The Incidental Resolution of Severe Alcohol Use Disorder during Esketamine Treatment of Major Depressive Disorder: A Case Report.
Zeeshan Faruqui, Christopher Kim
Case Reports in Psychiatry December 15, 2022 DOI: 10.1155/2022/8992697 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 61-year-old female with severe recurrent treatment-resistant major depressive disorder and severe alcohol use disorder |
| Intervention | Intranasal esketamine |
| Dose | 56 mg twice a week, then 84 mg weekly |
| Duration | 20 sessions of 56 mg twice weekly, then 5 weekly sessions and 14 weekly sessions of 84 mg |
| Measures | PHQ-9, HAM-D |
| Topics | Addiction Depression Esketamine |
| Key findings | The authors report that a 61-year-old woman with treatment-resistant depression and severe alcohol use disorder tolerated intranasal esketamine without complications, with mood improvement and, incidentally, complete cessation of alcohol use by the second week (one binge relapse while on 56 mg). They suggest esketamine can be used without risk of substance use disorder onset or exacerbation, though they call for further research. |
Abstract
Alcohol use disorder (AUD) is especially prevalent among individuals with major depressive disorder (MDD) and is associated with higher morbidity, mortality, disability, and risk for suicide. Intranasal esketamine has been documented to be a safe and effective option for treatment resistant MDD and received US FDA approval in 2019. However, the availability of esketamine is limited due to requirements for a Risk Evaluation and Mitigation Strategy program for its administration as well as concerns over substance use disorders (SUD) as a potential contraindication or adverse effect. This case presents a 61-year-old female with a history of severe recurrent treatment resistant MDD and severe AUD who has expressed interest in esketamine. To date, she has completed 20 sessions of 56 mg intranasal esketamine twice a week before increasing to 5 weekly sessions and then 14 weekly sessions of 84 mg. Although there was immediate subjective improvement in mood as well as reductions in PHQ-9 and HAM-D scores, the dosage was increased to extend the therapeutic benefit throughout the entire intertreatment interval. She was able to complete these sessions without complication. Incidentally, she also reported decreased desire to use alcohol, decreased impulsivity, and the complete cessation of alcohol use by the second week. While on 56 mg, she had a single relapse of binging which was addressed with motivational therapy and has remained alcohol-free since. This case presents the first documented example of the safe and effective use of intranasal esketamine in patient with treatment resistant MDD in which there was incidental resolution of their comorbid severe AUD. This suggests that esketamine can be used without risk of SUD onset or exacerbation. Thus, esketamine should not be discounted in patients with SUD and continued research is needed to further elucidate its role in treating SUD.
Comparable studies
Other case reports and case series on ketamine for addiction, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Ketamine Dependence in an Anesthesiologist: An Occupational Hazard? Anesthesiologist from India | 2014 | Case study | n = 1 |
| Qualitative analysis of a patient's experience of ketamine-assisted psychotherapy for substance use disorder: Empirical synergies with twelve-step programs 28-year-old female treated for alcohol and opioid use disorder | 2025 | Case study | n = 1 |
| Intravenous ketamine for severe alcohol use disorder at Moi Teaching & Referral Hospital, Kenya: a case report A 39-year-old African male with severe alcohol use disorder, comorbid tobacco use... | 2023 | Case study | n = 1 |
| Grayken lessons: a multidisciplinary approach to care for a patient with severe ketamine use disorder. Young woman with severe ketamine use disorder and PTSD | 2026 | Case study | n = 1 |
| Intensive ketamine use for multiple years: A case report Patient with bipolar I disorder and history of substance dependence | 2014 | Case study | n = 1 |