Adding cognitive behavioral therapy to esketamine treatment reduces suicidal ideation more than esketamine alone in people with major depression and suicidal thoughts. In a randomized trial of 93 patients, 72% completed the study, meeting feasibility goals. Those who received 16 weeks of CBT plus esketamine showed greater improvement on three measures of suicidal ideation than those receiving esketamine with usual care: a mean difference of -1.91 on the Beck Scale for Suicidal Ideation, -0.33 on the Clinician Global Improvement Scale for Suicide Severity, and -3.77 on the depression rating scale. No difference was found on the Columbia-Suicide Severity Rating Scale or in suicide-related events.
Reddit posts about treatment-resistant depression (TRD) show that 72.1% of medication mentions are neutral, 14.8% negative, and 13.1% positive. Conventional antidepressants, especially SSRIs and SNRIs, receive consistently more negative than positive sentiment, while ketamine and esketamine have comparatively more favorable sentiment profiles. The study analyzed 5,059 Reddit posts from 3,480 subscribers across 28 mental health subreddits from 2010 to 2025, extracting 23,399 mentions of 81 medications. An aspect-based sentiment classifier fine-tuned on DeBERTa-v3 achieved a micro-F1 score of 0.800. These large-scale patient narratives offer a complementary view to clinical trials on medication tolerability and effectiveness.