In a real-world clinical setting, intranasal esketamine and accelerated repetitive transcranial magnetic stimulation (rTMS) showed comparable effectiveness for treatment-resistant depression. Both treatments led to significant reductions in depressive symptoms, with no statistically significant difference between the two approaches. The findings suggest that either option can be a viable fast-acting intervention for patients who have not responded to prior treatments.
In a small retrospective study of 16 patients with treatment-resistant depression treated with intranasal esketamine, those who responded to treatment after 7 months had higher baseline neutrophil-to-lymphocyte ratios (NLR) than non-responders (1.81 vs. 1.23). The difference remained significant after adjusting for age. The findings suggest that a patient's inflammatory status before treatment may influence their response to esketamine, but the small sample and retrospective design limit confidence. Larger prospective studies are needed to clarify whether inflammatory markers can predict esketamine response.