Esketamine in Treatment-Resistant Depression and Suicidal Ideation: A Systematic Review
Journal of Education Health and Sport November 29, 2025 Natalia Dudziak, Zuzanna Drozd, Bartosz Niemiec et al.
Esketamine nasal spray rapidly reduces depressive symptoms and suicidal ideation, with effects appearing within hours and lasting benefits. In the ASPIRE II trial, a dose of 84 mg outperformed placebo at 24 hours, with a 15.7-point versus 12.4-point reduction on the MADRS depression scale. Among 456 patients, response rates were 34.5% versus 25.3%, and remission rates were 20.4% versus 9.8% at 24 hours. Compared to quetiapine, esketamine achieved 27.1% versus 17.6% remission at week 8. Long-term data from 1,148 patients over 31.5 months showed 0.361 suicide attempts and 0.036 deaths per 100 patient-years. Common side effects include dizziness (38–47%), nausea (27–33%), and transient dissociation; 4–11% discontinued treatment.