Efficacy of Intranasal Esketamine in Treatment-Resistant Depression: A Six-Month Real-World Follow-Up Study of Depressive Symptoms, Hopelessness, and Suicide Risk

Objective: Treatment-resistant depression is one of the most significant clinical challenges in psychiatric practice. The primary aim of the present study was to assess the efficacy and tolerability of intranasal esketamine on depressive symptoms in a real-world outpatient setting. A secondary objective was to explore the potential benefits of intranasal esketamine on hopelessness and suicide risk (suicidal ideation and suicide attempts). Methods: Twenty-one patients diagnosed with treatment-resistant depression were treated with intranasal esketamine. Depressive symptoms (MADRS and BDI), suicide risk (C-SSRS), and hopelessness (BHS) were assessed. We conducted a mixed model for repeated measures analysis to evaluate changes from baseline (T0), 3-month follow-up (T1), and 6-month follow-up (T2). Results: Results indicated that depressive symptoms decreased over time. Specifically, both clinician and self-report measures show lower levels of depressive symptoms at 3-month and 6-month follow-up. We also found a significant decrease in the presence of suicidal ideation between T0 and T2. Finally, patients also reported a reduction in hopelessness levels over time. Conclusions: Our findings indicate an overall response regarding depressive symptoms, hopelessness, and suicidal ideation after esketamine in treatment-resistant depression at 3-month and 6-month follow-up assessments.