Skip to content

Intranasal esketamine for ECT-refractory bipolar depression: a case report

Muhammad Abbas, Bruno Kallas, Max Garris

Frontiers in Psychiatry July 30, 2026 DOI: 10.3389/fpsyt.2026.1890002 (opens in new tab)

Relevant Not relevant

Study at a glance

AI-extracted from the abstract
Characteristics Case study Case report Peer reviewed
Sample size 1
Population 52-year-old female with ECT-refractory bipolar depression
Intervention Esketamine nasal spray
Topics Depression Esketamine
Key findings Esketamine nasal spray improved depressive symptoms in a patient with ECT-refractory bipolar depression, with relapse after dose reduction and improvement upon resuming the induction regimen; no manic or hypomanic events were reported.

Abstract

This is a case report of a 52 year old female with ECT-refractory bipolar depression who was treated with esketamine nasal spray, leading to a noticeable improvement in her depressive symptoms. She experienced a relapse after a reduction in her maintenance treatment in conjunction with psychosocial stressors, but improved once again after returning to her induction regimen. She tolerated the treatment well with minimal side effects and no reported manic or hypomanic events. More robust research is warranted to better characterize the effectiveness of esketamine in treating treatment-resistant bipolar depression.

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

Related reading

Explore topics

Depression Esketamine

By condition and practice

Esketamine for depression Ketamine for depression