University of Tasmania
140092 - Esketamine a new hope.pdf (214.19 kB)

Esketamine: new hope for the treatment of treatment-resistant depression? A narrative review

Download (214.19 kB)
journal contribution
posted on 2023-05-20, 16:26 authored by Mohammed SalahudeenMohammed Salahudeen, Cameron Wright, Gregory PetersonGregory Peterson
This narrative review aims to provide an overview of the current literature on the pharmacology, safety, efficacy and tolerability of intranasal esketamine, the S-enantiomer of ketamine, for the treatment of treatment-resistant depression (TRD). A literature search using Medline, Embase, PsycINFO and Cochrane Central was conducted (January 2000 to July 2019). Product information and were also reviewed. The literature search was limited to human studies published in English. PhaseI, II, and III studies of intranasal esketamine for TRD were reviewed. About a third of patients with major depressive disorder fail to achieve remission despite treatment with multiple antidepressants. This article examines the trials that led to the approval of esketamine in the United States, as well as other recent studies of esketamine for TRD. The findings from limited phaseIII trials illustrate that intranasal esketamine is effective and safe in reducing depressive symptoms and achieving clinical response in patients with TRD. The optimum duration and frequency of use are not fully understood. Although the nasal spray is a convenient dosage form, its use in practice may be limited by cost and administrative regulation. While it may prove beneficial to many patients who suffer from TRD, further long-term data are required, along with comparative trials with the R-isomer (arketamine). In the interim, care and monitoring should be exercised in its use in clinical practice.


Publication title

Therapeutic Advances in Drug Safety








School of Pharmacy and Pharmacology


Sage Publications Ltd.

Place of publication

United Kingdom

Rights statement

Copyright The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (

Repository Status

  • Open

Socio-economic Objectives

Health education and promotion; Mental health