The use of esketamine in comorbid treatment resistant depression and obsessive compulsive disorder following extensive pharmacogenomic testing: a case report

Annals of General Psychiatry

Ippolito Silvia¹  Bertola Francesca²  Villa Nicoletta²  Dakanalis Antonios³  Maggioni Laura³  Redaelli Chiara³  Matteo Sibilla³  Pellicioli Cristian³  Motta Federico³  Piperno Alberto³  Krivosova Michaela⁴  Ghelfi Lorenzo⁵  Clerici Massimo⁶  Caldiroli Alice⁶  Capuzzi Enrico⁶  Colmegna Fabrizia⁶  Marcatili Matteo⁶  Nava Roberto⁶  Benatti Beatrice⁷ 

[1] Clinical Chemistry Laboratory, San Gerardo Hospital, ASST Monza;Cytogenetics and Medical Genetics Unit, Centre for Disorders of Iron Metabolism, San Gerardo Hospital, ASST Monza;Department of Medicine and Surgery, University of Milano Bicocca;Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava;Faculty of Medicine, University Vita-Salute San Raffaele;Psychiatric Department, San Gerardo Hospital, ASST Monza;Psychiatry Unit, Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan;

关键词: Treatment resistant depression;    TRD;    Obsessive–compulsive disorder;    OCD;    Esketamine;    Ketamine;   

DOI  :  10.1186/s12991-021-00365-z

来源: DOAJ

【 摘 要 】

Abstract Background Major depressive disorder (MDD) patients not responding to two or more different antidepressant treatments are currently considered to suffer from treatment resistant depression (TRD). Recently, intranasal esketamine has been approved by both the American Food and Drug Administration and European Medicines Agency for TRD and, more recently, in moderate to severe episode of MDD, as acute short-term treatment for the rapid reduction of depressive symptoms, which, according to clinical judgement, constitute a psychiatric emergency. There is currently no indication for obsessive–compulsive disorder (OCD) although recently published studies have already shown a rapid and significant reduction of OCD-like symptoms following ketamine administration. The etiology of OCD has not yet been fully elucidated but there is a growing evidence that glutamate signaling dysfunction in the cortico-striatal–thalamo-cortical circuitry plays an essential role. This case report exemplifies possible clinical effects of esketamine on both depressive and OCD symptoms. Case presentation We present the case of a 39-year-old man suffering from TRD. During the first evaluation at our clinic, he also reported the presence of OCD spectrum symptoms, causing him to perform time-consuming mental rituals due to pathological doubts regarding the relationship with his wife as well as intrusive thoughts regarding his mental conditions. He underwent psychometric evaluations, therapeutic drug monitoring analysis, and pharmacogenomic tests. The overall results helped to explain patient’s treatment-resistance. Moreover, we observed a significant reduction in both depressive and OCD symptoms after administration of esketamine. Conclusion This case underlines the importance of pharmacogenomic tests in profiling TRD patients and confirms the possible use of esketamine in the treatment of comorbid OCD.

【 授权许可】

Unknown