Adjunctive Intranasal Esketamine for Comorbid Treatment-Resistant Depression with Suicidal Ideation in Patients Receiving Palliative Care at a Comprehensive Cancer Center: A Case Series.
Mercy Tomy, William B Alexander, Sanjay Gupta, Dylan Schaefer, Amy A Case
Journal of Palliative Medicine 2025 DOI: 10.1089/jpm.2024.0040 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 3 |
| Population | Patients with cancer, treatment-resistant depression, and suicidal ideation at a palliative care clinic |
| Intervention | Intranasal esketamine |
| Duration | Up to one year follow-up |
| Topics | Depression End-of-life distress Esketamine Ketamine |
| Keywords | Suicidal ideation #cancer-treatment oncology Cancer therapy Cancer care #mental-health psychiatric care Psychological health Behavioral health #esketamine-therapy ketamine treatment Ketamine therapy Nasal spray treatment #depression |
| Citations | 4 |
| Key findings | All three patients had substantial reduction in depression severity and no further suicidal ideation after intranasal esketamine treatment, with improvements maintained for up to a year. |
Abstract
Background: The psychiatric needs of those with cancer and other advanced illnesses are becoming increasingly recognized. Ketamine is emerging as a promising treatment option for depressive disorders in psychiatric and palliative care. In the palliative care setting, its study has been hindered by lack of consistent administration routes and dosing. Intranasal (IN) esketamine (Spravato®) has recently received U.S. Food and Drug Administration (FDA) approval as an adjunctive agent for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal ideation (SI).
Objective: We sought to offer IN esketamine to patients suffering from TRD and SI at a comprehensive cancer center.
Methods: We designed and implemented a protocol to administer IN esketamine and describe three cases in which it was provided to patients with TRD and SI at a palliative care clinic in the United States.
Results: Following treatment, all three patients had substantial reduction in depression severity and no further suicidalideation. These improvements were maintained for up to a year. No serious adverse events occurred.
Conclusions: These cases illustrate the potential utility of IN esketamine in the palliative care setting.
Comparable studies
Other case reports and case series on esketamine for depression, most cited first.