A HOPEFUL ALTERNATIVE “THERAPY WITH INTRANASAL ESKETAMINE IN A PATIENT WITH RESISTANT DEPRESSION”. A CASE REPORT

Abstract

Abstract. Major Depressive Disorder is the leading cause of disability worldwide. Treatment-resistant depression occurs in a subgroup of patients with this disorder, and consists of a lack of response to two or more different antidepressants under adequate doses and duration, with optimal adherence to treatment. In 2019, both the FDA and EMA approved intranasal esketamine for the treatment of Major Depressive Disorder, with a mechanism of action based on NMDA receptor antagonism. This article describes the case of a patient with Major Depressive Disorder treated with esketamine in compassionate use, the side effects experienced and their management.

The results were spectacular: a very favourable clinical response was observed from the third administration, with complete remission seen at 5 weeks. It proved to be very effective with a great speed of action, and was the only antidepressant capable of achieving complete remission for this complex, severe patient, in addition to being able to reduce the concomitant medication. Side effects were easy to manage, transient and self-limiting at the time of administration. As described in the SmPC and the intranasal esketamine therapeutic positioning report, treatment must be administered in an appropriate clinical setting (either a hospital or as an outpatient), with the necessary resources for administration and subsequent observation of the patient.