Esketamine-Induced acute transient psychotic episode in treatment-resistant depression: A case report

The approval of intranasal esketamine offers a novel therapeutic avenue for managing treatment-resistant depression (TRD), albeit concerns regarding its potential side effects persist. We present a case of esketamine-induced acute transient psychotic episode in a 55-year-old male with TRD who had no history of psychosis or substance abuse. The patient had a long history of depression with relapses after initial response to antidepressants or ECT (Electroconvulsive Therapy). In the recent treatment, esketamine was added to ongoing treatment with venlafaxine 300 mg/day and olanzapine 10 mg/day. Forty-eight hours after esketamine administration, he exhibited acute psychotic symptoms requiring emergency intervention. Subsequent treatment adjustments and electroconvulsive therapy led to partial remission. This case underscores the potential risk of psychosis associated with esketamine and highlights the need for further research into its short- and long-term adverse effects. Factors such as patient history, monitoring protocols, and optimal treatment duration remain uncertain, emphasizing the importance of careful patient selection and monitoring when using esketamine for TRD management.