Among 223 psychiatrists surveyed in Saudi Arabia, fewer than 20% had prescribed esketamine for treatment-resistant depression, and most of those had treated only 1-2 patients. The most frequently perceived side effects were dissociation, delusions, or hallucinations (66.82%) and dizziness or vertigo (59.19%). Older age, consultant-level practice, practice in the Western Region, lower concern about misuse, easier perceived access, and fewer concerns about the administration process were significantly linked to having prescribed esketamine. Senior registrars, registrars, and residents were less likely to prescribe than consultants. The main barriers were the administration process (66.37%) and cost (65.02%). Actual adoption remains low despite interest.
In a survey of 283 adults with depression, about half (52.3%) were willing to receive nasal esketamine, and 51.2% preferred its weekly or biweekly dosing over daily antidepressants. However, 79.5% cited cost as a barrier, and major concerns included medication unavailability (59.7%), fear of addiction (50.5%), anticipated stigma (24.4%), and first-month dosing frequency (21.2%). Notably, 77.4% were nonadherent to their current psychiatric medication. Adherence was higher among those who had previously used esketamine and among those who had someone to stay with them during and after treatment. The findings underscore the need for patient education, family involvement, and logistical support to address barriers and improve acceptance.