Real-world esketamine treatment for treatment-resistant depression: an analysis of comorbid post-traumatic stress disorder, comorbid anxiety disorder and line of therapy subgroups

This paper describes subgroup analyses of a recent real-world study examining the impact of esketamine nasal spray combined with a newly initiated oral antidepressant (OAD) on quality-of-life and depression severity in participants with treatment-resistant depression (TRD). Patients with TRD, defined as major depressive disorder in adults who have not responded adequately to ≥2 different OADs of adequate dose and duration to treat the current depressive episode, were recruited from the esketamine early access program in Australia and New Zealand. Subgroups were defined by prior antidepressant medications received in the current depressive episode (2, 3–5, or ≥6) and post-traumatic stress disorder (PTSD) or anxiety disorder comorbidity (with or without). Comorbid PTSD or anxiety disorder was identified by treating psychiatrists. Outcome measurements included Assessment of Quality-of-Life (AQoL-8D) and Hamilton Depression Rating (HAM-D) scales. From baseline to Week 16, all subgroups saw significant improvements in AQoL-8D and HAM-D. There was no statistical difference between outcome improvements for participants with or without comorbid anxiety or PTSD. When separated by prior therapy, participants with 2 prior therapies demonstrated the greatest outcome improvements. Real-world esketamine treatment in conjunction with a newly initiated OAD benefits real-world participants with TRD and comorbid anxiety or PTSD, regardless of previously failed treatments.