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.S, Kantesh Kumar, Khalid S. Khan, Kashaf Iman, Muhammad Momin Khan
Hospital Pharmacy October 23, 2025 DOI: 10.1177/00185787251384516 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Depression Ketamine Esketamine |
| Keywords | Psychological intervention Depression economics Antidepressant Quetiapine Intensive care medicine Primary care Adverse effect Healthcare system Mental healthcare |
| Citations | 1 |
| Key findings | 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.
Comparable studies
Other narrative reviews on esketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Long-term safety of ketamine and esketamine in treatment of depression | 2022 | Review | |
| Ketamine, Esketamine, and Arketamine: Their Mechanisms of Action and Applications in the Treatment of Depression and Alleviation of Depressive Symptoms. | 2024 | Review | |
| Variations in BDNF and Their Role in the Neurotrophic Antidepressant Mechanisms of Ketamine and Esketamine: A Review. Patients with depression | 2024 | Narrative review | |
| The Possible Application of Ketamine in the Treatment of Depression in Alzheimer’s Disease | 2022 | Review |