In short Article

Esketamine for severe depression

A recently published Cochrane systematic review and meta-analysis examined the efficacy and adverse effects of esketamine (and other drugs) to treat severe (or very severe) depression. Treatment of these patients with esketamine reduces the symptoms of depression within 24 hours. Most of the adverse effects resolve within a day. Long-term adverse effects could not be assessed in the meta-analysis, but these have been described previously. Since only a small number of studies were included, which moreover included small numbers of patients, the level of evidence from the meta-analysis of esketamine is low to moderate. 

  • Symptoms of depression in patients with severe (or very severe) depression decrease within 24 hours after treatment with esketamine.
  • The average level of evidence of this result is low to moderate, in view of the small number of studies and low numbers of patients included.
  • Esketamine can be considered as a fourth step in the treatment of therapy-resistant depression. 
  • The mechanism of action of esketamine, which underlies its rapid effect on depression, can be used as a starting point for the development of rapid-action antidepressants without long-term adverse effects. 

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  • Erik P. Schwarz