重度抑郁症是一种影响全球数百万人的精神障碍。相当比例的患者对常规治疗缺乏反应。随着最近引入的艾氯胺酮,一种新的治疗方案已被批准用于难治性抑郁症.虽然药物在很大一部分病例中有效,罕见,但可能很严重,可能会产生不利影响。本病例系列显示2例横纹肌溶解症,肌酸激酶水平升高对肌肉组织的破坏,服用艾氯胺酮后。出现的第一个病例是一名33岁的男性患者,他患有严重的抑郁症。他接受了鼻氯胺酮作为紧急治疗。虽然抑郁症状得到了初步改善,患者在服用第四剂后出现肌肉疼痛和疲劳,肌酸激酶(CK)水平高于22,000U/L,提示横纹肌溶解症.在停用艾氯胺酮和实施支持性护理后,CK水平恢复正常,抑郁症状减轻.第二例是关于一名22岁的男性患者,他也患有严重的抑郁发作,并接受了氯胺酮作为紧急治疗。第十次给药之后,患者表现为肌肉无力和CK水平升高(8,032U/L),即使在剂量减少后仍然存在。停止服用依斯克他明,以下监测显示CK和肝酶缓慢恢复至正常水平。在这两种情况下,无已知病史,且两名患者在服用艾氯胺酮后均出现横纹肌溶解.时间上的联系表明了一种可能的因果关系。我们没有发现关于鼻服用esketamine后esketamine诱导的横纹肌溶解的文献。然而,这两个案例强调需要监测实验室变化,如接受艾氯胺酮的患者CK水平升高,特别是考虑到它在难治性抑郁症中的应用越来越多。
Major depressive disorder is a mental disorder affecting millions of people worldwide. A considerable proportion of patients demonstrate a lack of response to conventional treatment. With the recent introduction of esketamine, a new treatment option has been approved for treatment-resistant depression. Although the medication is efficacious in a substantial portion of cases, rare, but possibly serious, adverse effects may occur. This
case series shows two cases of rhabdomyolysis, a destruction of muscle tissue with elevated creatine kinase levels, after administration of esketamine. The first
case presented is about a 33 year old male patient who suffered from a severe episode of a depressive disorder. He got nasal esketamine as an emergency treatment. While there was an initial improvement regarding the depressive symptoms, the patient developed muscle pain and fatigue after the administration of the fourth dose, with creatine kinase (CK) levels above 22,000 U/L, indicating rhabdomyolysis. Following the discontinuation of esketamine and the implementation of supportive care, the CK levels returned to normal and the depressive symptoms abated. The second
case is about a 22-year-old male patient who also suffered from a severe depressive episode and got eketamine as an emergency treatment. Following the tenth dose, the patient exhibited muscle weakness and elevated CK levels (8,032 U/L), which persisted even after dose reduction. Esketamine administration was stopped, and the following monitoring demonstrated a slow return to normal levels of CK and liver enzymes. In both cases, there was no known medical history and both patients developed rhabdomyolysis after administration of esketamine. The temporal connection suggests a possible causal relationship. We found no literature on esketamine-induced rhabdomyolysis following the administration of nasal esketamine. However, these two cases emphasize the need of monitoring for laboratory changes like elevated CK-levels in patients receiving esketamine, especially considering its growing use in treatment-resistant depression.