Esketamine for Treatment-Resistant Depression in Pakistan: A Promising Strategy
Hospital Pharmacy October 23, 2025 Moomal Memon, Rukhsana Gul, Arif Gul et al. 1 citation
Depression is projected to become the leading cause of global disability by 2030 and affects up to 19.62% of Pakistan's population. Treatment-resistant depression (TRD), defined by poor response to at least two antidepressants, remains a major clinical challenge. Esketamine, an NMDA receptor antagonist, provides rapid antidepressant effects and has shown higher remission rates than quetiapine in TRD trials. However, esketamine is not currently available in Pakistan due to cost and systemic barriers. Local studies indicate ketamine infusions are effective for TRD, including in patients who did not respond to electroconvulsive therapy. Pakistan's centralized, specialist-dependent mental health system limits access to novel treatments, especially for rural and marginalized groups. Integrating esketamine would require addressing regulatory, infrastructural, and economic challenges while expanding community-based services and digital solutions.