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17.04.2024 | perspective

Perspectives in treatment-resistant depression: esketamine and electroconvulsive therapy

verfasst von: Pia Baldinger-Melich, Marie Spies, Ina Bozic, Siegfried Kasper, Dan Rujescu, Richard Frey

Erschienen in: Wiener klinische Wochenschrift

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Abstract

Modern electroconvulsive therapy (ECT) and the approval of nasal esketamine for clinical use have significantly improved the approach to treatment-resistant depression (TRD), which is defined as non-response to at least two different courses of antidepressants with verified adherence to treatment, adequate dosage, and duration of treatment. The goal of this literature review is to present the newest evidence regarding efficacy and safety. Furthermore, we aim to provide an overview of future perspectives in this field of research, for example, regarding structural and molecular effects. Both treatment methods will be critically evaluated for their individual advantages, disadvantages, and response rates. Firstly, we will discuss the well-established method of ECT and its different treatment modalities. Secondly, we will discuss the properties of ketamine, the discovery of its antidepressive effects and the route to clinical approval of the esketamine nasal spray. We will comment on research settings which have evaluated intravenous ketamine against ECT. The decision-making process between esketamine nasal spray or ECT should include the assessment of contraindications, age, severity of disease, presence of psychotic symptoms, patient preference and treatment accessibility. We conclude that both treatment options are highly effective in TRD. If both are indicated, pragmatically esketamine will be chosen before ECT; however, ECT studies in ketamine non-responders are missing.

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Titel: Perspectives in treatment-resistant depression: esketamine and electroconvulsive therapy
verfasst von: Pia Baldinger-Melich
Marie Spies
Ina Bozic
Siegfried Kasper
Dan Rujescu
Richard Frey
Publikationsdatum: 17.04.2024
Verlag: Springer Vienna
Erschienen in: Wiener klinische Wochenschrift
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI: https://doi.org/10.1007/s00508-024-02358-w

Springer Medizin Österreich

Abstract

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