Is there an independant anti-suicidal effect of esketamine in treatment resistant depression?
Michel Danon, Gabriela Ostronoff, Anne-Cécile Petit, Pierre De Maricourt, Jakub M Kopeć, Lila Mekaoui, Lucie Berkovitch, Philip Gorwood
Journal of Affective Disorders May 1, 2026 DOI: 10.1016/j.jad.2026.121181 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational study Peer reviewed |
|---|---|
| Sample size | 261 |
| Population | Adults with moderate-to-severe treatment-resistant depression at Sainte-Anne Hospital, Paris, France |
| Intervention | Intranasal esketamine |
| Duration | Eight esketamine sessions over four weeks |
| Topics | Depression Esketamine |
| Keywords | Suicide |
| Key findings | The anti-suicidal effect of esketamine does not persist once its antidepressant effect is taken into account. |
Abstract
Regulatory approvals for intranasal esketamine in treatment-resistant depression (TRD) differ with respect to its indication for suicidal ideation. While rapid antidepressant effects are well documented, whether esketamine exerts an anti-suicidal effect independent of mood improvement remains unclear. In this two-center observational study, 261 adults with moderate-to-severe TRD at Sainte-Anne Hospital, Paris, France, received eight esketamine sessions over four weeks. MADRS-D (items 1-9) and MADRS-S (item 10) were rated before each session. Both MADRS-D (all p < .001) and MADRS-S (all p < .001) improved during esketamine treatment. In multivariate analysis, depressive improvement remained significant after adjusting for MADRS-S (all p < .001), whereas the reduction in suicidal ideation lost significance when adjusting for MADRS-D (all p > .949) in both samples. Our results suggest that the anti-suicidal effect of esketamine does not persist once its antidepressant effect is taken into account.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.