Case report: Intranasal esketamine for severe major depressive disorder with psychotic features
Maximilian Carter, Kassandra Solsrud, Nicholas Mischel
Frontiers in Psychiatry July 25, 2022 DOI: 10.3389/fpsyt.2022.937996 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 28-year-old patient with treatment-resistant major depressive disorder with psychotic features |
| Intervention | Intranasal esketamine |
| Duration | 14 treatments over a 3-month period; 1-year follow-up |
| Measures | Quick Inventory of Depressive Symptomatology (QIDS) |
| Topics | Depression Esketamine |
| Key findings | The authors report that a 28-year-old with treatment-resistant depression with psychotic features improved from severe to moderate depression on the QIDS after two intranasal esketamine sessions, stabilized at mild depression without suicidal ideation over 14 sessions, and remained stable one year later with no auditory hallucinations since treatment. They propose larger studies are needed to clarify effectiveness and safety. |
Abstract
IntroductionAbout one third of patients with major depressive disorder (MDD) have treatment resistant depression (TRD). The difficulty of treating TRD especially in those with suicidal ideation and psychotic features demands treatments that are fast-acting, safe, and effective. Limited access, lack of viable options, and incomplete characterization of rapid-acting antidepressants has prevented widespread incorporation into treatment of patients with TRD. However, ketamine and its variations have shown promise of being effective treatment options for patients with TRD with psychotic features.Case descriptionThis 28-year-old patient with TRD with psychotic features received 14 treatments of intranasal esketamine over a 3-month period. This patient initially presented with anhedonia, difficulty sleeping, suicidal thoughts, and auditory hallucinations. The Quick Inventory of Depressive Symptomology (QIDS) was used to assess depression before each session.ResultsAfter her first two treatment sessions within a week, this patient experienced a reduction in depression from severe to moderate according to the QIDS. Over 14 sessions, she had no significant adverse effects, including no psychotic symptoms during esketamine treatment, and was stabilized to mild depression without suicidal ideations. One year after treatment, she continues to be stable. She has not had auditory hallucinations since the esketamine treatment.ConclusionsThis case report provides an example of a patient with severe TRD with psychotic features that showed significant improvement after treatment with intranasal esketamine. Larger studies are indicated to further elucidate the effectiveness and safety of intranasal esketamine, so it can be more widely used for patients with TRD with psychotic features.