Intramuscular ketamine vs. escitalopram and aripiprazole in acute and maintenance treatment of patients with treatment-resistant depression: A randomized double-blind clinical trial

Autor: Marco Aurélio Cigognini, Alia Garrudo Guirado, Denise van de Meene, Mônica Andréia Schneider, Mônica Sarah Salomon, Vinicius Santana de Alexandria, Juliana Pisseta Adriano, Ana Maria Thaler, Fernando dos Santos Fernandes, Adriana Carneiro, Ricardo Alberto Moreno
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Frontiers in Psychiatry, Vol 13 (2022)
Druh dokumentu: article
ISSN: 1664-0640
DOI: 10.3389/fpsyt.2022.830301
Popis: ObjectiveKetamine, an N-methyl D-aspartate (NMDA) receptor antagonist, can promote rapid action in the management of individuals with treatment-resistant depression (TRD) at sub-anesthetic doses. However, few studies have investigated the long-term use of ketamine administered intravenously (IV) and intranasally (IN). We report the design and rationale of a therapeutic trial for assessing the efficacy, safety, and tolerability of repeated-dose intramuscular (IM) ketamine vs. active treatment (escitalopram and aripiprazole) in TRD patients.MethodsA comparative, parallel-group, randomized double-blind trial assessing the efficacy, safety, and tolerability of acute (4 weeks) and maintenance (24 weeks) use of IM ketamine (0.75 mg/kg) vs. active control (escitalopram 15 mg and aripiprazole 5 mg) in individuals with moderate-severe intensity TRD (no psychotic symptoms) with or without suicide risk will be conducted. Patients with TRD (18–40 years) will be randomized and blinded to receive ketamine IM or active treatment at a 1:1 ratio for 4 weeks (active treatment) and 24 weeks (maintenance treatment). Subjects will be assessed using clinical scales, monitored for vital signs (VS) after application of injectable medication, and undergo neuropsychological tests. The primary outcome will be changed on the Montgomery-Åsberg Depression Rating Scale (MADRS) during the course of the trial. The study is in running.ResultsThis study can potentially yield evidence on the use of IM ketamine in the treatment of depressive disorders as an ultra-rapid low-cost therapy associated with less patient discomfort and reduced use of medical resources, and can elucidate long-term effects on different outcomes, such as neuropsychological aspects.ConclusionsThe trial can help promote the introduction of a novel accessible approach for the treatment of complex disease (TRD) and also allow refinement of its long-term use.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04234776, identifier: NCT04234776.
Databáze: Directory of Open Access Journals