Investigating the Effectiveness and Tolerability of Intranasal Esketamine Among Older Adults With Treatment-Resistant Depression (TRD): A Post-hoc Analysis from the REAL-ESK Study Group

• Published in: The American journal of geriatric psychiatry 2023-12, Vol.31 (12), p.1032-1041
• Main Authors: d'Andrea, Giacomo, Chiappini, Stefania, McIntyre, Roger S., Stefanelli, Giulia, Carullo, Rosalba, Andriola, Ileana, Zanardi, Raffaella, Martiadis, Vassilis, Sensi, Stefano L., Sani, Gabriele, Clerici, Massimo, Di Lorenzo, Giorgio, Vita, Antonio, Pettorruso, Mauro, Martinotti, Giovanni
• Format: Article
• Language: English
• Subjects: Esketamine; geriatric psychiatry; real-world study; TRD
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2023.06.016

•What is the primary question addressed by this study?Treatment-resistant Depression (TRD) in older patients represents a severe condition characterized by more frequent treatment-related side effects and, globally, low response rates. Intranasal Esketamine (ESK-NS) has not been fully investigated in older subjects.•What is the main finding of this study?In this post-hoc analysis of the REAL-ESK study, ESK-NS proved to be effective for older patients with TRD, although with greater side effects than for nonolder adults.•What is the meaning of the finding?ESK-NS is effective for older patients, but clinicians should be aware of possible higher side effect rates; thus, precise treatment selection is crucial in this population to avoid their occurrence. Treatment-resistant depression (TRD) is a serious and debilitating psychiatric disorder that frequently affects older patients. Esketamine nasal spray (ESK-NS) has recently been approved as a treatment for TRD, with multiple studies establishing its efficacy and tolerability. However, the real-world effectiveness, tolerability, and safety of this treatment in older adults is still unclear. To evaluate the efficacy and tolerability of ESK-NS in older subjects with TRD. This is a post-hoc analysis of the REAL-ESK study, a multicenter, retrospective, observational study. Participants here selected were 65 years or older at baseline. The Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating Scale (HAM-A) were used to assess depressive and anxiety symptoms, respectively. Data were collected at three-time points: baseline, 1 month after the start of treatment (T1), and 3 months after treatment (T2). The sample included older adults with TRD (n = 30). MADRS and HAM-A values decreased significantly at T1 (T0 versus T1: pholm