Intranasal Esketamine for Treatment-Resistant Depression with Structural Brain Abnormality: A Case Report
Yu-Chih Shen, Chien-Chen Hung
Psychiatry and Clinical Psychopharmacology November 13, 2025 DOI: 10.5152/pcp.2025.251248 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 61-year-old female with treatment-resistant depression, structural brain abnormalities from left frontal lobe tissue loss due to traumatic brain injury, and prior poor response to electroconvulsive therapy |
| Intervention | Intranasal esketamine |
| Dose | 56 mg |
| Duration | 2 weeks |
| Measures | Montgomery-Åsberg Depression Rating Scale (MADRS) |
| Topics | Depression Esketamine |
| Key findings | Intranasal esketamine was associated with improvement from severe to mild depression, resolution of suicidal ideation, and no severe adverse events in a patient with treatment-resistant depression, structural brain abnormalities, and prior poor ECT response. |
Abstract
This case report describes the clinical response and safety of intranasal esketamine (Spravato®) in a 61-year-old female with treatment-resistant depression (TRD), a history of electroconvulsive therapy (ECT) poor response, and structural brain abnormalities secondary to left frontal lobe tissue loss from traumatic brain injury in 2008. Despite multiple antidepressant trials, atypical antipsychotic augmentation, and 6 ECT sessions since 2019, the patient achieved only partial remission. In 2024, she received four 56 mg doses of Spravato over 2 weeks while maintaining duloxetine, fluvoxamine, and clozapine therapy. Montgomery-Åsberg Depression Rating Scale (MADRS) scores improved from severe to mild depression, with resolution of suicidal ideation and symptom stabilization. Anxiety symptoms decreased and nightmares ceased post-treatment. Transient dizziness occurred approximately 10 minutes post-administration in all sessions, resolving with 90 minutes of bed rest. No severe adverse events (dissociation, psychosis, or hypertensive crises) were observed. Although limited by an abbreviated treatment regimen and a single-case design, this case suggests that esketamine may be considered in carefully selected TRD patients with structural brain abnormalities and prior ECT poor response, pending validation from larger studies.
Comparable studies
Other case reports and case series on esketamine for depression, most cited first.