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Esketamine in Treatment Resistant Depression: The Way to Remission

João Facucho-Oliveira, Daniel Esteves-Sousa, Bruno Prates, Rui Neves, Pedro Varandas

Revista Portuguesa de Psiquiatria e Saúde Mental March 5, 2021 DOI: 10.51338/rppsm.2021.v.i1.174 (opens in new tab)

Study at a glance

AI-extracted from the abstract
Characteristics Case study Case report Peer reviewed
Sample size 1
Population A 42-year-old Caucasian woman with severe treatment-resistant major depressive disorder and high functional impairment
Intervention Esketamine
Measures MADRS, PHQ-9, Sheehan scale
Topics Depression Esketamine
Key findings In this single case, a 42-year-old woman with severe treatment-resistant depression experienced marked clinical recovery after esketamine treatment, with an acute reduction in MADRS score at one week, progressive improvement in depressive symptoms over following weeks, and pronounced symptomatic and functional relief on the PHQ-9 and Sheehan scales.

Abstract

Major depressive disorder affects an estimate of 5% of the population with nearly 1‑third of patients failing to achieve remission with conventional pharmacological treatment. Esketamine, a novel rapid‑acting antidepressant, with a noncompetitive antagonism on N‑methyl‑D‑Aspartate receptor, have been recently approved by Food and Drug Administration (FDA) and European Medicines Agency (EMA) for treatment‑resistant depression. Here, we report a clinical case of a 42‑year‑old Caucasian woman who endured many years with severe depressive symptoms and high functional impairment. Previous treatments included cognitive behavioral therapy, numerous pharmacological trials with antidepressants and augmentation agents, and neurostimulation approaches. Upon treatment with esketamine, the patient presented remarkable clinical recovery. Psychometric assessments determined an acute reduction on the MADRS score after 1 week and progressive recovery of the depressive symptoms on the following weeks. Likewise, PHQ‑9 scale assessments, evaluating the relative frequency of depressive symptoms. and the Sheehan scale, assessing functional recovery, also determined a pronounced symptomatic relief.

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
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
Disembodiment and Affective Resonances in Esketamine Treatment of Depersonalized Depression Subtype: Two Case Studies. Patients with treatment resistant depression and depersonalized depression symptoms 2024 Case study n = 2

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