In the ESCAPE-TRD trial, esketamine nasal spray caused treatment-emergent adverse events more often than quetiapine extended release (91.9% versus 78.0%), but these events were typically mild or moderate and transient: 92.0% resolved the same day, and only 4.2% of patients discontinued esketamine due to adverse events compared with 11.0% for quetiapine. The median proportion of days with adverse events was lower with esketamine (11.9% versus 21.3%). Along with greater efficacy, esketamine's tolerability profile supports its use for treatment-resistant depression.
Among employed adults with treatment-resistant depression, esketamine nasal spray plus an oral antidepressant led to larger reductions in work productivity loss and related costs than quetiapine extended release plus an oral antidepressant. By week 8, total work productivity loss decreased by 30.3 percentage points with esketamine versus 17.3 with quetiapine, a difference of 13.0 percentage points. Weekly cost savings were $363 for esketamine and $207 for quetiapine. By week 32, reductions were 45.3 and 32.5 percentage points, respectively, with weekly cost savings of $543 versus $390. The results suggest greater benefits for both patient well-being and employer perspectives.