INTRANASAL ESKETAMINE AND MAOI COMBINATION IN THE MANAGEMENT OF TREATMENT-RESISTANT DEPRESSION: A CASE REPORT

Abstract

Introduction: Treatment-resistant depression (TRD) represents a significant clinical challenge, particularly when associated with suicidal ideation. Intranasal esketamine has emerged as an effective therapeutic option in refractory cases, while monoamine oxidase inhibitors (MAOIs) remain relevant in the management of severe and resistant conditions.

Objective: To describe the clinical course of a patient with TRD treated with the combination of intranasal esketamine and tranylcypromine.

Method: Case report of a 27-year-old female patient diagnosed with recurrent depressive disorder and a history of therapeutic failure to multiple classes of antidepressants, mood stabilizers, and antipsychotics, followed through clinical evaluation and standardized rating scales (HAM-A and MADRS).

Results: After initiation of the combined treatment, a rapid and sustained clinical improvement was observed, with significant reduction of depressive and anxiety symptoms, as well as remission of suicidal ideation. The treatment was well tolerated, with no relevant adverse events.

Conclusion: The association of intranasal esketamine and a MAOI proved to be effective and safe in this case of TRD, suggesting that it may represent a viable therapeutic alternative in selected situations, provided that strict clinical monitoring is ensured.