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鼻内使用艾司氯胺酮和静脉使用氯胺酮：两种治疗难治性抑郁症新疗法的有效性和耐受性
贵州医科大学 麻醉与心脏电生理课题组
翻译：王贵龙 编辑：王婷婷 审校：曹莹
背景：静脉注射（IV）氯胺酮和鼻内使用（IN）艾司氯胺酮是治疗重度抑郁症（MDD-TRD）中难治性抑郁症的新疗法。
方法：本试验为一项多中心观察性研究，旨在评估两种方法在MDD-TRD中的有效性和耐受性。53名患者纳入研究，其中26名接受静脉注射氯胺酮（69.23%为女性，52.81±14.33岁）、27名接受鼻内使用艾司氯胺酮（51.85%为女性，43.93±13.57岁）。使用Montgomery and Åsberg Depression Rating Scale (MADRS) 量表评估抑郁症严重程度的治疗效果，使用MADRS中第10项评估自杀意念（SI）的治疗效果。通过使用CADSS-6量表系统地跟踪副作用和耐受性。使用描述性统计、风险比和效应大小对数据进行综合分析。
结果：静脉注射氯胺酮和鼻内使用艾司氯胺酮均显著减轻了抑郁症状和自杀意念。鼻内使用艾司氯胺酮的患者和静脉注射氯胺酮治疗的患者发生副作用的风险相似。所有报告的副作用都是轻微和短暂的。
结论：静脉注射氯胺酮和鼻内艾司氯胺酮都能有效治疗抑郁症状，并且耐受性良好，本研究的结果可以为临床实践提供参考。
原始文献：Gilmar, Gutierrez; Jennifer, Swainson; Nisha, Ravindran; Raymond W, Lam; Peter, Giacobbe; Ganapathy, Karthikeyan; Annette, Kowara; André, Do; Anusha, Baskaran; Sean Michael, Nestor; Melody J Y, Kang; Aleksandar, Biorac; Gustavo, Vazquez；IN Esketamine and IV Ketamine: Results of a multi-site observational study assessing the effectiveness and tolerability of two novel therapies for treatment-resistant depression；Psychiatry Res 2024 Oct;340(0):116125；
DOI：10.1016/j.psychres.2024.116125
IN Esketamine and IV Ketamine: Results of a multi-site observational study assessing the effectiveness and tolerability of two novel therapies for treatment-resistant depression.
ABSTRACT:Intravenous (IV) ketamine and intranasal (IN) esketamine are novel therapies to manage treatment resistant depression within major depressive disorder (MDD-TRD). This is a multi-site observational study aiming to assess the real-world effectiveness and tolerability of these novel therapies in the management of MDD-TRD. 53 patients were referred to receive IV ketamine (n = 26, 69.23 % female, 52.81 ± 14.33 years old) or IN esketamine (n = 27, 51.85 % female, 43.93 ± 13.57 years old). Treatment effectiveness was assessed using the Montgomery and Åsberg Depression Rating Scale (MADRS) for depression severity and item 10 of the MADRS for suicidal ideation (SI). Tolerability was assessed by systematically tracking side effects and depersonalization using the 6-item Clinician administered dissociative symptom scale (CADSS-6). The data was analyzed using descriptive statistics, risk ratio and effect size. Both IV ketamine and IN esketamine significantly reduced depressive symptoms and suicidal ideation by treatment endpoint. Patients receiving IN esketamine, and patients receiving IV ketamine had a similar risk of developing side effects. All side effects reported were mild and transient. These results suggested that both IV ketamine and IN esketamine are effective in the management of depressive symptoms and were well tolerated. Therefore, the results of this study could serve to inform clinical practice.
