Neurocognitive changes in a patient receiving esketamine for treatment-resistant depression.

Esketamine, approved in 2019 as a rapid-acting intranasal spray for treatment-resistant depression, is self-administered under clinical supervision and generally well tolerated, with mild, temporary, and dose-dependent adverse reactions that improve over time. Although difficulty remembering or thinking is listed as a possible adverse reaction, neurocognitive evaluation is not part of initial patient assessment. This case report describes a patient whose neurocognitive symptoms worsened with esketamine treatment, leading to discontinuation of the therapy.

Study at a glance

Abstract

Esketamine, the s(+) enantiomer of ketamine, was approved in 2019 as the first rapid-acting intranasal spray medication for treatment-resistant depression; the drug is given in combination with an antidepressant. The treatment is self-administered in a clinical setting under the supervision of a healthcare provider and usually is well tolerated. Many of its adverse reactions are mild, temporary, and dose-dependent, and they improve with subsequent treatments. Although the prescribing information lists difficulty remembering or thinking as possible adverse reactions, a neurocognitive evaluation is not part of the initial patient evaluation. This case report focuses on a patient whose neurocognitive symptoms worsened with esketamine treatment, necessitating treatment discontinuation.