An Implementation Science Assessment of Intranasal Esketamine's Limited Integration into Mainstream Psychiatric Treatment.
Benjamin Anderson, Megan O'Grady
The journal of behavioral health services & research October 19, 2025 DOI: 10.1007/s11414-025-09975-x (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Intervention | Intranasal esketamine |
| Topics | Esketamine |
| Key findings | Despite FDA approval of intranasal esketamine for treatment-resistant depression in 2019 and evidence of its efficacy and real-world effectiveness, most psychiatric treatment settings do not offer it. The authors use the Consolidated Framework for Implementation Research to review this limited implementation and propose steps to improve accessibility for patients with TRD. |
Abstract
Major Depressive Disorder is one of the most common mental illnesses worldwide, with oral antidepressant medication being the first-line psychopharmacological treatment option. The term Treatment Resistant Depression (TRD) is used to describe patients who remain symptomatic despite multiple trials of antidepressant medication. There had been limited FDA-approved treatment options for patients with TRD, but in 2019, intranasal esketamine was approved by the FDA for patients with TRD after safety and efficacy were established in the drug development clinical trial program. Since approval, multiple researchers have explored esketamine's effectiveness in real-world treatment settings. Despite established efficacy and effectiveness, most psychiatric treatment settings do not offer intranasal esketamine. This limited implementation is reviewed using the Consolidated Framework for Implementation Research (CFIR), and steps forward are proposed to improve accessibility for patients with TRD.
Comparable studies
Other narrative reviews on esketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Long-term safety of ketamine and esketamine in treatment of depression | 2022 | Review | |
| Ketamine, Esketamine, and Arketamine: Their Mechanisms of Action and Applications in the Treatment of Depression and Alleviation of Depressive Symptoms. | 2024 | Review | |
| The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence. | 2023 | Review | |
| Variations in BDNF and Their Role in the Neurotrophic Antidepressant Mechanisms of Ketamine and Esketamine: A Review. Patients with depression | 2024 | Narrative review |
Citations in the library
Cites 6
- Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study American Journal of Psychiatry May 21, 2019
- Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression JAMA Psychiatry June 5, 2019
- A REVIEW OF KETAMINE ABUSE AND DIVERSION Depression and Anxiety August 1, 2016
- Comparative Effectiveness of Intravenous Ketamine and Intranasal Esketamine in Clinical Practice Among Patients With Treatment-Refractory Depression: An Observational Study. The Journal of Clinical Psychiatry February 1, 2023
- Use of Esketamine Nasal Spray in Patients with Treatment-Resistant Depression in Routine Practice: A Real-World French Study. Depression and Anxiety 2024
and 1 more in the library