Efficacy of intranasal esketamine in resistant depression: a scoping review
DOI:
https://doi.org/10.34024/rnc.2025.v33.19845Keywords:
Intranasal Esketamine, Efficacy, Treatment-Resistant Depression Disorder, Drug TherapyAbstract
Introduction. Treatment-resistant depression (TRD) is defined as a depressive condition that does not achieve remission despite the use of two antidepressants from different classes. In this context, intranasal esketamine emerges as a potential alternative to alleviate this condition. Objective. To analyze the efficacy of intranasal esketamine in the management of TRD. Method. The research question was developed using the Population/Concept/Context (PCC) methodology, and systematic reviews and randomized clinical trials found in the Biblioteca Virtual em Saúde, Clinical Trials, Embase, PubMed, Scielo, and Scopus databases were analyzed. Results. A total of 276 articles were identified, of which 12 were included based on defined criteria. Intranasal esketamine showed greater efficacy when administered in fixed doses of 56 mg and 84 mg, particularly within 24 hours after administration, while flexible doses or fixed dose of 28 mg demonstrated statistical insignificance and clinical inferiority. Furthermore, clinical stabilization, relapse prevention, and a rapid reduction in suicidal thoughts were observed. However, gaps remain in the literature regarding the long-term efficacy of the medication, treatment discontinuation, and the risk of abuse. Conclusion. Intranasal esketamine demonstrated rapid clinical efficacy within the first hours of administration, particularly with the use of doses of 56 mg and 84 mg. Nevertheless, further studies are needed to evaluate the long-term efficacy of the compound and with larger samples, in order to better assess potential new therapeutic pathways.
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Copyright (c) 2025 Giovana Medeiros Guerra, Lara de Freitas Barros Galvão, Maria Clara Cavalcanti de Siqueira, Mirela Pinheiro Pinto do Rêgo, Rodrigo Botelho Florentino, Pedro Guilherme Gouveia de Oliveira, Hugo Rafael de Souza e Silva
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