Esketamine for treatment resistant depression is not recommended by NICE
Abstract
An esketamine nasal spray may not be made available on the NHS for patients with treatment resistant depression because of uncertainties over its clinical and cost effectiveness, says draft guidance from the National Institute for Health and Care Excellence.1 NICE reviewed the effectiveness of esketamine in combination with a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor for adults with treatment resistant depression that have not responded to at least two different antidepressants in the current moderate to severe depressive episode. It said that …
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These causes of death have been observed previously in ketamine use: blood pressure spikes cause heart failure and myocardial infarction in at-risk patients, and impaired coordination and dissociation increase motor vehicle accident risk.
“These causes of death have been observed previously in ketamine use: blood pressure spikes cause heart failure and myocardial infarction in patients at risk; impairment of hand-eye coordination and its dissociative effects increase the risk of motor vehicle accidents.3,4,8,9”
From Are we repeating mistakes of the past? A review of the evidence for esketamine (2021) · cites this paper as [4]
Ketamine commonly elevates blood pressure and heart rate, which has been associated with fatal heart failure and myocardial infarction, as well as stroke and cerebral haemorrhage, more often in those with pre-existing risk factors.
“Ketamine commonly elevates blood pressure and heart rate, 4 which has been associated with fatal heart failure and myocardial infarction, 4 as well as stroke and cerebral haemorrhage 3 more often in those with pre-existing risk factors.”
From Are we repeating mistakes of the past? A review of the evidence for esketamine (2021) · cites this paper as [4]
Cites
Esketamine is approved in Europe for treating resistant major depressive disorder
Mahase, E. (2019) · BMJ · doi:10.1136/bmj.l7069 · Cited by 68 · see citing works
Self-citationEsketamine for treatment resistant depression
Jauhar, S., & Morrison, P. (2019) · BMJ · doi:10.1136/bmj.l5572 · Cited by 40 · see citing works
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Malhi, G. S., Bell, E., Bassett, D., Boyce, P., Bryant, R., Hazell, P., Hopwood, M., Lyndon, B., Mulder, R., Porter, R., et al. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867420979353 · Cited by 614 · see citing works
Are we repeating mistakes of the past? A review of the evidence for esketamine
Horowitz, M. A., & Moncrieff, J. (2021) · The British Journal of Psychiatry · doi:10.1192/bjp.2020.89 · Cited by 53 · see citing works
Naudet, F., Pellen, C., Fodor, L. A., Gastaldon, C., Barbui, C., Turner, E. H., Le Pabic, E., & Cristea, I. A. (2025) · BMC Medicine · doi:10.1186/s12916-025-04435-x · Cited by 6 · see citing works
- Authors
- Mahase, E.
- Affiliations
- BMJ Group (United Kingdom) (GB)
- Corresponding author
- Mahase, Elisabeth
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2020-01-28
- Volume
- 368
- Pages
- m329
- ISSN
- 1756-1833 (ISSN-L)
- OpenAlex
- W3004068133
- Cited by
- 13
- References
- 2
- Citations by year
- 2024: 2 · 2022: 2 · 2021: 3 · 2020: 6
- Type
- other
- Language
- en
- Open access
- closed
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- esketamine, treatment-resistant depression, NICE guidelines, nasal spray, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, antidepressant combination therapy, cost-effectiveness, NHS prescribing
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