Inflammatory response to repeated subcutaneous esketamine in treatment-resistant depression: The role of baseline C-reactive protein
| Author | Cavalcanti-Ribeiro, Patricia; Souza, Lara Carvalho Araújo Melo de; Tavares, Vagner Deuel de Oliveira; Almeida, Raíssa Nóbrega de; Lima, Nicole Bezerra de Medeiros; Gonçalves, Kaike Thiê da Costa; Lopes, Eduardo Igor Torquato Cardoso; Gomes, Raynara Bolcont de Oliveira; Brito, Aldielyson Jorge Cavalcanti de; Silva, Marcelo Falchi Parra Carvalho; Arcoverde,Emerson Nunes; Araújo, Draulio Barros de; Fontes, Fernanda Palhano Xavier de; Coelho, Nicole Leite Galvão | |
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| Publisher | Journal of Affective Disorders | |
| Date | 2025-03-15 | |
| Keywords | Treatment-resistant depression Esketamine Subcutaneous administration C-reactive protein Inflammation Antidepressant response | |
| Citation | ||
| Abstract | Background: Treatment-resistant depression (TRD) remains a major clinical challenge, with inflammation increasingly implicated in its pathophysiology. C-reactive protein (CRP), an accessible biomarker, has emerged as a potential predictor of antidepressant response. While intravenous and intranasal ketamine have shown anti-inflammatory effects, evidence linking inflammation and clinical outcomes remains inconsistent. The effects of subcutaneous (SC) esketamine on CRP and symptom improvement have not been explored. Objective: To investigate whether baseline CRP predicts clinical response, whether SC esketamine reduces CRP in inflamed patients, and whether CRP changes are associated with symptom improvement. Methods: This secondary analysis derived from an open-label trial included 22 TRD patients who received seven weekly SC esketamine doses. Patients were stratified by CRP (>1 mg/L = inflammation; ≤1 mg/L = non-inflammation). Depression severity was assessed with the Montgomery–Åsberg Depression Rating Scale (MADRS). Results: The inflammation group (n = 8) showed significant CRP reductions (week 4: p = 0.005; week 8: p < 0.001); non-inflamed patients showed no significant change. By week 8 (which corresponded to the seventh application), both groups had comparable CRP levels (p = 0.170; 95 % CI [−2.923 to 0.258]). Age, sex, and BMI did not influence CRP changes. Although the inflammation group had greater depressive symptom reduction (ΔMADRS = 15.88 vs. 11.14), this was not statistically significant (p = 0.280). CRP changes did not predict to symptom improvement (p = 0.774). Conclusion: Exploratory findings suggest that patients with elevated baseline CRP showed within-group decreases over time, without clinical correlation. Larger controlled studies with broader immune profiling are needed | |
| URI | https://repositorio.ufrn.br/handle/123456789/67913 | |
| Collections | ICe - Artigos publicados em periódicos |
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