Clinical experiences with intranasal esketamine for major depressive disorder resistant to treatment and with a psychiatric emergency: case presentations.
Maurizio Pompili, Giuseppe Sarli, Denise Erbuto, Giovanni Manfredi, Anna Comparelli
International Clinical Psychopharmacology May 1, 2023 DOI: 10.1097/yic.0000000000000455 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 3 |
| Population | Adults with treatment-resistant major depressive disorder, two with active suicidal ideation and intent |
| Interventions | Esketamine Oral antidepressant therapy |
| Topics | Depression Esketamine |
| Key findings | In three treatment-resistant depression cases, intranasal esketamine with concomitant oral antidepressants was followed by rapid reduction of depressive symptoms in all three and complete resolution of suicidal ideation and intent in the two patients with such risk. The authors present this as preliminary evidence of esketamine's effectiveness in treatment-resistant depression and psychiatric emergencies. |
Abstract
Recently, esketamine became availableas an intranasal formulation, proposed for treatment-resistant depression (TRD). Three cases of TRD are presented, two with features of a psychiatric emergency. The first case is a 35-year-old man with MDD onset at the age of 27 years, with five previous failed therapies. The second patient is a middle-aged man with a 21-year MDD onset and six previous antidepressant treatments discontinued for poor therapeutic effects and tolerability. He also presented suicidal ideation with intent and a history of a failed suicide attempt by self-cutting his forearms. The third case is a 28-year-old female with a first MDD episode in 2020, treated first with amitriptyline and then with intravenous clomipramine. She had a history of a previous suicide attempt by self-cutting and, by her admission, showed active suicidal ideation with intent. In all three cases, a rapid reduction of depressive symptoms was observed with a subsequent complete resolution of suicidal ideation and intent in the two patients with such risk. Intranasal esketamine treatment was carried out with concomitant oral antidepressant therapy. The third patient reported the only recorded side effect: dissociation 20 min after every esketamine administration. Our preliminary experience proved esketamine's effectiveness on TRD symptoms and successful outcomes in psychiatric emergencies such as suicide risk.
Comparable studies
Other case reports and case series on esketamine, most cited first.