Abstract
Management of treatment-resistant depression (TRD) is complex and frustrating for patients, requiring several treatment courses before (or without) achieving remission. This investigation aims to highlight and analyze real-world instances of using esketamine for patients with TRD who have failed electroconvulsive therapy (ECT). Four case reports from a single Hackensack-Meridian care center are described in detail. They, along with a literature review, were then used to drive a narrative discussion on the potential of esketamine as a TRD therapy. Of the four cases analyzed, three patients experienced significant improvement in symptoms. However, largely due to side effects, only one case resulted in effective long-term treatment using esketamine. Given that all four patients previously failed ECT, these results are encouraging. Even a humble success rate may inspire hope in a patient population that is largely considered intractable using current methodology. This study found that esketamine is a viable alternative for some patients suffering from TRD. This even remains true in some of our patients who have failed ECT - one of the more effective, more aggressive therapies for TRD.