Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy.
Expert Opin Drug Saf. 2022 Jun;21(6):803-812. doi: 10.1080/14740338.2022.2071422. Epub 2022 May 4.
Esketamine was approved for adults with treatment-resistant depression (TRD) in conjunction with an oral antidepressant, and for treating depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. However, evidence of great efficacy and safety of esketamine is accompanied by a widespread concern regarding its addictive potential.
A comprehensive review on the craving and addictive potential of ketamine and esketamine was carried out. In addition, a clinical case of a 34-year-old TRD woman treated with esketamine who experienced drug-seeking behaviors and craving symptomatology was described and critically discussed, with a particular focus on treatment strategies to manage craving in the short- and long term.
Esketamine showed great efficacy and safety in treating TRD and MDD with acute suicidal ideation or behavior. Our clinical experience demonstrated the presence of an additive potential, which has been favorably managed with slow esketamine de-titration and combination with bupropion. However, literature so far published is scant and shows contradictory findings. Therefore, it is crucial to promptly detect and manage craving symptomatology in esketamine-treated TRD patients. In our experience, the use of bupropion to counteract craving and addictive symptoms was proven to be effective and safe.
氯胺酮与口服抗抑郁药联合用于治疗成人难治性抑郁症（TRD），以及用于治疗伴有急性自杀意念或行为的成人重性抑郁障碍的抑郁症状。然而，氯胺酮具有显著疗效和安全性的同时，也引发了人们对其潜在成瘾性的广泛关注。
对氯胺酮和 Esketamine 的成瘾性和潜在成瘾性进行了全面的综述。此外，还描述并批判性地讨论了一例接受 Esketamine 治疗的 34 岁 TRD 女性患者出现觅药行为和渴求症状的临床病例，特别关注了短期和长期管理渴求的治疗策略。
Esketamine 在治疗 TRD 和伴有急性自杀意念或行为的 MDD 方面显示出了很好的疗效和安全性。我们的临床经验表明存在附加的潜在风险，通过缓慢降低 Esketamine 的剂量并与安非他酮联合使用，可以很好地管理这种风险。然而，到目前为止，已发表的文献很少，且结果相互矛盾。因此，及时发现和管理接受 Esketamine 治疗的 TRD 患者的渴求症状至关重要。根据我们的经验，使用安非他酮来对抗渴求症状和成瘾症状被证明是有效和安全的。
