Since the FDA approved esketamine (Spravato) for treatment-resistant depression and depressive symptoms in adults with MDD who had acute suicidal ideation in 2019, new information is emerging of it’s effect in patients with comorbid chronic pain and depression. At the annual American Psychiatric Association (APA) 2024 conference, a case report of sustained improvement of both pain and depression with esketamine and treatment of a 40-year-old female with fibromyalgia (1). Esketamine was started for treatment-resistant depression. As other patient’s, she tried many oral antidepressants and augmentation agents without improvement. With esketamine, her pain and depression improved within days of beginning esketamine. This patient had a fantastic response to esketamine with a 70-80% reduction in baseline pain with weekly treatment. If she extended the interval her pain reduction was 30-40%.
“Our observations in this case and in our migraine patient noted above have led us to ask whether certain comorbid pain syndromes might favor earlier use of esketamine in some [treatment-resistant depression] patients,” presenters wrote in their poster.
Cautious optimism vs therapeutic potential
The overlap of chronic pain and depression is documented extensively. With nearly 60-80% of chronic pain suffers experiencing depression, treatment of BOTH pain and depression is important to long term recovery.
Esketamine, like it’s parent molecular ketamine, has pain relieving properties. This is documented in multiple studies for a variety of medical issues. At Libertas Mind, we work within the FDA’s indication for treatment resistant depression for use but recognize the therapeutic potential of this treatment.
The bridge is fairly simple. Esketamine is an excellent treatment for depression. Many patients with chronic pain have treatment resistant depression. We think esketamine will be helpful for depression, and could be very help for chronic pain complaints.
- Fichtner, Christopher. Incident Pain Relief with Esketamine for Depression: Sustained Benefit in Fibromyalgia and Migraine. Paper presented at: American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 4-8, 2024.
- Zhang, Qw., Wang, X., Wang, Zy. et al. Low-dose esketamine improves acute postoperative pain in patients undergoing thoracoscopic surgery. APS 2, 5 (2024). https://doi.org/10.1007/s44254-023-00039-x
- FDA Alerts Health Care Professionals Of Potential Risks Associated With Compounded Ketamine Nasal Spray. US Food and Drug Administration. February 16, 2024. https://www.fda.gov/drugs/human-drug-compounding/fda-alerts-health-care-professionals-potential-risks-associated-compounded-ketamine-nasal-spray. Accessed May 5, 2024.