Practical recommendations for the management of treatment-resistant depression with esketamine nasal spray therapy: Basic science, evidence-based knowledge and expert guidance

Summary

Esketamine nasal spray, an NMDA glutamate receptor antagonist, offers a fast-acting treatment option for patients with treatment-resistant depression (TRD) who have not responded to several prior therapies. A group of six European experts with clinical experience using esketamine nasal spray developed consensus statements on practical considerations before, during, and after administration. The guidance is based on their experience and available literature, aiming to help clinicians unfamiliar with the treatment. Further real-world use is expected to expand existing knowledge.

Study at a glance

Abstract

OBJECTIVES: -methyl-d-aspartate (NMDA) glutamate receptor antagonist, is a novel, fast-acting option in this patient population. This manuscript provides expert guidance on the practicalities of using esketamine nasal spray. METHODS: A group of six European experts in major depressive disorder (MDD) and TRD, with clinical experience of treating patients with esketamine nasal spray, first generated practical recommendations, before editing and voting on these to develop consensus statements during an online meeting. RESULTS: The final consensus statements encompass not only pre-treatment considerations for patients with TRD, but also specific guidelines for clinicians to consider during and post-administration of esketamine nasal spray. CONCLUSIONS: Esketamine nasal spray is a novel, fast-acting agent that provides an additional treatment option for patients with TRD who have previously failed several therapies. The guidance here is based on the authors' experience and the available literature; however, further real-world use of esketamine nasal spray will add to existing knowledge. The recommendations offer practical guidance to clinicians who are unfamiliar with esketamine nasal spray.