Symptom Reduction and Deprescribing in a Patient With Treatment-Resistant Depression Using Sublingual Ketamine Troches: A Case Report.
Elizabeth Francis
Cureus July 1, 2025 DOI: 10.7759/cureus.87343 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 37-year-old male with treatment-resistant depression, PTSD, and social anxiety disorder |
| Intervention | low-dose sublingual ketamine troches |
| Topics | Psychedelic-assisted therapy Depression Esketamine Ketamine |
| Keywords | Complex-PTSD Ketamine infusion Low dose ketamine |
| Key findings | Low-dose sublingual ketamine troches led to clinically meaningful improvements in depression and anxiety and enabled discontinuation of four psychotropic medications. |
Abstract
Treatment-resistant depression (TRD) remains a significant clinical challenge, often accompanied by polypharmacy and comorbid anxiety or trauma-related disorders. This report describes a 37-year-old male with longstanding major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and social anxiety disorder who demonstrated limited response to traditional pharmacologic strategies, including escitalopram, quetiapine, trazodone, and gabapentin. After initiating low-dose sublingual ketamine troches, the patient experienced clinically meaningful improvements in depression and anxiety scores. These improvements were accompanied by successful tapering and discontinuation of four psychotropic medications. No adverse effects were reported. This case highlights the potential utility of sublingual ketamine in reducing symptom burden and supporting deprescribing efforts in complex TRD presentations.
Comparable studies
Other case reports and case series on ketamine and psychedelic-assisted therapy, most cited first.
Citations in the library
Cites 8
- Mechanisms of Ketamine Action as an Antidepressant Molecular Psychiatry March 13, 2018
- Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation American Journal of Psychiatry March 17, 2021
- Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review BJPsych Open December 23, 2021
- Repeated oral ketamine for out-patient treatment of resistant depression: randomised, double-blind, placebo-controlled, proof-of-concept study The British Journal of Psychiatry September 24, 2018
- Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder. Cochrane Database of Systematic Reviews September 12, 2021
and 3 more in the library