Esketamine Nasal Spray for Depression in Older Patients?

Depression is a major contributor to disability in elderly people and is less likely to respond to traditional treatment modalities in this patient population. Esketamine has been successfully used in adults younger than 65 with treatment-resistant depression. In a manufacturer-funded, phase 3 trial of esketamine nasal spray, researchers enrolled 138 individuals aged 65 and older who had treatment-resistant depression.

The patients were started on an oral antidepressant (venlafaxine, duloxetine, escitalopram, or sertraline) that had previously not been used during the current episode and were randomized to either esketamine or placebo nasal spray, twice weekly for 4 weeks. On a standardized scale, improvement was not statistically greater wi…