Hospital PharmacyOctober 23, 2025Moomal Memon, Rukhsana Gul, Arif Gul et al.1 citation
Depression, projected to be the leading cause of global disability by 2030, affects up to 19.62% of Pakistan's population. Treatment-resistant depression (TRD), characterized by poor response to at least two antidepressants, poses a major clinical challenge. Although interventions like ECT exist, their use is limited by systemic barriers. Esketamine, an NMDA receptor antagonist, offers a...
Esketamine rapidly improved suicidality and depression in TRD, with preliminary evidence suggesting gender-specific responses, and highlighting the importance of tailored interventions to maximize outcomes. Further research is needed to confirm these differences, explore the long-term effects, and understand the underlying mechanisms.
Major Depressive Disorder is one of the most common mental illnesses worldwide, with oral antidepressant medication being the first-line psychopharmacological treatment option. The term Treatment Resistant Depression (TRD) is used to describe patients who remain symptomatic despite multiple trials of antidepressant medication. There had been limited FDA-approved treatment options for patients...
Psychiatry InvestigationOctober 15, 2025Hong-Ci Lin, Chia-Yu Chang, Ching-Huang Lin et al.1 citation
This case report discusses a 62-year-old male with treatment-resistant bipolar II depression and hypertension. After poor responses to multiple treatments, an add-on esketamine nasal spray (ESK-NS) was introduced in October 2022. Improvement was seen, and the patient's depressive episode was nearly remitted during the maintenance phase. However, recurrence was noted when ESK-NS frequency was...
Clinical response and remission may not fully reflect patient priorities in treatment-resistant depression (TRD). Health-related quality-of-life (HRQoL) outcomes should be assessed to comprehensively capture treatment benefits. ESCAPE-TRD (NCT04338321) was a 32-week randomized, phase IIIb trial comparing esketamine nasal spray (NS) versus quetiapine extended release (XR), both alongside an...
Major depressive disorder (MDD) frequently co-occurs with substance use disorders (SUDs), leading to poorer outcomes and limited options. Esketamine is approved for treatment-resistant depression (TRD); its effects on craving and abstinence in SUD are less explored. A 41-year-old man with recurrent MDD (suicidal ideation) and polysubstance use (daily morphine/prescription opioids; intermittent...
In elderly patients with preoperative anxiety who undergo gastrointestinal tumor surgery, administering a low-dose intravenous esketamine injection (0.25 mg/kg) during anesthesia induction can decrease the incidence of POD and improve early postoperative cognitive function.
Major depressive disorder is a public health issue that negatively impacts quality of life and leads to cognitive impairments, causing significant disruptions in work, education, and social life. Treatment-resistant depression is defined as the failure to achieve improvement in depressive symptoms despite the use of at least two different antidepressant medications at adequate doses and...
Research SquareSeptember 26, 2025Soria López, Cinto Segalàs, Eva Real et al.
preprint
Abstract Background: Intranasal esketamine has gained attention as a rapidly acting intervention for treatment-resistant depression, and there is growing interest in its potential anti-obsessional effects. To our knowledge, no published case series has focused on intranasal esketamine in patients with both treatment-resistant obsessive–compulsive disorder (TR‑OCD) and comorbid major depression...
Propofol sedation in patients with Obstructive Sleep Apnea (OSA) frequently induces hypoxemia, posing significant clinical risks. Esketamine, an N-Methyl-D-Aspartate (NMDA) receptor antagonist, may reduce propofol requirements while preserving respiratory stability, but its efficacy in OSA patients remains unproven. At the studied dose (0.25 mg/kg), esketamine's potential side effects...
Abstract Introduction Treatment-resistant depression (TRD) affects up to one-third of patients with major depressive disorder, leading to poor outcomes and increased suicide risk. Esketamine nasal spray, a novel glutamatergic modulator, has emerged as an adjunctive option with rapid onset of action. However, the efficacy and safety of esketamine across randomized controlled trials (RCTs) remain...
Intraoperative low-dose esketamine failed to further improve the QoR-40 score after gynecologic malignancy laparotomy when used as part of a multimodal analgesic regimen. Further research is needed to explore the optimal dosage and indications of esketamine in this patient population.
Objective: Both intravenous (IV) racemic ketamine and intranasal (IN) esketamine have emerged as rapid-acting antidepressants for treatment-resistant depression (TRD) and are increasingly used in clinical settings. Relatively few studies, however, have compared these interventions in larger, naturalistic cohorts. This study was conducted to assess the comparative efficacy and rapidity of...
This is the first systematic review to assess the effectiveness of ketamine/esketamine in this cohort. Our findings suggest that ketamine/esketamine may be useful in improving symptoms of depression, in those with comorbid borderline personality disorder. Limited study data are available; however, given case reports of suicidal ideation and self-harm following treatment cessation, as well as...
Background: Treatment-resistant depression (TRD) has a poor response to clinical treatment. Patients with TRD do not respond adequately to standard antidepressants. Even after receiving a full dose and sufficient duration of combined antidepressant therapy, significant improvement is still difficult to achieve. At present, electroconvulsive therapy (ECT) remains a clinically effective method...
This trial aims to provide Level I evidence comparing the respiratory depression risk between esketamine-based and fentanyl-based analgesia during HHNB-guided liver ablation. Should esketamine prove to be demonstrably superior in terms of respiratory safety, HHNB-esketamine has the potential to be a viable treatment option.
OBJECTIVE The objective of this study was to comprehensively examine the real-world safety of esketamine using 58 months of postapproval data in the United States. METHODS U.S. safety data from patient monitoring forms submitted to the esketamine Risk Evaluation and Mitigation Strategy (REMS) program and reports submitted to the Janssen U.S. Global Medical Safety (US-GMS) database were...
Ketamine， a non-competitive N-methyl-D-aspartate （NMDA） receptor antagonist， has gained increasing attention for its rapid antidepressant effects in treatment-resistant depression （TRD） and suicidal ideation. Its mechanisms include NMDA receptor blockade， AMPA receptor activation， and upregulation of BDNF/mTOR signaling. Its enantiomers， esketamine and R-ketamine， as well as its metabolites，...
CureusSeptember 2025Muhammad Abbas, David B Adams, Jack Noto et al.
Management of treatment-resistant depression (TRD) is complex and frustrating for patients, requiring several treatment courses before (or without) achieving remission. This investigation aims to highlight and analyze real-world instances of using esketamine for patients with TRD who have failed electroconvulsive therapy (ECT). Four case reports from a single Hackensack-Meridian care center are...
Treatment-resistant depression (TRD) remains a major clinical challenge, affecting nearly one-third of individuals with major depressive disorder (MDD) who fail to respond to standard antidepressant therapies. Esketamine, the S-enantiomer of ketamine, has emerged as a novel therapeutic option. Esketamine, initially introduced as an add-on therapy, has more recently also received recognition for...