Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract
Suicidal ideation can be a clinical manifestation of major depressive disorder. Besides hospitalization, pharmacotherapy with antidepressants should be initiated. Current treatments can take four to six weeks to see a full response. There were historically no medication options to improve depression with suicidal ideation acutely.

Esketamine nasal spray was approved in August 2020 to treat major depressive disorder with acute suicidal ideation or behavior. There are currently only three trials published evaluating the efficacy in intranasal esketamine to treat suicidal ideation and behavior. Because of the lack of robust evidence, it is difficult to advocate for esketamine use for major depressive disorder with suicidal ideation.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Describe depression with suicidal ideations and review current treatment guidelines.
• Identify current literature examining esketamine for depression with suicidal ideation.
• Discuss the current role of esketamine in treatment plans.

Pharmacy Continuing Education Credits In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.. The assigned universal program number(s) is JA4008223-0000-23-079-H01-P. .  This knowledge-based activity provides 1  contact hours of continuing pharmacy education credit

Suggested Additional Reading & Joint Accreditation Statement - Note: This Accreditation Statement Supersedes All Other Statements :

Suggested Additional Reading

1. World Health Organization (WHO): Preventing Suicide: A Global Imperative. Geneva, WHO, 2014.
2. World Health Organization. Depression. WHO website: https://www.who.int/news-room/fact-sheets/detail/depression/. March 2018.
3. Canuso CM, Singh JB, Fedgchin M, et al. Efficacy and safety of intranasal esketamine for the rapid reduction of symptoms of depression and suicidality in patients at imminent risk for suicide: results of a double-blind, randomized, placebo-controlled study. Am J Psychiatry. 2018;175(7):620–630
4. Product Information: SPRAVATO nasal spray, esketamine nasal spray. Janssen Pharmaceuticals Inc, Titusville, NJ, 2020.
5. DiazGranados N, Ibrahim LA, Brutsche NE, Ameli R, Henter ID, Luckenbaugh DA, Machado-Vieira R, Zarate CA Jr. Rapid resolution of suicidal ideation after a single infusion of an N-methyl-D-aspartate antagonist in patients with treatment-resistant major depressive disorder. J Clin Psychiatry. 2010 Dec;71(12):1605-11.
6. Zarate CA, Singh JB, Carlson PJ, et al. A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression. Arch Gen Psychiatry. 2006;63(8):856–864.
7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Fifth Edition. Washington, DC, American Psychiatric Association; 2013.
8. Fu DJ, Ionescu DF, Li X, Lane R, Lim P, Sanacora G, Hough D, Manji H, Drevets WC, Canuso CM. Esketamine Nasal Spray for Rapid Reduction of Major Depressive Disorder Symptoms in Patients Who Have Active Suicidal Ideation With Intent: Double-Blind, Randomized Study (ASPIRE I). J Clin Psychiatry. 2020 May 12.
9. Ionescu DF, Fu DJ, Qiu X, Lane R, Lim P, Kasper S, Hough D, Drevets WC, Manji H, Canuso CM. Esketamine Nasal Spray for Rapid Reduction of Depressive Symptoms in Patients with Major Depressive Disorder Who Have Active Suicide Ideation with Intent: Results of a Phase 3, Double-Blind, Randomized Study (ASPIRE II). Int J Neuropsychopharmacol. 2020 Aug 29.
10. Sajatovic M and Ramirez LF (Eds). Rating Scales in Mental Health 2nd ed. USA: Lexi-Comp; 2003.
11. Hasin DS, Sarvet AL, Meyers JL, et al. Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry. 2018;75(4):336–346.
12. Williams JB, Kobak KA. Development and reliability of a structured interview guide for the Montgomery-Asberg Depression Rating Scale (SIGMA). Br J Psychiatry. 2008;192(1):52–58.
13. Chung D, Hadzi-Pavlovic D, Wang M, Swaraj S, Olfson M, Large M (2019) Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalization. BMJ Open 9(3):e023883.
14. Deisenhammer EA, Ing CM, Strauss R, et al.: The duration of the suicidal process: how much time is left for intervention between conideration and accomplishment of a suicide attempt? J Clin Psychiatry 2009; 70:19–24.

Joint Accreditation Statement
In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
The University of Pittsburgh School of Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit[s]™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
This educational activity is approved for 1.0 contact hours.
Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.