Original Research J Clin Psychiatry September 2025

Comparative Effects of Repeated Ketamine Infusion Versus Intranasal Esketamine in Patients With Treatment-Resistant Depression: A Retrospective Chart Review

Full Article Read the complete peer-reviewed article in J Clin Psychiatry. Clinical Summary Patients with treatment-resistant depression often need options that work quickly, especially when symptom burden is severe and conventional strategies have already failed. This study addresses a common real-world choice in ketamine clinics: whether repeated IV racemic ketamine or intranasal esketamine delivers a faster or larger antidepressant effect during induction. FAQ Which treatment reduced depression symptoms more during induction: IV ketamine or intranasal esketamine?

Key Takeaways Baseline depression severity was comparable, but by the end of induction QIDS-SR16 scores fell from 19.23 ± 0.23 to 9.65 ± 0.48 with IV ketamine and from 19.52 ± 0.39 to 11.80 ± 0.65 with IN esketamine, supporting a larger absolute symptom reduction with the IV protocol in this clinic population. Clinical Guide How should clinicians identify appropriate outpatients with severe treatment-resistant depression for an induction course of ketamine-based treatment? Clinical Guide How should clinicians choose between repeated IV ketamine and intranasal esketamine for induction treatment of severe treatment-resistant depression?