Inflammatory response to repeated subcutaneous esketamine in treatment-resistant depression: The role of baseline C-reactive protein

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dc.contributor.authorCavalcanti-Ribeiro, Patricia
dc.contributor.authorSouza, Lara Carvalho Araújo Melo de
dc.contributor.authorTavares, Vagner Deuel de Oliveira
dc.contributor.authorAlmeida, Raíssa Nóbrega de
dc.contributor.authorLima, Nicole Bezerra de Medeiros
dc.contributor.authorGonçalves, Kaike Thiê da Costa
dc.contributor.authorLopes, Eduardo Igor Torquato Cardoso
dc.contributor.authorGomes, Raynara Bolcont de Oliveira
dc.contributor.authorBrito, Aldielyson Jorge Cavalcanti de
dc.contributor.authorSilva, Marcelo Falchi Parra Carvalho
dc.contributor.authorArcoverde,Emerson Nunes
dc.contributor.authorAraújo, Draulio Barros de
dc.contributor.authorFontes, Fernanda Palhano Xavier de
dc.contributor.authorCoelho, Nicole Leite Galvão
dc.contributor.authorIDhttps://orcid.org/0000-0003-3356-282X
dc.contributor.authorIDhttps://orcid.org/0000-0003-3025-9825
dc.contributor.authorIDhttps://orcid.org/0000-0003-3687-8790
dc.contributor.authorIDhttps://orcid.org/0009-0009-3600-4453
dc.contributor.authorIDhttps://orcid.org/0000-0001-9376-3979
dc.contributor.authorIDhttps://orcid.org/0009-0003-4723-4840
dc.contributor.authorIDhttps://orcid.org/0000-0002-7407-880X
dc.contributor.authorIDhttps://orcid.org/0000-0002-6934-2485
dc.contributor.authorIDhttps://orcid.org/0000-0002-1612-6703
dc.contributor.authorIDhttps://orcid.org/0000-0002-4887-8635
dc.date.accessioned2026-01-22T16:29:00Z
dc.date.available2026-01-22T16:29:00Z
dc.date.issued2025-03-15
dc.description.resumoBackground: 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
dc.identifier.citationCAVALCANTI-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 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. Inflammatory response to repeated subcutaneous esketamine in treatment-resistant depression: The role of baseline C-reactive protein. Journal of Affective Disorders, v. 397, p. 120877, 15 mar. 2026. DOI: https://doi.org/10.1016/j.jad.2025.120877. Disponível em: https://www.sciencedirect.com/science/article/pii/S0165032725023195?via%3Dihub. Acesso em: 12 jan. 2026.
dc.identifier.doihttps://doi.org/10.1016/j.jad.2025.120877
dc.identifier.issn1573-2517
dc.identifier.urihttps://repositorio.ufrn.br/handle/123456789/67913
dc.language.isoen
dc.publisherJournal of Affective Disorders
dc.subjectTreatment-resistant depression
dc.subjectEsketamine
dc.subjectSubcutaneous administration
dc.subjectC-reactive protein
dc.subjectInflammation
dc.subjectAntidepressant response
dc.titleInflammatory response to repeated subcutaneous esketamine in treatment-resistant depression: The role of baseline C-reactive protein
dc.typearticle

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