Intravenous esketamine in treatment-resistant depression

Background:
Treatment-resistant depression (TRD) is a severe psychiatric condition associated with high morbidity and increased suicide risk. Standard antidepressant therapies often fail, necessitating alternative approaches. Intravenous esketamine has emerged as a rapid-acting treatment for TRD.

Objective:
To provide a concise clinical protocol for the administration of intravenous esketamine in patients with TRD, outlining indications, contraindications, monitoring, dosing, and management of adverse effects.

Methods:
Patients with inadequate response to at least two antidepressants or with severe suicidal ideation may receive intravenous esketamine under strict psychiatric supervision. Treatment is administered in a monitored inpatient setting, with continuous observation of vital signs. Adverse effects are managed symptomatically, and laboratory monitoring includes renal and liver function every three months. Dosing is individualized, typically starting at 25 mg every two weeks, with escalation to 37.5–50 mg or increased frequency as needed.

Results:
Intravenous esketamine demonstrates rapid antidepressant effects, with improvement in depressive symptoms often within hours. Most adverse effects (e.g., hypertension, dissociation, nausea) are transient and reversible. Chronic use requires monitoring for hepatic and urinary complications.

Conclusion:
Intravenous esketamine is a safe and effective option for selected patients with TRD when administered in a controlled, multidisciplinary setting. This protocol ensures structured, evidence-based application while minimizing risk.

To be updated shortly..