Esketamine treatment: advances in personalized clinical monitoring

Treatment-resistant depression (TRD) represents a serious problem, therefore, the efficacy and safety of optimal antidepressant treatment is crucial. We aimed to evaluate the intranasal esketamine effect on the autonomic nervous system (ANS) activity at rest and during stress using objective biomarkers, including the assessment of depressive/anxiety symptomatology, in an adult patient with TRD. Sixty-year-old female patient with TRD diagnosis, was examined before and two hours after the intranasal esketamine application at a dose of 56 mg. Stress profile consisted of basal period, three stress tasks (Stroop, negative, and positive emotional stimuli), each followed by recovery phase. Evaluated parameters: the high-frequency of the heart rate variability (HF-HRV) as a biomarker of cardiovagal control, the electrodermal activity (EDA) as a biomarker of sympathetic activity. Additionally, the heart rate (HR), systolic and diastolic blood pressure (SBP, DBP) were evaluated. The parameters HF-HRV, EDA, HR, SBP, DBP were lower after two hours of intranasal esketamine administration. The HAMA evaluation revealed decreasing total score (14 vs. 12), BDI assessment showed reduced scores in 3 items (“past failure”, “self-criticism” and “irritability”) and increased scores in 3 items (“loss of energy”, “concentration” and “fatigue”) after esketamine treatment. Our results revealed decreased cardiovagal and sympathetic activity associated with more pronounced anxiolytic effect after two hours of intranasal esketamine administration in TRD patient. It seems that clinical application of intranasal esketamine after two hours is safe, effective, and not associated with adverse health complications.