Abstract：
Treatment-resistant depression (TRD) is a major public health problem worldwide. There are currently five strategies for its treatment: optimization, change, combination, augmentation, and somatic therapies. However, many of these therapies are not fully effective, are not accessible, or have a significant number of side effects. Esketamine nasal spray has recently been approved, in combination with another oral antidepressant, for TRD, with excellent results in short-term studies. We consider in this review whether this therapy is also safe and effective in the long-term treatment of patients. A narrative review, using a comprehensive Pubmed search, and other search strategies, of long-term studies evaluating the safety and efficacy of esketamine nasal spray for the treatment of TRD has been conducted. Five studies have been included in the review. Esketamine nasal spray has demonstrated long-term efficacy and safety in both placebo-controlled and open-label studies evaluating maintenance of antidepressant response. In addition, one study has reported a high level of patient satisfaction with treatment. As limitations, a systematic search for studies has not been carried out and these are still scarce, given the short time that has elapsed since the discovery of the molecule. Esketamine nasal spray is the greatest pharmacological novelty in the treatment of major depression in the last 50 years. It constitutes a new paradigm in the treatment of TRD, which should make us rethink the care protocols that we currently follow. However, more studies are still needed to consolidate the data found so far. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
摘要：
难治性抑郁症（TRD）是全球范围内的主要公共卫生问题。目前有五种治疗策略：优化，改变,组合,增强，和躯体疗法。然而,其中许多疗法并不完全有效，无法访问，或有大量的副作用。最近批准了Esketamine鼻腔喷雾剂,与另一种口服抗抑郁药联合使用，对于TRD，在短期研究中取得了优异的成绩。我们在这篇综述中考虑这种疗法在患者的长期治疗中是否也是安全有效的。叙事回顾，使用全面的Pubmed搜索，和其他搜索策略，已经进行了评估艾氯胺酮鼻喷雾剂治疗TRD的安全性和有效性的长期研究。5项研究已纳入审查。Esketamine鼻腔喷雾剂在安慰剂对照和开放标签研究中都显示出长期疗效和安全性，评估抗抑郁药反应的维持。此外,一项研究报告患者对治疗的满意度很高.作为限制,尚未进行系统的研究，这些研究仍然很少，考虑到自发现分子以来的短时间。依斯克他明喷鼻剂是近50年来在医治主要抑郁症方面最年夜的药理新颖性。它构成了治疗TRD的新范式，这应该让我们重新考虑我们目前遵循的护理协议。然而,仍然需要更多的研究来巩固到目前为止发现的数据。(PsycInfo数据库记录(c)2023年APA，保留所有权利)。
