The cognitive effects of esketamine: what do we know so far?. (1st June 2022)

• Record Type: Journal Article
• Authors: Barbosa, M.; Guedes, R.
• Is Part Of: European psychiatry. Volume 65:Supplement 1(2022)
• Page Start: S728
• Page End: S728
• Publication Date: 2022-06-01
• Subjects: esketamine -- cognition; Psychiatry -- Periodicals; Mental illness -- Periodicals; Electronic journals; 616.89
• DOI: 10.1192/j.eurpsy.2022.1879
• Languages: English
• ISSNs: 0924-9338

Abstract

Abstract : Introduction: Esketamine is an S-enantiomer of ketamine approved by the EMA for treatment-resistant depression (TRD). As an NMDA receptor antagonist, its administration results in increase of glutamate release and AMPA receptor activation, supporting both rapid-onset and long-term antidepressant effects. Short-term tolerability seems acceptable but major concerns remain regarding long-term safety, specifically regarding potential neurocognitive toxicity. Objectives: To clarify the potential short and long-term cognitive beneficial-effects and side-effects of esketamine. Methods: Research was made using the Medline database, through the Pubmed search engine, using the keywords: "esketamine", "cognition". Only randomized-controlled trials were considered. Results: One study focused on the effects of intranasal esketamine (INE) on cognitive functioning in 24 healthy individuals, who were evaluated pre- and postdose (40 min, 2h, 4h and 6h). The results showed a decline in cognitive performance at 40 min postdose, returning to comparable levels as placebo by 2h postdose. Another study, with a follow-up of 1 year, involving 802 TRD patients, accessed the long-term safety of INE. In patients aged <65 years-old, performance on all cognitive tests remained stable or slightly improved from baseline during long-term treatment. In patients ≥ 65 years-old, the mean performance on all tests improved or remained stable, while the simple and choice reaction time began slowing at week 20. Conclusions: Esketamine has proven to be a promising new option for the treatment of TRD and available studies have shown promising results regarding patients' cognitive function. Larger clinical trials are needed to further evaluate its short-term and long-term cognitive effects. Disclosure: No significant relationships.