Repeated intranasal esketamine augmentation in treatment-resistant obsessive-compulsive disorder with comorbid major depressive disorder: a prospective case series.
BMC psychiatry April 26, 2026 Sergi López-rodríguez, Cinto Segalàs, Eva Real et al.
In eight adults with treatment-resistant obsessive-compulsive disorder and comorbid major depressive disorder, twelve weeks of intranasal esketamine (56-84 mg per session) substantially improved depressive symptoms, with MADRS scores decreasing by 48.8%. Obsessive-compulsive symptoms showed a more modest and heterogeneous reduction, with Y-BOCS scores decreasing by 30.3%. Half of participants achieved depression response, and half met OCD response criteria. Depressive symptoms improved earlier, while OCD symptoms followed a slower and more variable trajectory. These preliminary findings suggest that repeated intranasal esketamine may offer a therapeutic window for this severe subgroup, supporting further controlled studies.