Esketamine nasal spray in routine care: 50 patients with treatment-resistant depression tracked

The question

How do people with treatment-resistant depression actually fare on esketamine nasal spray in everyday clinical practice, and what predicts who responds?

What they did

Researchers looked back at the records of 50 adults (52% women) treated at three Spanish centres. All had treatment-resistant depression, meaning their depression had not improved after multiple standard treatments, and all completed at least the initial (induction) phase of esketamine nasal spray. Depression severity, day-to-day functioning and suicide risk were rated at the start and at weeks 2, 4, 8, 12, 16 and at discharge, using standard clinician scales.

What they found

Depression and functioning scores improved significantly at every time point (all p < 0.001), with marked gains between weeks 8 and 16, during the dose-optimization phase. The median time to response was 8 weeks and to remission 16 weeks. At the last available assessment, 70% met criteria for response and 68% for remission. Suicide risk categories shifted toward lower risk early on, and no suicide attempts occurred during monitored treatment. Patients rated as more treatment-refractory at baseline had lower odds of response (odds ratio 0.50, 95% confidence interval 0.29-0.86) and remission (0.59, 0.36-0.97). Among those discharged, 86% remained clinically stable over roughly 10 months.

The fine print

This was a retrospective chart review with no comparison group and no placebo, so improvement over time cannot be attributed to esketamine alone; natural fluctuation, other medications and therapy may all contribute. Only 50 people were included, and only those who completed the induction phase, which can make results look more favourable. The abstract does not report side effects or dropout details. This summary is based on the abstract alone.

What it means

In everyday clinical practice, people with treatment-resistant depression taking esketamine nasal spray showed steady improvement, with much of the gain appearing after the first weeks of treatment, but the study design cannot prove the drug caused it.

Evidence grade: Low. A retrospective observational cohort with no control group, no blinding and a small sample, so improvement cannot be separated from other influences.

This summary is based on the study’s published abstract.