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. 2025 Jul 1.
doi: 10.1007/s00406-025-02041-9. Online ahead of print.

Intranasal esketamine significantly alleviates depression severity and suicidal ideations in electroconvulsive therapy (ECT) non-responders

Erhan Kavakbasi  1   2 , Kevin Rosemann  3 , Mert Yilmaz  3 , Helmut Berndt  3 , Bernhard T Baune  3   4   5
Affiliations

Intranasal esketamine significantly alleviates depression severity and suicidal ideations in electroconvulsive therapy (ECT) non-responders

Erhan Kavakbasi et al. Eur Arch Psychiatry Clin Neurosci. .

Abstract

Introduction: Intranasal esketamine (ESK) is a novel therapy option in patients with treatment-resistant depression (TRD). Patients with a history of electroconvulsive therapy (ECT) non-response (ECT+) in the current episode have usually been excluded from previous studies. Data on the effectiveness of ESK in ECT non-responders are sparse.

Methods: In this retrospective study, we investigated the effectiveness of intranasal ESK in real-world inpatients with (ECT+, n = 39) history of ECT non-response compared to patients who have not received an adequate course of ECT in their current episode (ECT-, n = 57). A factorial analysis of variance (ANOVA) has been used to determine the impact of ECT non-response on treatment outcome.

Results: A total of n = 96 patients (mean age 47.0; 52.1% women) with TRD were included in this study. There was a significant main effect of history of ECT non-response on MADRS score in the ANOVA (F = 10.386, p = 0.002). However, there was no significant interaction effect of time (pre-treatment, post-treatment)*history of ECT non-response in current episode (F = 2.166, p = 0.143). The response (34.9% vs. 21.9%, χ2 = 1.498, p = 0.167) and remission rates (24.4% vs. 12.1%, χ2 = 1.861, p = 0.141) were none significantly lower in the ECT + group than in the ECT- group. There was significant improvement in MADRS and BDI-II in the ECT + group. No major safety concerns occurred during the study.

Conclusion: There was no significant impact of ECT non-response on esketamine treatment outcome. Our results support the approach to offer esketamine to ECT non-responders given that the array of treatment alternatives is limited for these patients.

Keywords: Electroconvulsive therapy; Esketamine; Major depressive disorder; Novel antidepressants; Treatment resistant depression.

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Conflict of interest statement

Declarations. Conflict of interest: EK received speaker and advisor honoraria from LivaNova and Janssen-Cilag. BTB received speaker/consultation fees from: AstraZeneca, Lundbeck, Pfizer, Takeda, Servier, Bristol Myers Squibb, Otsuka, LivaNova, Biogen, Angelini and Janssen-Cilag.

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