Editorial: Retuning the Adolescent Brain: Esketamine and Rapid Structural Change in the rACC.
Journal of the American Academy of Child and Adolescent Psychiatry March 17, 2026 Yunjia Liu, Qiang Wang
Adolescent major depressive disorder is a leading cause of disability and a major risk factor for suicide. For 30% to 50% of patients who do not achieve remission after multiple treatments, consequences are substantial. Selective serotonin-reuptake inhibitors, though first-line, often take weeks to work and many adolescents do not respond, leaving a critical treatment gap. Esketamine, an NMDA receptor antagonist, may provide faster relief than conventional antidepressants, including as a monotherapy for treatment-resistant depression, but its neural mechanisms in the developing brain are not fully understood. Understanding these mechanisms is needed to guide clinical use and targeted prevention.