Efficacy of intranasal esketamine versus rTMS for treatment-resistant depression: analysis of individual participant data from two clinical trials.
EClinicalMedicine December 1, 2025 Tyler S Kaster, Yi Dai, Fidel Vila-Rodriguez et al. 5 citations
Both repetitive transcranial magnetic stimulation (rTMS) and intranasal esketamine are more effective than starting a new antidepressant medication for treatment-resistant depression. In a secondary analysis of individual patient data from two clinical trials involving 282 matched participants, rTMS reduced depression severity scores by 5.35 points and esketamine by 2.89 points more than medication alone. The difference between rTMS and esketamine was not statistically significant, but the results suggest rTMS may be at least as effective as esketamine. The analysis highlights the need for direct head-to-head trials comparing these two interventions.