Esketamine for Treatment-Resistant Depression in Pakistan: A Promising Strategy
Moomal Memon, Rukhsana Gul, Arif Gul, Sahir Bansari, Mahek Bansari, Asif Raza Khowaja, Suresh Kumar, Kantesh Kumar, Khalid S. Khan, Kashaf Iman, Muhammad Momin Khan
Hospital Pharmacy October 23, 2025 DOI: 10.1177/00185787251384516 (opens in new tab) via OpenAlex
Summary
AI-generated from the abstractDepression 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.
Study at a glance
| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Depression Ketamine |
| Keywords | Psychological intervention Depression economics Antidepressant |
| Citations | 1 |
| Key finding | Esketamine is not currently available in Pakistan, and cost-related barriers hinder its adoption, despite evidence of effectiveness in treatment-resistant depression. |
Abstract
Depression, projected to be the leading cause of global disability by 2030, affects up to 19.62% of Pakistan's population. Treatment-resistant depression (TRD), characterized by poor response to at least two antidepressants, poses a major clinical challenge. Although interventions like ECT exist, their use is limited by systemic barriers. Esketamine, an NMDA receptor antagonist, offers a rapid-onset antidepressant effect and has shown higher remission rates compared to quetiapine in TRD trials. Despite promising evidence, esketamine is not currently available in Pakistan, and cost-related barriers hinder its adoption. Local studies suggest ketamine infusions are effective in TRD, including among ECT non-responders. Pakistan's centralized, specialist-dependent mental health system limits access to such novel treatments, particularly for rural and marginalized populations. Integrating esketamine requires addressing regulatory, infrastructural, and economic challenges while leveraging digital solutions and expanding community-based mental health services.