What clinicians need to know about intranasal esketamine for treatment-resistant depression?

Abstract

Objective: To review the usefulness of esketamine for treatment-resistant depression. Method: Pivotal trials of intranasal esketamine in treatment-resistant depression were synthesized as a narrative review. Results: Esketamine is postulated to act through antagonism of N-methyl-D-aspartate (NMDA) glutamate receptors, but opioidergic effects may also be involved. Unlike intravenous ketamine, esketamine is given intranasally (under clinical observation), usually in addition to an oral antidepressant. Trials compared esketamine plus antidepressant versus placebo plus antidepressant. At 4 weeks, remission was 37% higher with esketamine/antidepressant than placebo/antidepressant. Speed of respon..