Zeiss René, Schweizer Melissa, Connemann Bernhard, Malejko Kathrin
Department of Psychiatry and Psychotherapy III, Ulm University Hospital, Ulm, Germany.
Front Psychiatry. 2024 Jul 31;15:1450092. doi: 10.3389/fpsyt.2024.1450092. eCollection 2024.
Major depressive disorder is a mental disorder affecting millions of people worldwide. A considerable proportion of patients demonstrate a lack of response to conventional treatment. With the recent introduction of esketamine, a new treatment option has been approved for treatment-resistant depression. Although the medication is efficacious in a substantial portion of cases, rare, but possibly serious, adverse effects may occur. This case series shows two cases of rhabdomyolysis, a destruction of muscle tissue with elevated creatine kinase levels, after administration of esketamine. The first case presented is about a 33 year old male patient who suffered from a severe episode of a depressive disorder. He got nasal esketamine as an emergency treatment. While there was an initial improvement regarding the depressive symptoms, the patient developed muscle pain and fatigue after the administration of the fourth dose, with creatine kinase (CK) levels above 22,000 U/L, indicating rhabdomyolysis. Following the discontinuation of esketamine and the implementation of supportive care, the CK levels returned to normal and the depressive symptoms abated. The second case is about a 22-year-old male patient who also suffered from a severe depressive episode and got eketamine as an emergency treatment. Following the tenth dose, the patient exhibited muscle weakness and elevated CK levels (8,032 U/L), which persisted even after dose reduction. Esketamine administration was stopped, and the following monitoring demonstrated a slow return to normal levels of CK and liver enzymes. In both cases, there was no known medical history and both patients developed rhabdomyolysis after administration of esketamine. The temporal connection suggests a possible causal relationship. We found no literature on esketamine-induced rhabdomyolysis following the administration of nasal esketamine. However, these two cases emphasize the need of monitoring for laboratory changes like elevated CK-levels in patients receiving esketamine, especially considering its growing use in treatment-resistant depression.
重度抑郁症是一种影响全球数百万人的精神障碍。相当一部分患者对传统治疗无反应。随着艾氯胺酮的近期引入，一种新的治疗选择已被批准用于治疗难治性抑郁症。尽管该药物在很大一部分病例中有效，但可能会出现罕见但可能严重的不良反应。本病例系列展示了两例在使用艾氯胺酮后发生横纹肌溶解的病例，即肌肉组织破坏且肌酸激酶水平升高。第一个病例是一名33岁男性患者，患有严重的抑郁症发作。他接受了鼻内艾氯胺酮作为紧急治疗。虽然抑郁症状最初有所改善，但在服用第四剂后患者出现肌肉疼痛和疲劳，肌酸激酶（CK）水平高于22,000 U/L，表明发生了横纹肌溶解。停用艾氯胺酮并实施支持性护理后，CK水平恢复正常，抑郁症状减轻。第二个病例是一名22岁男性患者，也患有严重的抑郁发作，接受了艾氯胺酮作为紧急治疗。在服用第十剂后，患者出现肌肉无力和CK水平升高（8,032 U/L），即使在减量后仍持续升高。停止使用艾氯胺酮，随后的监测显示CK和肝酶水平缓慢恢复正常。在这两个病例中，均无已知病史，两名患者在使用艾氯胺酮后均发生了横纹肌溶解。时间上的关联表明可能存在因果关系。我们未找到关于鼻内使用艾氯胺酮后发生艾氯胺酮诱导的横纹肌溶解的文献。然而，这两个病例强调了在接受艾氯胺酮治疗的患者中监测如CK水平升高等实验室变化的必要性，尤其是考虑到其在难治性抑郁症治疗中的使用日益增加。
