Obermüller, A.M. (2025) Incidence rate of lower urinary tract symptoms in patients receiving maintenance oral esketamine for treatment-resistant depression. thesis, Medicine.
Full text available on request.Abstract
Background. Esketamine has recently been approved for the management of treatment-resistant depression (TRD). Despite promising antidepressant effects, there are concerns about the potential risks of esketamine maintenance treatment, particularly regarding urological safety. Data from studies in recreational users of ketamine demonstrate that severe urinary pathology can occur, particularly in individuals exposed to high cumulative dosages. However, data on the urological side effects of long-term therapeutic use of esketamine are limited. Objectives. To assess urinary disorders and changes over time in lower urinary tract symptoms (LUTS) in a cohort of TRD patients receiving oral esketamine maintenance treatment. Methods. Patients receiving off-label oral esketamine maintenance treatment for TRD filled in the Interstitial Cystitis Symptom and Problem Indices (ICSI/ICPI) monthly. Using these scores, the incidence rate of LUTS, defined as instances of ICSI/ICPI ≥ 12 per 1000 patient-months, was assessed, and a linear mixed-effect model was performed to assess changes over time. Results. Of 93 patients receiving esketamine maintenance treatment, 54 were included in our analysis, providing 1123 ICSI/ICPI measurements. Median treatment duration was 23.5 months (range: 1- 68). We observed a LUTS incidence rate of 114 per 1000 patient-months. LUTS were reported by 16 (29.6%) patients, with a median of 3.5 (range: 1-48) instances per patient. Ten (18.5%) patients reported LUTS over consecutive months. One patient stopped treatment due to cystitis, likely related to esketamine. Group-level ICSI/ICPI scores did not change significantly over time (p=0.607). Conclusion. Maintenance oral esketamine TRD treatment appears urologically safe for most patients, and LUTS incidence rates are comparable to the general population. Nevertheless, one in three patients showed LUTS, one in five reported LUTS on consecutive measurements, and one patient showed progressive LUTS requiring esketamine cessation. Although no causal relationship can be derived from our data, we recommend further critical evaluation of the long-term urological safety of this novel treatment strategy and the development of effective low-burden screening protocols.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Schoevers, Prof. Dr. Robert A. and Smith-Apeldoorn, Drs. Sanne |
| Faculty: | Medical Sciences |
| Date Deposited: | 21 Apr 2026 12:52 |
| Last Modified: | 21 Apr 2026 12:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3928 |
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