Intranasal esketamine: real-world clinical practice in treatment-resistant depression and factors associated with treatment response.
Bernhard T Baune, Kevin Rosemann, Dimitri Hefter, Mustafa Tonkul, Erhan Kavakbasi
BMC Psychiatry March 17, 2026 DOI: 10.1186/s12888-026-07980-8 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective observational chart review Peer reviewed |
|---|---|
| Sample size | 101 |
| Population | Inpatients with treatment-resistant depression at the University Hospital Münster, Germany (mean age 47.7 years; 51.5% women) |
| Intervention | Intranasal esketamine |
| Measures | Montgomery-Åsberg Depression Rating Scale (MADRS), Beck's Depression Inventory-II (BDI-II) |
| Topics | Depression Ketamine Esketamine |
| Keywords | Humans Antidepressive agents Treatment outcome Administration, intranasal Retrospective studies Adult Middle aged Female Depressive disorder, treatment-resistant Major depression Treatment resistant depression Intranasal esketamine Novel antidepressant agents |
| Citations | 2 |
| Key findings | Intranasal esketamine was associated with significant reductions in depression severity in this inpatient cohort: mean MADRS reduction of 10.7 points and BDI-II reduction of 11.5 points, with 28.8% responding, 52.5% showing at least partial response, and 19.3% achieving remission. Older age was associated with higher remission likelihood (OR 4.06) and male gender with partial response (OR 3.71). The authors argue that older patients and those with psychiatric comorbidities may particularly benefit from extended induction beyond eight sessions. |
Abstract
Background: Intranasal esketamine has recently emerged as an innovative treatment option for treatment-resistant depression (TRD). This retrospective, uncontrolled study aimed to evaluate the real-world effectiveness of esketamine in an naturalistic inpatient setting and explore demographic and clinical factors associated with treatment response.
Methods: We conducted a chart review of 101 inpatients with TRD treated with intranasal esketamine at the University Hospital Münster, Germany. Depression severity was assessed pretreatment and posttreatment with the Montgomery-Åsberg Depression Rating Scale (MADRS) and Beck’s Depression Inventory-II (BDI-II). Repeated measures ANOVAs and logistic regression models were applied to identify treatment outcomes and associated factors.
Results: Patients (mean age 47.7 years; 51.5% women) presented with severe depression and frequent psychiatric comorbidities. Esketamine treatment led to significant improvements in MADRS (mean reduction − 10.7, p < 0.001) and BDI-II scores (mean reduction − 11.5, p < 0.001), with large effect sizes. Suicidality scores decreased significantly as well. Overall, 28.8% achieved response, 52.5% at least partial response, and 19.3% remission. Older age was associated with higher remission likelihood (OR 4.06, p = 0.041), while male gender was associated with partial response (OR 3.71, p = 0.012). Extended induction beyond eight sessions was particularly beneficial for older patients and those with psychiatric comorbidities. No treatment-related serious adverse events were observed.
Conclusions: In this large real-world inpatient cohort, intranasal esketamine significantly improved depression severity. Older patients and those with comorbid psychiatric disorders may particularly benefit from extended induction treatment. These findings support intranasal esketamine as an effective therapeutic option in TRD while highlighting the need for further controlled studies to refine patient selection and optimize treatment protocols. CLINICAL TRIAL NUMBER: Not applicable.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.