EFFICACY OF THE USE OF ESCETAMINE NASAL SPAY IN THE TREATMENT OF TREATMENT-RESISTANT DEPRESSION IN ADULTS: A SYSTEMATIC REVIEW

Resumo

Inadequate response or la ck of response to antidepressants defines treatment -resistant depression (TRD). Evidence clearly shows that the use of esketamine is associated with a very significant reduction in the severity of depressive symptoms, with nasal administration being a key advantage. This study carefully evaluated the efficacy of intranasal esketamine in the treatment of TRD in adults. This is a systematic literature review based on the PRISMA protocol, with a search in PubMed. Randomized controlled trials published between 2010 and 2025, in English, Portuguese, or Spanish, were included. Of the 21 studies found, 11 met the eligibility criteria. Nasal esketamine proved much safer and more tolerable than quetiapine XR, with notably greater adherence and rapid remission of symp toms. The 56 mg spray resulted in especially significant symptomatic improvement in the TRD, with a highly effective maintenance dose to prevent relapses (p = 0.003). Combination with oral antidepressants was more effective than monotherapy, including in c ases with associated anxiety. With an NNT (Number Needed to Treat) <10, the study strongly suggested clear benefits for both acute treatment and maintenance. Regarding affective/anhedonic symptoms, anxiety/vegetative symptoms, and hopelessness on the MADRS scale, the combined treatment showed significant improvement. Adverse effects were reported; however, the clinical benefits and safety of the medication stand out. The use of esketamine nasal spray is effective in treating TRD in adults, consistently prom oting patient adherence and reporting partial relief of depressive symptoms, as well as reducing the risk of relapse and increasing the chances of remission.