Clinical Pearls

4 pearls

  1. Do not stop treatment planning at the end of the 4-week esketamine index course; acute benefit was modest, with a mean MADRS change of −14.1 points (SD = 11.1), a response rate of 26.5%, and a remission rate of 10.8% at week 5.

  2. If you are tracking suicidal ideation after esketamine, use more than the C-SSRS ideation subscale; CBT separated from TAU on BSSI at week 18 (−6.01 vs −4.10; mean difference of −1.91, 95% CI, −3.57 to −0.24, P=.025) but not on the C-SSRS (−0.80 vs −0.93; group difference 0.13, 95% CI −0.39 to 0.65, P=.623).

  3. A structured 16-week CBT course is deliverable even in patients with MDSI during and after esketamine treatment; 72/93 (77.4%) were retained through week 18, CBT session completion was 80.7%, and completion of the 9 computer-assisted modules was 76.7%.

  4. When designing or interpreting suicide-focused trials, remember that risk clusters in hospitalized patients; 14/19 suicide-related events occurred in those hospitalized at enrollment, and the authors estimate that detecting a moderate treatment effect would require 200–300 participants from hospitals or similar settings.

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Physicians Postgraduate Press, Inc. (PPP) makes no warranties about the accuracy or completeness of any information published in The Journal of Clinical Psychiatry or other PPP materials, and disclaims liability for any use or non-use of that information. Clinicians should not rely solely on these materials and should exercise their own professional judgment when making patient care decisions on an individualized basis.

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