Esketamine-induced post-traumatic stress disorder flashbacks during treatment-resistant depression indication: is it just a side effect?
Esketamine-induced post-traumatic stress disorder flashbacks during treatment-resistant depression indication: is it just a side effect?
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艾氯胺酮诱发的创伤后应激障碍在难治性抑郁症适应症期间出现闪回：这只是副作用吗？
DOI：
10.1101/2024.01.09.24300998
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发表时间：
2024
期刊：
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作者：
Rothärmel,Maud;Mekaoui,Lila;Kazour,François;Herrero,Morgane;Beetz-Lobono,Eva-Maria;Lengvenyte,Aiste;Holtzmann,Jérôme;Raynaud,Philippe;Cuenca,Macarena;Bulteau,Samuel;deMaricourt,Pierre;Husson,Thomas;Olié,Emilie;Gohier,Bénédicte;
研究背景创伤后应激障碍（Posttraumatic stress disorder，PTSD）是一种严重的多发性情感障碍，与抑郁症高度共病。PTSD和抑郁症的共病通常是治疗抵抗性的，功能障碍和自杀的风险很高。艾司氯胺酮鼻用喷雾剂是一种最近经过验证的治疗难治性抑郁症（TRD）的药物，但其对TRD-PTSD共病的疗效尚未得到充分记录。特别是，在艾司氯胺酮给药期间可能发生闪回，其对临床结局的影响尚不清楚。ObjectivesOur main objectives is to describe esketamine诱导的创伤性闪回及其对合并TRD患者样本中临床轨迹的影响。我们回顾性收集了接受艾司氯胺酮鼻用喷雾剂治疗TRD伴PTSD患者的临床数据，这些患者在治疗过程中至少经历了一次创伤闪回。结果在2020年2月至2023年3月期间，22例TRD成人患者符合入选标准。在16例患者（72.7%）中，随着疗程的进展，闪回消失。6例患者（27.3%）因持续性闪回而停止艾司氯胺酮治疗。当艾司氯胺酮继续给药时，观察到抑郁和PTSD的临床应答（抑郁反应率：45.5%，缓解率：22.7%; PTSD反应率：45.5%，缓解率：18.2%）。局限性研究的回顾性设计和缺乏对照组是我们研究的主要局限性。结论我们的结果表明，艾司氯胺酮的发生率-诱发的创伤性闪回不妨碍临床反应。相反，如果管理得当，并与有针对性的心理治疗相结合，它甚至可能有助于积极的结果。
BackgroundPosttraumatic stress disorder (PTSD) is a severe and frequent affection that is highly comorbid to major depressive disorder. Comorbid PTSD and depression are usually treatment-resistant, with a high risk of functional impairment and suicide. Esketamine nasal spray is a recent validated treatment for treatment-resistant depression (TRD), but its efficacy on comorbid TRD-PTSD remains insufficiently documented. In particular, flashbacks can occur during esketamine administration and their influence on clinical outcomes is unknown.ObjectivesOur main objective was to describe esketamine-induced traumatic flashbacks and their impact on clinical trajectories within a sample of patients with comorbid TRD-PTSD.MethodsWe retrospectively collected clinical data of patients receiving esketamine nasal spray for TRD with comorbid PTSD who experienced at least one flashback of their trauma during esketamine sessions across 11 psychiatric departments.ResultsBetween February 2020 and March 2023, 22 adult patients with TRD met inclusion criteria. In sixteen patients (72.7%) flashbacks disappeared as the sessions progressed. In six patients (27.3%), esketamine treatment was stopped because of persistent flashbacks. When esketamine was continued, clinical response was observed both for depression and PTSD (depression response rate: 45.5% and remission rate: 22.7%; PTSD response rate: 45.5% and remission: 18.2%).LimitationsThe retrospective design of the study and the absence of a comparator group are the main limitations of our study.ConclusionsOur results suggest that the occurrence of esketamine-induced traumatic flashbacks does not hinder clinical response. On the contrary, when managed appropriately and combined with targeted psychotherapy, it could even contribute to positive outcomes.