4CPS-042 Experience with intranasal esketamine in treatment-resistant depression

<h3>Background and Importance</h3> Major depressive disorder (MDD) is the most common mental illness and is one of the global causes of disability. Intranasal esketamine is a new approved alternative for treatment-resistant MDD (TRD), in combination with selective serotonin (SSRI) or serotonin and norepinephrine (SNRI) reuptake inhibitors. Hospital-administered medication that requires 90’ of observation to control temporary side effects. MADRS scale calculates the change in the intensity of depressive symptoms as a result of the treatment. <h3>Aim and Objectives</h3> Evaluate the effectiveness and safety of intranasal esketamine for treatment-resistant depression. <h3>Material and Methods</h3> This retrospective observational study included patients with TRD treated with esketamine (January 2023 to February 2024) according to the technical data sheet. Demographic, clinical and treatment data were collected. Per protocol, follow-up data are collected at 4, 8 and 28 weeks after baseline. Effectiveness was defined as follows; remission was considered if MADRS≤12, response to treatment if reduction ≥50% and partial response if reduction ≥35% and ≤49 on the baseline MADRS, taking into account patients with at least one value of MADRS follow-up. <h3>Results</h3> 43 patients (63% women, 55 years ±9.27) with TRD in treatment with esketamine were included. Predominant symptoms were anhedonia, apathy, anxiety and insomnia. 25 (58.1%) had psychiatric comorbidities such as personality disorders. Concomitant antidepressant were SSRI (37.21%), SNRI (51.16%), antipsychotics (51.16%) and others (48.84%). Considering the 34 patients with at least one follow-up MADRS value, the treatment was effective in 18 (52.94%) patients: 6 (17.67%) remission, 10 (29.4%) response and 7 (20.59%) partial response. The mean MADRS reduction was 15.66 (SD 11.56). Regarding treatment discontinuation, 12 (27.90%) patients uncomplete the treatment: 4(9.30%) due to patient decision, 4 (9.30%) due to unacceptable toxicity, 2 (4.65%) due to loss of response and 2 (4.65%) by referral. The treatment was generally well tolerated. Most adverse effects were temporary and occurred during the administration. For patients who experienced unacceptable toxicity, the notable issues included vasovagal symptoms, nightmares, and nasal bleeding. <h3>Conclusion and Relevance</h3> Approximately 60% of patients had psychiatric comorbidities. Moderate/high effectiveness where more than 50% of patients have presented remission and/or response. Regarding safety, esketamine is generally well tolerated, though it does require hospital observation and some patients may experience adverse effects during administration. A longer follow-up is necessary to provide more effectiveness and safety data. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest