Real-world comparison of intranasal racemic ketamine and esketamine in treatment-resistant depression: A retrospective observational study.
Journal of affective disorders January 21, 2026 Jan Sarlon, Deanne Thomi, Annette B Brühl et al. 1 citation
Intranasal racemic ketamine is non-inferior to esketamine for reducing depression symptoms in adults with treatment-resistant depression, with comparable symptom improvement over four weeks. However, remission rates were higher with esketamine (38.7%) than with racemic ketamine (15.6%), and racemic ketamine failed to meet non-inferiority for remission. Safety profiles were similar, though racemic ketamine caused slightly more transient blood pressure elevations. Racemic ketamine may be a cost-effective alternative where esketamine access is limited, but higher remission with esketamine warrants further study.