System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Preprint Epublish 4 citations

PubMed: 38293161 DOI: 10.1101/2024.01.09.24300998

Esketamine-induced post-traumatic stress disorder flashbacks during treatment-resistant depression indication: is it just a side effect?

medRxiv

Authors: Maud Rothärmel, Lila Mekaoui, François Kazour, Morgane Herrero, Eva-Maria Beetz-Lobono, Aiste Lengvenyte, Jérôme Holtzmann, Philippe Raynaud, Macarena Cuenca, Samuel Bulteau, Pierre de Maricourt, Thomas Husson, Emilie Olié, Bénédicte Gohier, Anne Sauvaget, Raphaël Gaillard, Raphaëlle Richieri, David Szekely, Ludovic Samalin, Olivier Guillin, Virginie Moulier, Wissam El-Hage, Andrew Laurin, Lucie Berkovitch

Affiliations

  • University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry - Rouvray Hospital Centre, Sotteville-lès-Rouen, France.
  • Mental and Brain Illness Clinic, Sainte-Anne Hospital, GHU Paris - Psychiatry and Neurosciences, Paris, France.
  • Department of Psychiatry and Addictology, CHU Angers, Angers, France.
  • Department of Psychiatry, CHU Saint Etienne, Saint Etienne, France.
  • Centre Hospitalier Princesse Grace, Service de psychiatrie, Principauté de Monaco.
  • Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.
  • Service de Psychiatrie de l'Adulte, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, hôpital Nord, Grenoble, France.
  • Department of Psychiatry, Thuir Hospital Centre, Thuir, France.
  • University Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15, Groupe Hospitalier Universitaire Paris, Paris, France.
  • Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France.
  • Service Universitaire de santé mentale et physique, Centre Expert Dépression Résistante, CHU Sainte-Marguerite, APHM, Université Aix-Marseille, Marseille, France; Aix Marseille Univ, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France.
  • Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France.
  • CHU Rouen, Normandy University, Rouen, France.
  • Unité de Recherche Clinique (URC), EPS Ville Evrard, Neuilly-sur-Marne, France.
  • Centre Régional de Psychotraumatologie, Centre Hospitalier Régional.
  • Universitaire (CHRU) de Tours, Tours, France, 3 INSERM U1253 Imagerie et Cerveau (iBrain), Tours, France.
  • Paris Cité University, Paris, France.
  • Department of Psychiatry, Yale University School of Medicine, 40 Temple Street, New Haven, CT, 06511, United States.
  • Saclay CEA Centre, Neurospin, Gif-Sur-Yvette Cedex, France.

Abstract

Background

Posttraumatic 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.

Objectives

Our main objective was to describe esketamine-induced traumatic flashbacks and their impact on clinical trajectories within a sample of patients with comorbid TRD-PTSD.

Methods

We 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.

Results

Between 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%).

Limitations

The retrospective design of the study and the absence of a comparator group are the main limitations of our study.

Conclusions

Our 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.

MeSH

Depression, Wounds And Injuries, Stress, Physiological, Therapeutics, Stress Disorders, Traumatic, Stress Disorders, Post-Traumatic, Depressive Disorder, Treatment-Resistant