A six-month observational study of 36 patients with treatment-resistant depression found that those with poor mentalization abilities at the start had more severe depressive symptoms throughout treatment with esketamine. Greater cognitive rigidity appeared protective, possibly by stabilizing emotions and reducing negative thinking. The findings suggest esketamine may help break cognitive inflexibility and improve mentalization, supporting a personalized approach to treatment-resistant depression.
Intranasal esketamine rapidly reduces suicidal ideation and depressive symptoms in patients with treatment-resistant depression. Suicidal ideation scores dropped from 1.56 at baseline to 0.78 after one week and to 0.12 after six months. Depressive symptoms improved from a mean Montgomery-Åsberg Depression Rating Scale score of 30.9 at baseline to 17.5 after one week and 9.8 after six months. Male gender was a negative predictor of response; no other baseline variable predicted outcomes. The findings suggest intranasal esketamine is effective for rapid reduction and resolution of suicidal ideation in this population, and gender differences should be considered in treatment planning.