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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)

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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 Ketamine
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.

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
Oral Administration of the NMDA Receptor Antagonist S-Ketamine as Add-On Therapy of Depression: A Case Series Four depressed patients taking standard antidepressants 2009 Case series n = 4
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

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