Safety and efficacy of esketamine nasal spray in a depressed patient who was being treated with tranylcypromine: A case report

Background

Treatment of depression with monoamine oxidase inhibitors (MAOIs) is complicated by the risk of drug interactions and possible serotonin syndrome if antidepressants with monoamine enhancement are used concomitantly. Esketamine nasal spray is a recently FDA approved antidepressant for individuals with treatment resistant depression and is to be used adjunctively with antidepressant pharmacotherapy. We report a patient who was successfully and safely treated with esketamine nasal spray while being treated with tranylcypromine.

Methods

This patient was treated in our Center and data regarding blood pressure and side effect were reviewed from her clinical record.

Results

Baseline depression and anxiety ratings, including HAM A, QIDS, HAMD and MADRS, were in the range of moderate range of anxiety and depression. Baseline GAD 7 was only slightly elevated. At the end of the 4 week acute treatment phase (treatments of esketamine nasal spray twice weekly at doses ranging from 28 to 56 mg), all of her mood and anxiety ratings were in the normal range. Blood pressure usually increases during treatment with esketamine nasal spray, and increases during treatment were within the normal range and there was no evidence of hypertension. Esketamine nasal spray was well tolerated and there was no evidence of a serotonin syndrome.

Limitations

This is a single case report, but we review the literature of treatment of patients taking MAOIs with ketamine and with intravenous esketamine.

Conclusions

Esketamine nasal spray appears to be a safe treatment even if administered to a patient being treated with tranylcypromine, an MAOI.