Adjunctive Intranasal Esketamine for Comorbid Treatment-Resistant Depression with Suicidal Ideation in Patients Receiving Palliative Care at a Comprehensive Cancer Center: A Case Series.
Mercy TomyWilliam B AlexanderSanjay GuptaDylan SchaeferAmy A CasePublished in: Journal of palliative medicine (2024)
Background: The psychiatric needs of those with cancer and other advanced illnesses are becoming increasingly recognized. Ketamine is emerging as a promising treatment option for depressive disorders in psychiatric and palliative care. In the palliative care setting, its study has been hindered by lack of consistent administration routes and dosing. Intranasal (IN) esketamine (Spravato ® ) has recently received U.S. Food and Drug Administration (FDA) approval as an adjunctive agent for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal ideation (SI). Objective: We sought to offer IN esketamine to patients suffering from TRD and SI at a comprehensive cancer center. Methods: We designed and implemented a protocol to administer IN esketamine and describe three cases in which it was provided to patients with TRD and SI at a palliative care clinic in the United States. Results: Following treatment, all three patients had substantial reduction in depression severity and no further suicidalideation. These improvements were maintained for up to a year. No serious adverse events occurred. Conclusions: These cases illustrate the potential utility of IN esketamine in the palliative care setting.
Keyphrases
- physical activity
- palliative care
- major depressive disorder
- advanced cancer
- sleep quality
- end stage renal disease
- papillary thyroid
- ejection fraction
- chronic kidney disease
- depressive symptoms
- newly diagnosed
- bipolar disorder
- mental health
- peritoneal dialysis
- squamous cell
- prognostic factors
- randomized controlled trial
- squamous cell carcinoma
- drug administration
- primary care
- childhood cancer
- combination therapy
- young adults
- pain management
- stress induced
- ionic liquid