Esketamine

The case report demonstrates the successful outpatient treatment of a patient with treatment-resistant depression (TRD). Although modern medicine already offers a whole range of antidepressants, we still often encounter a delayed clinical onset of effect in the range of three to six weeks, insufficient effectiveness or intolerance of treatment, which are a significant limit for effective treatment. The result is a certain percentage of patients who do not achieve remission or a long-term reduction of symptoms even after exhausting all available treatment options – a combination of antidepressants, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), chronotherapy, etc.

In contrast, with esketamine, a prompt effect and acute immediate relief from depressive symptoms is recorded including suicidal thoughts or plans to commit suicide (1). The positive effects of esketamine treatment are demonstrated by the presented case report of the patient XY, in whom the occurrence of symptoms of a depressive illness decreased rapidly after starting treatment with Spravato. One month after starting treatment, her score on the MADRS (Montgomery Asberg depression rating scale) dropped from 32 to 18 points. However, the patient reported a subjective improvement in her condition already after the second application of the drug. The presented case report also demonstrates the long-term effect of the treatment, as after two months of using Spravato, as the MADRS score remained stable at 18 points after two months of use.

Keywords: treatment-resistant depression, esketamine, Spravato, case study.