Systematic review and meta-analysis of intranasal esketamine for treatment-resistant depression: Evidence from real-world studies.
Journal of affective disorders January 28, 2026 Clara De Oliveira Lapa, Thiago Viola, Rodrigo Delfino et al. 3 citations
Intranasal esketamine substantially reduces depressive symptoms and increases remission rates over time in patients with treatment-resistant depression treated in routine clinical practice. A meta-analysis of nine observational studies found a large effect size (Hedges' g = -1.98) and that patients were about five times more likely to achieve remission at three months compared with the induction phase (odds ratio = 5.1). Treatment effectiveness was not influenced by gender or the presence of anxiety, personality, or substance use disorders. Any adverse event occurred in 82% of patients, most commonly dissociation (49%). The findings support esketamine's effectiveness and tolerability in real-world settings, though the observational design and lack of control groups warrant cautious interpretation.