Equivalent Antidepressant Outcomes with Esketamine in TMS Non-Responders

This work was sponsored by Mindful Health Solutions Both Transcranial Magnetic Stimulation (TMS) and Esketamine are FDA approved therapies for patients with Major Depressive Disorder (MDD) who have failed at least one conventional antidepressant. However, there is little data to guide selection between these two treatments or sequence them appropriately in a depression treatment algorithm. One critical unanswered question is whether the antidepressant efficacy of Esketamine is the same in patients who have previously failed TMS compared to those who have not. In this retrospective analysis of outcomes data from a large psychiatric practice that uses both Esketamine and TMS to treat MDD, we analyzed Esketamine treatment outcomes in a cohort of patients who had previously failed TMS (Nf108) versus a cohort of non-TMS failures (Nf277). While the TMS-failure cohort had a higher PHQ-9 score (mean=19.25; SEM=0.47) at Esketamine treatment start versus the non-failure cohort (mean=16.00; SEM=0.31), both groups showed equivalent PHQ-9 score change at treatments 8 and 12 (Group-by-Time interaction effect, p=.37; main effect of Time within the TMS-failure group, p<.001 and="" within="" the="" non-tms-failure="" group="" p="" further="" roughly="" half="" of="" patients="" in="" both="" groups="" showed="" at="" least="" a="" improvement="" phq-9="" non-tms-failure:="" suggesting="" similar="" clinically="" meaningful="" benefit="" for="" groups.="" we="" report="" first="" demonstration="" equivalent="" esketamine="" outcomes="" mdd="" who="" have="" previously="" failed="" tms.="" these="" findings="" provide="" real-world="" evidence="" that="" can="" guide="" clinicians="" rational="" treatment="" selection="" as="" well="" useful="" information="" when="" counseling="" about="" options.="">