Intranasal Esketamine for Treatment-Resistant Depression with Structural Brain Abnormality: A Case Report
Psychiatry and Clinical Psychopharmacology November 13, 2025 Yu-Chih Shen, Chien-Chen Hung
A 61-year-old woman with treatment-resistant depression, a history of poor response to electroconvulsive therapy, and structural brain damage from a traumatic brain injury received four doses of intranasal esketamine over two weeks. Her depression severity, measured by the Montgomery-Åsberg Depression Rating Scale, improved from severe to mild, suicidal thoughts resolved, anxiety decreased, and nightmares stopped. She experienced only transient dizziness after each dose, with no severe side effects. This single case suggests esketamine may help carefully selected patients with similar complex histories, but larger studies are needed to confirm.