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Esketamine, an antagonist of N-methyl-D-aspartate receptors, is a U.S. FDA-approved medication for patients with treatment-resistant depression. It is available as a nasal spray that is administered in a healthcare facility (not at home) and is approved for use only in conjunction with an oral antidepressant.
In a 32-week randomized trial, 676 patients with major depressive disorder and minimal response to two different antidepressants received esketamine nasal spray (initially twice weekly) or daily oral extended-release quetiapine; patients continued the antidepressant (i.e., selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor) that they already were taking. (Note: The comparator, quetiapine, is an aty…