Esketamine in resistant depression: a case report

In a 62-year-old patient with treatment-resistant major depressive disorder, intranasal esketamine led to marked improvement. From the fifth administration onward, the patient showed clear progress. At three months, the MADRS depression scale score dropped from a baseline of 46 to 14, and at six months to 1, indicating euthymia. The only adverse effect was very mild dizziness after each dose. This case suggests that esketamine can be a fast, safe, and well-tolerated option for patients who do not respond to other treatments.

Study at a glance

Abstract

Introduction Major depressive disorder is a common psychiatric condition affecting around 264 million people worldwide (WHO: Depression Fact Sheet. [Apr;2021]). Despite pharmacological advances, many patients still do not respond to antidepressant treatment or do so partially. It is estimated that only 50-70% of patients respond to the initial antidepressant treatment according to the STAR-D study. 15% percent of cases do not respond significantly to various pharmacological and psychotherapeutic attempts (Rush AJ et. STAR*D report. al Am J Psychiatry). The current consensus places resistant depression for a practical approach in one that has been treated with two different antidepressant strategies in adequate doses and time and has not been remitted (Souery D et el, Treatment-resistant depression. J Clin Psychiatry 2006). We present a clinical case of a patient with Major Depressive Disorder, resistant to several therapeutic lines, in which intranasal esketamine was initiated. Objectives The main objective is to report the result of treatment with esketamine in a clinical case. Methods This work analyze the clinical evolution and reponse of a 62-year-old patient after initiating intranasal esketamine. This is a patient with a single depressive episode, with no personal psychiatric history of interest that, after exhausting several options of pharmacological and non-pharmacological treatment. Regulated psychotherapy based on cognitive behavioral therapy was carried out along with different pharmacological strategies according to the recommendations of the main clinical guidelines: antidepressant dose increase, antidepressant change, combination of several antidepressants and potentiation with another drug. We measured clinical changes with MADRS Scale (Montgomery-Asberg Depression Rating Scale) at diferent times. Results From the fifth administration of esketamine the patient presented a clear improvement. At three months, the score on the MADRS scale improved markedly and at 6 months, the patient reported euthymia. Score MADRS: - Basal 46 - 3 Months 14 - 6 Months 1 As for the adverse effects, the patient presented in all administrations very mild dizziness. Conclusions The use of esketamine is a new therapeutic approach, being fast, safe and well tolerated in patients with depression who do not respond to other treatments (Sapkota A et al. Efficacy and Safety of Intranasal Esketamine in Treatment-Resistant Depression in Adults: A Systematic Review. Cureus.2021 Aug 21;13(8)). In our patient has proven to be effective and fast. Disclosure of Interest None Declared