# Esketamine for Treatment-Resistant Depression: A Case Series and Literature Review

## TL;DR

This paper explores the use of esketamine for treating depression that doesn't respond to other therapies, including electroconvulsive therapy.

## Contribution

The study presents real-world case reports and a literature review on esketamine's potential for treatment-resistant depression.

## Key findings

- Three out of four patients showed significant symptom improvement with esketamine.
- Only one patient experienced long-term benefits due to side effects.
- Esketamine may be a viable option for patients who failed electroconvulsive therapy.

## Abstract

Management of treatment-resistant depression (TRD) is complex and frustrating for patients, requiring several treatment courses before (or without) achieving remission. This investigation aims to highlight and analyze real-world instances of using esketamine for patients with TRD who have failed electroconvulsive therapy (ECT).

Four case reports from a single Hackensack-Meridian care center are described in detail. They, along with a literature review, were then used to drive a narrative discussion on the potential of esketamine as a TRD therapy. Of the four cases analyzed, three patients experienced significant improvement in symptoms. However, largely due to side effects, only one case resulted in effective long-term treatment using esketamine.

Given that all four patients previously failed ECT, these results are encouraging. Even a humble success rate may inspire hope in a patient population that is largely considered intractable using current methodology. This study found that esketamine is a viable alternative for some patients suffering from TRD. This even remains true in some of our patients who have failed ECT - one of the more effective, more aggressive therapies for TRD.