preclinical and human neuroimaging studies. Dr. Niciu then provided a clinical review of the intravenous subanesthetic dose ketamine literature for major depression, with a historical perspective dating back to the first randomized controlled trial in 2000. Subanesthetic dose ketamine has rapid-acting antidepressant efficacy, on the order of hours-to-days, with a larger effect size than seen with traditional\/monoaminergic antidepressants and other medication augmentation strategies. Yet, a major critique has been functional unblinding. In response, several studies were presented using the short-acting intravenous benzodiazepine midazolam as a psychoactive comparator. Intravenous ketamine has also been demonstrated to have anti-suicidal efficacy in treatment-resistant major depressive disorder and bipolar disorder. Finally, alternative dose and frequency studies were presented, which demonstrated that 0.5-1.0 mg\/kg appears to be the optimal antidepressant dosing, and 2-3x\/week the optimal frequency for an acute\/index series.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To date, subanesthetic dose ketamine infusion remains off-label for all psychiatric indications including treatment-resistant major depressive disorder (MDD) and bipolar depression. As a result, very few insurance companies will reimburse treatment costs, so the model remains mostly fee-for-service\/out-of-pocket. In 2019, a proprietary intranasal formulation of the S-enantiomer of ketamine, Spravato\u00ae (intranasal esketamine), was approved by the U.S. Food and Drug Administration for the treatment of treatment-resistant MDD. A second indication for MDD with acute suicidal ideation or behavior followed on the heels of the initial approval in 2020. Dr. Niciu stressed that both approvals are first-in-class, i.e. intranasal esketamine is the first glutamate-based antidepressant and anti-suicidal medication approved for MDD. Dr. Niciu then reviewed the clinical studies leading to intranasal esketamine\u2019s approval for both indications. He also presented a meta-analysis comparing the efficacy and adverse effects of intravenous ketamine and intranasal esketamine, indicating intravenous ketamine as more effective with fewer adverse effects than intranasal esketamine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In the third portion and final portion of his lecture, Dr. Niciu presented recommendations for both intravenous ketamine and intranasal esketamine in the treatment algorithm for treatment-refractory MDD and bipolar depression. To wit, he presented some of his absolute, e.g. psychotic spectrum disorder diagnosis and pregnancy\/lactation, and relative contraindications, e.g. substance use disorder and illicit substance na\u00efve, to ketamine. He then discussed his hands-on experience with intravenous ketamine and intranasal esketamine including dosing, ancillary support, and setting. For intranasal esketamine, Dr. Niciu introduced the audience to the FDA-mandated Risk Evaluation and Mitigation Strategy (REMS), including the compliance challenges, e.g. mandatory registration, post-administration monitoring and paperwork burden. Dr. Niciu then concluded his talk with several \u201ctake home\u201d points and fielded questions from the attendees to conclude our afternoon panel.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Mark J. Niciu, MD, PhDAssistant Professor of Psychiatry\/Iowa Neuroscience InstituteUniversity of Iowa Health Care Dr. Niciu\u2019s lecture was entitled \u201cEs\/ketamine for Treatment-Resistant Depression.\u201d After briefly reviewing his potential conflicts of interest and CME objectives, he provided an outline of the talk. The first segment was a brief discussion of the putative mechanisms of action [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[43],"class_list":["post-1485","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-spring-2023"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v16.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Es\/ketamine for Treatment-Resistant Depression - PSV News<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/news.psva.org\/?p=1485\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Es\/ketamine for Treatment-Resistant Depression - PSV News\" \/>\n<meta property=\"og:description\" content=\"By Mark J. Niciu, MD, PhDAssistant Professor of Psychiatry\/Iowa Neuroscience InstituteUniversity of Iowa Health Care Dr. Niciu\u2019s lecture was entitled \u201cEs\/ketamine for Treatment-Resistant Depression.\u201d After briefly reviewing his potential conflicts of interest and CME objectives, he provided an outline of the talk. The first segment was a brief discussion of the putative mechanisms of action [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/news.psva.org\/?p=1485\" \/>\n<meta property=\"og:site_name\" content=\"PSV News\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-06T17:51:31+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-14T15:06:04+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Ray Hall\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebSite\",\"@id\":\"https:\/\/news.psva.org\/#website\",\"url\":\"https:\/\/news.psva.org\/\",\"name\":\"PSV News\",\"description\":\"Psychiatric Society of Virginia Newsletters\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/news.psva.org\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/news.psva.org\/?p=1485#webpage\",\"url\":\"https:\/\/news.psva.org\/?p=1485\",\"name\":\"Es\/ketamine for Treatment-Resistant Depression - PSV News\",\"isPartOf\":{\"@id\":\"https:\/\/news.psva.org\/#website\"},\"datePublished\":\"2023-04-06T17:51:31+00:00\",\"dateModified\":\"2023-04-14T15:06:04+00:00\",\"author\":{\"@id\":\"https:\/\/news.psva.org\/#\/schema\/person\/b3ff623305ba59e337e22c31c9fc42e7\"},\"breadcrumb\":{\"@id\":\"https:\/\/news.psva.org\/?p=1485#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/news.psva.org\/?p=1485\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/news.psva.org\/?p=1485#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/news.psva.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Es\/ketamine for Treatment-Resistant Depression\"}]},{\"@type\":\"Person\",\"@id\":\"https:\/\/news.psva.org\/#\/schema\/person\/b3ff623305ba59e337e22c31c9fc42e7\",\"name\":\"Ray Hall\",\"image\":{\"@type\":\"ImageObject\",\"@id\":\"https:\/\/news.psva.org\/#personlogo\",\"inLanguage\":\"en-US\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/77c2e3f00618d6950c250a915344c15d9f601fb38bd861cae3882e3489cd7d18?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/77c2e3f00618d6950c250a915344c15d9f601fb38bd861cae3882e3489cd7d18?s=96&d=mm&r=g\",\"caption\":\"Ray Hall\"},\"url\":\"https:\/\/news.psva.org\/?author=3\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Es\/ketamine for Treatment-Resistant Depression - PSV News","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/news.psva.org\/?p=1485","og_locale":"en_US","og_type":"article","og_title":"Es\/ketamine for Treatment-Resistant Depression - PSV News","og_description":"By Mark J. Niciu, MD, PhDAssistant Professor of Psychiatry\/Iowa Neuroscience InstituteUniversity of Iowa Health Care Dr. Niciu\u2019s lecture was entitled \u201cEs\/ketamine for Treatment-Resistant Depression.\u201d After briefly reviewing his potential conflicts of interest and CME objectives, he provided an outline of the talk. The first segment was a brief discussion of the putative mechanisms of action [&hellip;]","og_url":"https:\/\/news.psva.org\/?p=1485","og_site_name":"PSV News","article_published_time":"2023-04-06T17:51:31+00:00","article_modified_time":"2023-04-14T15:06:04+00:00","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Ray Hall","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebSite","@id":"https:\/\/news.psva.org\/#website","url":"https:\/\/news.psva.org\/","name":"PSV News","description":"Psychiatric Society of Virginia Newsletters","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/news.psva.org\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/news.psva.org\/?p=1485#webpage","url":"https:\/\/news.psva.org\/?p=1485","name":"Es\/ketamine for Treatment-Resistant Depression - PSV News","isPartOf":{"@id":"https:\/\/news.psva.org\/#website"},"datePublished":"2023-04-06T17:51:31+00:00","dateModified":"2023-04-14T15:06:04+00:00","author":{"@id":"https:\/\/news.psva.org\/#\/schema\/person\/b3ff623305ba59e337e22c31c9fc42e7"},"breadcrumb":{"@id":"https:\/\/news.psva.org\/?p=1485#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/news.psva.org\/?p=1485"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/news.psva.org\/?p=1485#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/news.psva.org\/"},{"@type":"ListItem","position":2,"name":"Es\/ketamine for Treatment-Resistant Depression"}]},{"@type":"Person","@id":"https:\/\/news.psva.org\/#\/schema\/person\/b3ff623305ba59e337e22c31c9fc42e7","name":"Ray Hall","image":{"@type":"ImageObject","@id":"https:\/\/news.psva.org\/#personlogo","inLanguage":"en-US","url":"https:\/\/secure.gravatar.com\/avatar\/77c2e3f00618d6950c250a915344c15d9f601fb38bd861cae3882e3489cd7d18?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/77c2e3f00618d6950c250a915344c15d9f601fb38bd861cae3882e3489cd7d18?s=96&d=mm&r=g","caption":"Ray Hall"},"url":"https:\/\/news.psva.org\/?author=3"}]}},"featured_image_src":null,"featured_image_src_square":null,"author_info":{"display_name":"Ray Hall","author_link":"https:\/\/news.psva.org\/?author=3"},"_links":{"self":[{"href":"https:\/\/news.psva.org\/index.php?rest_route=\/wp\/v2\/posts\/1485","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/news.psva.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/news.psva.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/news.psva.org\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/news.psva.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1485"}],"version-history":[{"count":0,"href":"https:\/\/news.psva.org\/index.php?rest_route=\/wp\/v2\/posts\/1485\/revisions"}],"wp:attachment":[{"href":"https:\/\/news.psva.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1485"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/news.psva.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1485"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/news.psva.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1485"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}