Esketamine-Associated Lower Urinary Tract Symptoms Suggestive of Bladder Overactivity in Treatment-Resistant Depression: A Case Report
Clara De Oliveira Lapa, Mario F Juruena, Danilo Costa Pereira, Karine Furlanetto, Mariana Carvalho Moura Castiglioni, Vicente Arturi, Thiago Wendt Viola, Lucas Spanemberg
Research Square October 23, 2026 preprint DOI: 10.21203/rs.3.rs-11132874/v1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report |
|---|---|
| Sample size | 1 |
| Population | A middle-aged male patient with severe treatment-resistant depression |
| Interventions | Esketamine Mirabegron |
| Topics | Depression Esketamine Ketamine |
| Key findings | The authors report that a middle-aged man with treatment-resistant depression developed urinary urgency and pelvic discomfort shortly after starting intranasal esketamine, with no infection or inflammation on urological evaluation. Symptoms partially improved with mirabegron and resolved after esketamine dosing was spaced out. The authors suggest a probable association between intranasal esketamine and lower urinary tract symptoms suggestive of bladder overactivity. |
Abstract
Abstract Background Intranasal esketamine is an approved therapy for treatment-resistant depression and is recognized for its rapid and effective antidepressant effects. Although ketamine-associated cystitis has been documented in recreational users, the urinary safety profile of therapeutic esketamine remains incompletely characterized. Functional lower urinary tract disturbances suggestive of bladder overactivity have not yet been reported in the scientific literature among patients receiving esketamine for treatment-resistant depression. Case presentation: We present the case of a middle-aged male patient with severe treatment-resistant depression who developed urinary urgency and pelvic discomfort shortly after initiating intranasal esketamine. Urological evaluation showed no evidence of infection or inflammation, and the urine culture was negative. Partial symptomatic control was achieved with mirabegron. Urinary symptoms resolved after spacing the frequency of esketamine administration. Conclusions This case suggests a probable association between intranasal esketamine and lower urinary tract symptoms suggestive of bladder overactivity in the absence of inflammatory findings, with symptoms resolving after spacing of treatment administration.
Comparable studies
Other case reports and case series on esketamine for depression, most cited first.
Citations in the library
Cites 13
- A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression Archives of General Psychiatry August 1, 2006
- 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
- Efficacy and Safety of Fixed-Dose Esketamine Nasal Spray Combined With a New Oral Antidepressant in Treatment-Resistant Depression: Results of a Randomized, Double-Blind, Active-Controlled Study (TRANSFORM-1) The International Journal of Neuropsychopharmacology July 9, 2019
- Esketamine Nasal Spray Plus Oral Antidepressant in Patients With Treatment-Resistant Depression The Journal of Clinical Psychiatry April 20, 2020
and 8 more in the library