USE OF INTRANASAL KETAMINE IN THE TREATMENT OF TREATMENT-RESISTANT DEPRESSION: CURRENT EVIDENCE ON EFFICACY AND SAFETY

Authors

  • Valéria Goulart Viana
  • Dário Rodrigo Salvador de Lima
  • Denis Rossanez Rodrigues
  • João Gonçalves Simões Filho
  • Sara Regina de Jesus Bandeira
  • Carlos Alberto Barbieri
  • Ariane de Souza Alves
  • Laura Leme de Araujo Rodrigues da Silva
  • Luís Antonio dos Santos da Silva
  • Jemina Vieira e Freitas Lourenço
  • Thiago Moreira Goivinho
  • Marcel dos Santos Gonçalves
  • Dieniffer Rios Viana
  • Matheus Maciel de Oliveira
  • Mayara Gazolla Ribeiro
  • Luís Henrique Oliveira de Moura
  • Fernanda Costa Rodrigues
  • Giovana Mitie Bansho
  • Mauro Ricardo Junior
  • Allan Jacques Garcia
  • Lucas Rodrigues Gato Gonzalez

Keywords:

Ketamine, Treatment-Resistant Depression, Esketamine, Intranasal Administration, Psychiatry

Abstract

Treatment-resistant depression (TRD) remains one of the most challenging conditions in modern psychiatry, defined by the lack of satisfactory response to at least two adequate antidepressant regimens. In this context, ketamine—particularly its S-enantiomer (esketamine)—has emerged as a rapid-acting and innovative therapeutic alternative. This integrative review aimed to critically evaluate current evidence regarding the efficacy and safety of intranasal ketamine in TRD management. Literature searches were conducted across PubMed, Scopus, Web of Science, and SciELO databases between 2014 and 2025, including randomized controlled trials, systematic reviews, and meta-analyses. Findings indicate that intranasal esketamine produces significant antidepressant effects within 24–48 hours, with higher response and remission rates compared to placebo. The safety profile was favorable, with predominantly mild and transient adverse events such as dissociation, dizziness, and transient blood pressure increases. Long-term studies (SUSTAIN-1 and SUSTAIN-3) confirmed sustained efficacy and no cumulative toxicity. Despite these encouraging outcomes, questions remain regarding optimal dosing protocols, duration of therapeutic effects, and combination strategies with other treatments. Overall, intranasal esketamine represents a major therapeutic advancement for treatment-resistant depression, provided it is administered under strict medical supervision and evidence-based clinical protocols.

DOI: https://doi.org/10.56238/sevened2025.037-011

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Published

2025-10-31

Issue

Contemporary Dialogues in Health Sciences - 2° Edição

Section

Articles

License

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

How to Cite

Viana, V. G., de Lima, D. R. S., Rodrigues, D. R., Simões Filho, J. G., Bandeira, S. R. de J., Barbieri, C. A., Alves, A. de S., da Silva, L. L. de A. R., da Silva, L. A. dos S., Lourenço, J. V. e F., Goivinho, T. M., Gonçalves, M. dos S., Viana, D. R., de Oliveira, M. M., Ribeiro, M. G., de Moura, L. H. O., Rodrigues, F. C., Bansho, G. M., Ricardo Junior, M., … Gonzalez, L. R. G. (2025). USE OF INTRANASAL KETAMINE IN THE TREATMENT OF TREATMENT-RESISTANT DEPRESSION: CURRENT EVIDENCE ON EFFICACY AND SAFETY. Seven Editora, 131-148. https://sevenpubl.com.br/editora/article/view/8360