Care Next Door: Community Outpatient Esketamine Across Urban and Rural Clinics
Jesús García-Jiménez, S. Posik, B. Herrejón, Luis Gutiérrez-Rojas
European Psychiatry June 1, 2026 DOI: 10.1192/j.eurpsy.2026.10607 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Prospective cohort Peer reviewed |
|---|---|
| Sample size | 7 |
| Population | Adults with treatment-resistant depression (at least two adequate antidepressant failures) in community mental-health clinics |
| Intervention | Intranasal esketamine |
| Duration | Mean exposure 4.9 months; assessments through week 24 and post-discharge at 3 and 6 months |
| Measures | MADRS, SDS, C-SSRS, SHS, SWLS, TSQM-9 |
| Topics | Esketamine |
| Key findings | Intranasal esketamine in community outpatient settings reduced MADRS scores by a mean of 25.1 points (about 56.6%) from baseline to last observation, with response in 4/7 (57.1%) and remission in 2/7 (28.6%). Functioning and suicidality improved. The authors propose that proximity and relational continuity may act as outcome amplifiers in TRD. |
Abstract
Introduction: Treatment-resistant depression (TRD) is highly burdensome. Intranasal esketamine is effective, yet hospital-centric delivery adds travel and continuity barriers that may hinder adherence and outcomes. We hypothesize that community outpatient, patient-proximal delivery —often with the patient’s usual psychiatrist—improves effectiveness, engagement and acceptability, consistent with Spanish implementation experience and expert consensus (Molero et al. XLI Congr Nac Enferm Salud Ment 2024; — —; Ramos-Quiroga et al. Eur J Psychiatry 2025; 39(3) 100313; Young et al. Neurosci Appl 2024; 3 105240).
Objectives: Primary: evaluate the effectiveness of intranasal esketamine for TRD in community outpatient clinics. Secondary: trajectories of functioning, suicidality, well-being and treatment satisfaction; engagement/continuity and tolerability; exploratory association between proximity/continuity and outcomes.
Methods: Multicentre, prospective, pragmatic cohort across urban and rural public community mental-health clinics; consecutive recruitment. Adults with TRD (≥2 adequate antidepressant failures) initiated esketamine per routine care. Assessments: baseline; weeks 2, 4, 8, 16, 24; program discharge; and 3/6-month post-discharge.
Outcomes: MADRS (primary; response ≥50%; remission ≤10), SDS , C-SSRS , SHS , SWLS , TSQM-9 ; engagement (retention, attendance, continuity with the same psychiatrist); safety/tolerability. Planned analyses: mixed-effects models and time-to-event.
Results: Preliminary subset (n = 7, single site); median age 55 years. MADRS means: 44.1 (baseline) → 35.1 (wk-2) → 32.3 (wk-4) → 26.4 (wk-8) → 24.4 (wk-12); last-observation mean 19.0 ; mean absolute change −25.1 (≈ −56.6% ). Response 4/7 (57.1%); remission 2/7 (28.6%). SDS mean: 28.1 (baseline) → 16.0 (last); mean change −12.1 . C-SSRS median: 4 (baseline) → 0 (last). Mean exposure 4.9 months ; at cut-off: 5/7 in treatment, 1/7 suspended for lack of efficacy, 1/7 discharged with 4-month post-discharge stability. No discontinuations for safety recorded; adverse-event monitoring ongoing.
Conclusions: Early real-world signals indicate that near-patient outpatient delivery yields rapid, clinically meaningful improvements in symptoms, functioning and suicidality with good feasibility and retention. Findings support the hypothesis that proximity and relational continuity act as outcome amplifiers in TRD, aligning with Spanish implementation experience and expert recommendations on practical delivery and adequate duration (Molero et al. XLI Congr Nac Enferm Salud Ment 2024; — —; Ramos-Quiroga et al. Eur J Psychiatry 2025; 39(3) 100313; Young et al. Neurosci Appl 2024; 3 105240). Disclosure of Interest None Declared
Comparable studies
Other observational and cohort studies on esketamine, most cited first.