Case Report: Intranasal esketamine and accelerated intermittent theta-burst stimulation for severe treatment-resistant depression with suicidal ideation
Frontiers in Psychiatry July 1, 2026 Chun-Hung Chang, Yu-Der Hsia, W Liu et al.
A 29-year-old woman hospitalized for severe depression with high-risk suicidal ideation, who had not responded to multiple antidepressants, psychotherapy, and standard transcranial magnetic stimulation, received a combination of intranasal esketamine (84 mg) and an accelerated schedule of intermittent theta-burst stimulation (iTBS) over four days. Her depressive symptoms improved, with scores on the Patient Health Questionnaire-9 dropping from 15 to 11, the Hamilton Depression Rating Scale from 27 to 20, and the Beck Depression Inventory from 41 to 28. Suicidal ideation also improved, and gains were maintained at a two-week follow-up. The case suggests the combined treatment is feasible for inpatient settings, though controlled studies are needed.