Case reportClinical experiences with intranasal esketamine for major depressive disorder resistant to treatment and with a psychiatric emergency: case presentationsPompili, Maurizioa; Sarli, Giuseppeb; Erbuto, Denisec; Manfredi, Giovannic; Comparelli, Annac Author Information aDepartment of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome bPsychiatry Residency Training Programme, Faculty of Medicine and Psychology, Sapienza University of Rome cSant’Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy Received 18 September 2022 Accepted 5 December 2022. Correspondence to Maurizio Pompili, MD, PhD, Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035, Rome 00189, ItalyTel. +390633775675; e-mail: [email protected] International Clinical Psychopharmacology ():10.1097/YIC.0000000000000455, January 11, 2023. | DOI: 10.1097/YIC.0000000000000455 Buy PAP Metrics Abstract Recently, esketamine became availableas an intranasal formulation, proposed for treatment-resistant depression (TRD). Three cases of TRD are presented, two with features of a psychiatric emergency. The first case is a 35-year-old man with MDD onset at the age of 27 years, with five previous failed therapies. The second patient is a middle-aged man with a 21-year MDD onset and six previous antidepressant treatments discontinued for poor therapeutic effects and tolerability. He also presented suicidal ideation with intent and a history of a failed suicide attempt by self-cutting his forearms. The third case is a 28-year-old female with a first MDD episode in 2020, treated first with amitriptyline and then with intravenous clomipramine. She had a history of a previous suicide attempt by self-cutting and, by her admission, showed active suicidal ideation with intent. In all three cases, a rapid reduction of depressive symptoms was observed with a subsequent complete resolution of suicidal ideation and intent in the two patients with such risk. Intranasal esketamine treatment was carried out with concomitant oral antidepressant therapy. The third patient reported the only recorded side effect: dissociation 20 min after every esketamine administration. Our preliminary experience proved esketamine’s effectiveness on TRD symptoms and successful outcomes in psychiatric emergencies such as suicide risk. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.