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Navigating Treatment-Resistant Major Depressive Disorder With Suicidal Ideation: Exploring the Efficacy of Spravato (Esketamine) in an 86-Year-Old Male.

Aarman P Jivraj, Katherine A Heimer, Christopher J Wukovits, Justin B Itteera, Annupriya Itteera

Cureus December 1, 2024 DOI: 10.7759/cureus.76090 (opens in new tab)

Study at a glance

AI-extracted from the abstract
Characteristics Case study Case report Peer reviewed
Sample size 1
Population 86-year-old patient with treatment-resistant major depressive disorder and suicidal ideation
Topics Depression Esketamine
Keywords Geriatrics population Geriatric psychiatry Elderly mental health
Citations 1
Key findings Intranasal esketamine therapy led to positive treatment outcomes in an 86-year-old patient with treatment-resistant major depressive disorder and suicidal ideation.

Abstract

This case study examines the novel application of Spravato (intranasal esketamine) to address treatment-resistant Major Depressive Disorder (MDD) in an 86-year-old patient. Notably, this represents one of the oldest documented individuals to be administered intranasal esketamine for a diagnosis of Treatment-Resistant Depression (TRD) alongside suicidal ideation. This case study contributes to the growing body of evidence on its use in elderly populations suffering from MDD with suicidal ideation. Given the limited research on intranasal esketamine therapy in geriatric populations, this study highlights unique pharmacodynamic and clinical challenges specific to this demographic, particularly regarding advanced age, comorbidities, and sensitivity to adverse effects. Under the supervision of a double board-certified adult and geriatric psychiatrist, this case study examines how intranasal esketamine therapy can lead to positive treatment outcomes in geriatric populations. This case study also addresses the safety and efficacy of intranasal esketamine therapy, contributing to the broader discourse on its potential as a viable treatment option for TRD, especially for geriatric patients resistant to traditional therapies. While current literature primarily focuses on individuals aged 65 and younger, this case study aims to provide insights into future applications in geriatric populations to improve existing clinical guidelines.

Comparable studies

Other case reports and case series on esketamine for depression, most cited first.

Study Year Design Participants
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety... 2025 Case report n = 1
Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD 2022 Retrospective case series n = 35
Case report: Intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa Patients with anorexia nervosa and a comorbid depressive disorder treated at a private... 2023 Case report n = 4
Repeated oral esketamine in patients with treatment resistant depression and comorbid posttraumatic stress disorder Patients with treatment-resistant depression and comorbid PTSD 2023 Case series n = 5
Disembodiment and Affective Resonances in Esketamine Treatment of Depersonalized Depression Subtype: Two Case Studies. Patients with treatment resistant depression and depersonalized depression symptoms 2024 Case study n = 2

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