A systematic review and meta-analysis of five randomized controlled trials found that esketamine nasal spray, compared to a control treatment, significantly reduced depression severity measured by the MADRS scale, increased the rate of response, and improved functioning and depressive symptoms on the Sheehan Disability Scale and PHQ-9. However, it also led to more dizziness and nausea. The results suggest esketamine nasal spray is beneficial for treatment-resistant depression.
A 55-year-old woman with depressive catatonia, who had a poor response to initial treatment with benzodiazepines and aripiprazole and could not receive modified electroconvulsive therapy due to deep vein thrombosis, was given a single sub-anesthetic dose of intravenous esketamine (0.2 mg/Kg) combined with desvenlafaxine. Catatonia symptoms, measured by the Bush-Francis Catatonia Rating Scale, dropped from 19 to 0 within 4 hours. Depressive symptoms, measured by the Montgomery-Åsberg Depression Rating Scale, fell from 46 to 9 at 48 hours, and the improvement remained stable over 20 weeks. Esketamine may offer a rapid and safe option for catatonic patients who cannot undergo electroconvulsive therapy or do not respond to conventional treatment.