PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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%).
UNASSIGNED: The retrospective design of the study and the absence of a comparator group are the main limitations of our study.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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%).
UNASSIGNED: The retrospective design of the study and the absence of a comparator group are the main limitations of our study.
UNASSIGNED: 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.
摘要：
■创伤后应激障碍（PTSD）是一种严重且频繁的情感，与重度抑郁症高度共病。PTSD和抑郁症合并症通常对治疗有抵抗力，有很高的功能障碍和自杀风险。Esketamine鼻腔喷雾剂是最近验证的治疗难治性抑郁症（TRD），但其对合并症TRD-PTSD的疗效仍未得到充分证实。特别是,在给予艾氯胺酮期间可发生闪回现象,其对临床结局的影响尚不清楚.
■我们的主要目的是在患有TRD-PTSD合并症的患者样本中描述埃塞氯胺酮引起的创伤性闪回及其对临床轨迹的影响。
■我们回顾性地收集了接受esketamine鼻腔喷雾剂治疗TRD合并PTSD患者的临床数据，这些患者在11个精神科的esketamine期间经历了至少一次创伤闪回。
■在2020年2月至2023年3月期间，22名TRD成年患者符合纳入标准。在16名患者（72.7％）中，闪回随着会话的进行而消失。在6名患者（27.3%）中，由于持续的闪回，停止了艾氯胺酮治疗。当继续使用艾氯胺酮时，观察到抑郁症和PTSD的临床反应(抑郁症缓解率:45.5%,缓解率:22.7%;PTSD缓解率:45.5%,缓解率:18.2%).
■研究的回顾性设计和没有比较组是我们研究的主要局限性。
■我们的结果表明，esketamine引起的创伤性闪回的发生并不妨碍临床反应。相反,当管理得当并与针对性的心理治疗相结合时，它甚至可以带来积极的结果。
■Esketamine鼻喷雾剂最近被验证用于治疗难治性抑郁症，其对创伤后应激障碍合并症的疗效记录很少。在给予艾氯胺酮期间可发生创伤性闪回。Esketamine诱导的创伤性闪回并不妨碍其临床反应。
■Esketamine鼻喷雾剂最近被验证用于治疗难治性抑郁症（TRD）。它对合并症创伤后应激障碍（PTSD）的疗效记录很少。在这项研究中,我们报告了22例成人患者的数据,这些患者接受了esketamine鼻喷雾剂治疗TRD合并PTSD合并症,并在esketamine治疗期间出现闪回.这些闪回似乎不是给予艾氯胺酮的适应症，并且观察到抑郁症和PTSD的临床反应。我们的结果表明，埃塞氯胺酮可以安全地用于患有PTSD和TRD的合并症患者，埃塞氯胺酮可以导致该人群的实质性改善。
■我们的主要目的是在患有TRD-PTSD合并症的患者样本中描述埃塞氯胺酮引起的创伤性闪回及其对临床轨迹的影响。
■我们回顾性地收集了接受esketamine鼻腔喷雾剂治疗TRD合并PTSD患者的临床数据，这些患者在11个精神科的esketamine期间经历了至少一次创伤闪回。
■在2020年2月至2023年3月期间，22名TRD成年患者符合纳入标准。在16名患者（72.7％）中，闪回随着会话的进行而消失。在6名患者（27.3%）中，由于持续的闪回，停止了艾氯胺酮治疗。当继续使用艾氯胺酮时，观察到抑郁症和PTSD的临床反应(抑郁症缓解率:45.5%,缓解率:22.7%;PTSD缓解率:45.5%,缓解率:18.2%).
■研究的回顾性设计和没有比较组是我们研究的主要局限性。
■我们的结果表明，esketamine引起的创伤性闪回的发生并不妨碍临床反应。相反,当管理得当并与针对性的心理治疗相结合时，它甚至可以带来积极的结果。
■Esketamine鼻喷雾剂最近被验证用于治疗难治性抑郁症，其对创伤后应激障碍合并症的疗效记录很少。在给予艾氯胺酮期间可发生创伤性闪回。Esketamine诱导的创伤性闪回并不妨碍其临床反应。
■Esketamine鼻喷雾剂最近被验证用于治疗难治性抑郁症（TRD）。它对合并症创伤后应激障碍（PTSD）的疗效记录很少。在这项研究中,我们报告了22例成人患者的数据,这些患者接受了esketamine鼻喷雾剂治疗TRD合并PTSD合并症,并在esketamine治疗期间出现闪回.这些闪回似乎不是给予艾氯胺酮的适应症，并且观察到抑郁症和PTSD的临床反应。我们的结果表明，埃塞氯胺酮可以安全地用于患有PTSD和TRD的合并症患者，埃塞氯胺酮可以导致该人群的实质性改善。
