Investigating the effectiveness and tolerability of intranasal esketamine among older adults with treatment-resistant depression (TRD): a post-hoc analysis from the REAL-ESK study group

IntroductionTreatment-resistant depression (TRD) is a serious and debilitating psychiatric disorder that frequently affects older patients. Esketamine nasal spray (ESK-NS) has recently been approved as treatment for TRD, with multiple studies establishing its efficacy tolerability. However, the real-world effectiveness, tolerability, safety of this in adults still unclear.ObjectivesTo evaluate tolerability ESK-NS subjects TRD.MethodsThis post-hoc analysis REAL-ESK study, multicenter, retrospective, observational study. Participants here selected were 65 years or at baseline. The Montgomery-Åsberg Depression Rating Scale (MADRS) Hamilton Anxiety (HAM-A) used to assess depressive anxiety symptoms, respectively. Data collected three time points: baseline, one month after start (T1), months (T2).ResultsThe sample included TRD (n=30). MADRS HAM-A values decreased significantly T1 (T0vsT1: pholm<0.001, Cohen's d=0.840) T2 follow-ups (T0vsT2: d=1.419). At T2, 53.3% responders (MADRS score reduced ≥ 50%), while 33.33% remission (MADRS<10). ESK-NS-related adverse effects order frequency dizziness (50%), followed by dissociation (33.3%), sedation (30%), hypertension (13.33%). Six out 30 participants (20%) discontinued treatment.ConclusionsOur findings provide preliminary evidence effectiveness highly presentation. Furthermore, we observe high levels treatment-emergent events, which, majority instances, did not require suspension.