Three patients with cancer, treatment-resistant depression, and suicidal ideation received intranasal esketamine (Spravato®) at a palliative care clinic. After treatment, all three had substantial reductions in depression severity and no further suicidal ideation, with improvements lasting up to a year. No serious adverse events occurred. The cases suggest intranasal esketamine may be a useful option for treating depression and suicidal thoughts in palliative care.
Loss of meaning is a hallmark of demoralization syndrome, a prevalent condition in palliative care linked to diminished quality of life, increased symptom burden, and higher suicide risk. Existential psychological interventions improve psychosocial outcomes, but evidence for their effect on demoralization is limited. Psychedelic therapies, which enhance meaning-making and integrate existential approaches, show promise for existential distress and demoralization in early clinical trials. Novel combined pharmacological and psychological interventions like psychedelic therapy warrant further investigation.