Intranasal esketamine for treatment-resistant depression: real-world effectiveness in electroconvulsive therapy non-responders
Rocío Gómez-juanes, Guillermo Mompaler Lázaro, Adoración Castro, Guillem Navarra-Ventura, Josep Antoni Mestre Quetglas, Ana Bolon Marset, Julia van der Walt Monasterio, Jaume Andreu Garcias Trullols, Miquel Roca, Margalida Gili, Joan Salvà, Mauro Garcia-Toro
The European Journal of Psychiatry March 7, 2026 DOI: 10.1016/j.ejpsy.2026.100349 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational study Peer reviewed |
|---|---|
| Sample size | 60 |
| Population | Patients with Treatment-Resistant Depression (TRD) who had not responded to prior electroconvulsive therapy or for whom ECT had not been attempted |
| Intervention | Intranasal esketamine |
| Duration | 6-month intervention and follow-up |
| Topics | Depression Esketamine |
| Citations | 1 |
| Key findings | Intranasal esketamine reduced depression scores over 6 months, but prior non-response to ECT did not significantly affect therapeutic outcomes. |
Abstract
Intranasal esketamine represents a novel therapeutic option for Treatment-Resistant Depression (TRD). However, its medium-to-long-term risk-benefit profile in real-world clinical practice remains controversial. Limited data is available regarding its effectiveness, particularly in patients who have not responded to electroconvulsive therapy (ECT), which is the focus of this study. We conducted a 6-month observational study investigating intranasal esketamine treatment in the first TRD patients managed at our care centers. We compared outcomes between patients who had not responded to prior ECT and those for whom ECT had not been attempted. The sample comprised 60 patients exhibiting high chronicity (mean episode duration: 41.2 ± 54.7 months) and complexity, with psychiatric comorbidity observed in 37 cases (61.6%). The mean Montgomery-Åsberg Depression Rating Scale (MADRS) score decreased from a baseline of 33.9 ± 7.8 to 15.7 ± 9.6 at 6 months. No significant differences in therapeutic responses were observed in patients who had not responded to ECT during the current episode. This real-world study suggests the opportunity to promptly test intranasal esketamine in ECT refractory subtype of TDR patients.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.
Citations in the library
Cites 24
- Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression JAMA Psychiatry June 5, 2019
- Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy Journal of Psychoactive Drugs March 15, 2019
- Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression New England Journal of Medicine October 4, 2023
- Efficacy and Safety of Ketamine vs Electroconvulsive Therapy Among Patients With Major Depressive Episode: A Systematic Review and Meta-analysis. JAMA Psychiatry October 19, 2022
- Esketamine Treatment for Depression in Adults: A PRISMA Systematic Review and Meta-Analysis. American Journal of Psychiatry March 1, 2025
and 19 more in the library