A case study published in the scientific journal Frontiers demonstrates the efficacy and tolerability of intranasal esketamine in a patient with severe treatment-resistant depression associated with psychotic symptoms.
Frontiers in Psychiatry (2022). Intranasal esketamine for severe major depressive disorder with psychotic features: A case report. Available here.
Major depression with psychotic features is one of the most serious and complex clinical manifestations of depressive illness. Characterized by the presence of delusions and/or hallucinations, often associated with persecutory ideation or extreme guilt, this form of depression poses significant challenges to treatment, especially in cases refractory to conventional pharmacological approaches.
A case study published in the journal Frontiers in Psychiatry has reinforced the therapeutic potential of intranasal esketamine as a viable alternative in situations of high therapeutic resistance. The article describes the clinical evolution of a patient diagnosed with severe major depression with psychotic symptoms, who showed a significant response after the introduction of esketamine in a supervised clinical context.
Clinical context
The patient, who had a long history of treatment-resistant depression, had not improved significantly with multiple combinations of antidepressants (including selective serotonin reuptake inhibitors and tricyclic antidepressants) and atypical antipsychotics. After a multidisciplinary assessment, the decision was made to introduce intranasal esketamine, which has been approved for resistant depression in several countries.
Esketamine acts mainly as an NMDA receptor antagonist, promoting a rapid effect on brain neuroplasticity and modulation of circuits involved in mood regulation. Its intranasal formulation allows for supervised administration in a clinical setting, with monitoring of vital parameters and continuous psychiatric assessment.
Clinical results
The response to treatment was rapid and clinically significant. In the first few sessions, there was a marked reduction in depressive symptoms and a gradual alleviation of psychotic manifestations. The patient showed improvements in mood, cognition and overall functionality, maintaining clinical stability over the following weeks.
It should be noted that no serious adverse effects were recorded during the observation period. The transient symptoms observed, such as slight dissociation and dizziness, were self-limiting and controlled in the supervised environment.
Therapeutic implications
This case reinforces the potential of intranasal esketamine as an innovative therapeutic option in contexts of resistant severe depression, particularly when associated with psychotic symptoms - an area where pharmacological options are still limited.
The rapid antidepressant response observed is an important clinical asset, especially in situations where the risk of suicide is high. In addition, the good tolerability profile reinforces the safety of its use, as long as it is used in a controlled environment.
See our esketamine treatment program here.
