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. 2021 Sep 16;20(1):43.
doi: 10.1186/s12991-021-00365-z.

The use of esketamine in comorbid treatment resistant depression and obsessive compulsive disorder following extensive pharmacogenomic testing: a case report

Marcatili Matteo  1   2 , Pellicioli Cristian  3 , Maggioni Laura  3 , Motta Federico  3 , Redaelli Chiara  3 , Ghelfi Lorenzo  4 , Krivosova Michaela  5 , Matteo Sibilla  3 , Nava Roberto  6 , Colmegna Fabrizia  6 , Dakanalis Antonios  3 , Caldiroli Alice  6 , Capuzzi Enrico  6 , Benatti Beatrice  7   8 , Bertola Francesca  9 , Villa Nicoletta  9 , Piperno Alberto  3   9 , Ippolito Silvia  10 , Clerici Massimo  6   3
Affiliations

The use of esketamine in comorbid treatment resistant depression and obsessive compulsive disorder following extensive pharmacogenomic testing: a case report

Marcatili Matteo et al. Ann Gen Psychiatry. .

Abstract

Background: Major depressive disorder (MDD) patients not responding to two or more different antidepressant treatments are currently considered to suffer from treatment resistant depression (TRD). Recently, intranasal esketamine has been approved by both the American Food and Drug Administration and European Medicines Agency for TRD and, more recently, in moderate to severe episode of MDD, as acute short-term treatment for the rapid reduction of depressive symptoms, which, according to clinical judgement, constitute a psychiatric emergency. There is currently no indication for obsessive-compulsive disorder (OCD) although recently published studies have already shown a rapid and significant reduction of OCD-like symptoms following ketamine administration. The etiology of OCD has not yet been fully elucidated but there is a growing evidence that glutamate signaling dysfunction in the cortico-striatal-thalamo-cortical circuitry plays an essential role. This case report exemplifies possible clinical effects of esketamine on both depressive and OCD symptoms.

Case presentation: We present the case of a 39-year-old man suffering from TRD. During the first evaluation at our clinic, he also reported the presence of OCD spectrum symptoms, causing him to perform time-consuming mental rituals due to pathological doubts regarding the relationship with his wife as well as intrusive thoughts regarding his mental conditions. He underwent psychometric evaluations, therapeutic drug monitoring analysis, and pharmacogenomic tests. The overall results helped to explain patient's treatment-resistance. Moreover, we observed a significant reduction in both depressive and OCD symptoms after administration of esketamine.

Conclusion: This case underlines the importance of pharmacogenomic tests in profiling TRD patients and confirms the possible use of esketamine in the treatment of comorbid OCD.

Keywords: Esketamine; GABRA6; GABRP; Ketamine; MTHFR; OCD; Obsessive–compulsive disorder; SLC6A4; TRD; Treatment resistant depression.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Mood variations from the first MDD episode to present
Fig. 2
Fig. 2
Variations of psychometric scales score. BPRS Brief Psychiatric Rating Scale, MADRS Montgomery-Åsberg Depression Rating Scale, YBOCS Yale–Brown obsessive–compulsive scale
See this image and copyright information in PMC

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