Esketamine for treatment-resistant depression: Comparing two maintenance schedules in an observational real-world study
Research Square July 9, 2026 Samuel Westenhöfer, Yamina Ehrt, Barbora Provaznikova et al.
For people with treatment-resistant depression, intranasal esketamine significantly reduced depressive symptoms during an initial four-week induction phase. After induction, two different maintenance schedules—one with a front-loaded pattern and one with a spaced interval-extension pattern—were compared. No significant differences in depressive symptom trajectories were observed between the two schedules over the maintenance period. By the end of maintenance, response rates were 35.3% on the clinician-rated scale and 26.0% on the self-report scale; remission rates were 31.4% and 38.0%, respectively. These results suggest that maintenance dosing intervals may be scheduled flexibly without loss of efficacy, though the retrospective, observational design and small sample size warrant caution.