# Mental health professionals’ perspective on the use of esketamine in treatment-resistant depression and their motivation to adopt it: a Saudi cross-sectional study

## TL;DR

This study explores how Saudi psychiatrists view and adopt esketamine for treatment-resistant depression, finding that logistical issues, cost, and concerns about side effects limit its use.

## Contribution

The study provides novel insights into the factors influencing Saudi psychiatrists' adoption of esketamine for TRD, including demographic and motivational factors.

## Key findings

- Only 19.73% of surveyed psychiatrists reported prescribing esketamine, typically to 1–2 patients.
- Logistical barriers, cost, and concerns about administration and side effects were major factors limiting adoption.
- Senior registrars, registrars, and residents were significantly less likely to prescribe esketamine compared to consultants.

## Abstract

Esketamine is an innovative treatment for individuals with treatment-resistant depression (TRD). However, its adoption could depend on the perceptions and motivations of prescribing psychiatrists, among other factors.

This study aims to explore the attitudes of psychiatrists (of all levels, including those in training) across Saudi Arabia toward the use of esketamine for TRD and investigate the motivational factors related to their willingness to adopt it.

This is a cross-sectional study that utilized a convenience sampling method. The study tool consisted of a questionnaire developed by the research team and the Physician-Motivation Adoption Scale.

Of the 223 participants surveyed, 19.73% reported having prescribed esketamine, most commonly to 1–2 patients. The most frequently perceived adverse effects were dissociation/delusions/hallucinations (66.82%), followed by dizziness/vertigo (59.19%). Esketamine prescription was significantly associated with older age (p = 0.049), consultant-level practice (p = 0.003), practice in the Western Region (p < 0.001), lower concern about potential misuse (p = 0.027), perceiving easier access (p = 0.004), and fewer concerns about the administration process (p = 0.007). Ordinal logistic regression demonstrated that senior registrars, registrars, and residents were significantly less likely to prescribe esketamine than consultants (OR = 0.21, 0.17, and 0.10, respectively). “Not being sure” that cost was a barrier was associated with lower odds of prescribing (OR = 0.32, p = 0.022), whereas higher functional subscale scores were strongly associated with willingness to prescribe (OR = 1.62, p < 0.001). The most commonly reported barriers to prescribing esketamine included the administration process (66.37%) and cost (65.02%).

Despite significant interest, actual adoption of esketamine is low, mainly due to logistical barriers, high costs, and availability issues. Concerns about side effects and potential misuse are also linked to hesitation. Accordingly, interventions to address the obstacles and concerns are needed.