Background: Esketamine nasal spray has garnered interest as a pharmacotherapy for treatment-resistant depression (TRD). However, there is currently limited real-world and long-term evidence for patients with TRD receiving esketamine.

Aims: To evaluate the demographic/clinical characteristics, treatment patterns, clinical outcomes, adverse events, and cost of care of patients with TRD receiving esketamine therapy at a private outpatient psychiatric clinic.

Methods: This retrospective cohort study evaluated data collected from a private outpatient psychiatric clinic’s EHR system. The inclusion criteria were adults 18+ years of age with a diagnosis of major depressive disorder and who received esketamine during July 2019—June 2020. Individuals who received racemic ketamine at the psychiatric clinic prior or during the study timeframe were excluded from the analysis.

Results: A total of 171 patients with TRD received esketamine treatment July 2019—June 2020 at the psychiatric clinic. This predominantly female (60%, 103/171), white population (92%, 157/171) had several mental health comorbidities (GAD (39%, 67/171), Insomnia (25%, 43/171), ADHD (25%, 43/171), PTSD (12%, 20/171)) and high exposure to psychiatric medications (mean=5.8, SD=4.0). We observed significant reductions (p-value<0.001) in average PHQ-9 and GAD-7 scores from baseline (PHQ-9: mean=16.7, SD=5.8; GAD-7: mean=12.0, SD=5.8) to last observation (PHQ-9: mean=12.0, SD=6.4; GAD-7: mean=8.7, SD=5.6). Patients received esketamine every 3-6 days for treatments 1-9 and every 7 days for treatment session 10 onwards. There were no reports noted in health records of issues with tolerability or serious adverse events. Most patients (170, 99%) had esketamine provided via specialty pharmacies; therefore, medication cost was not available. The average payment per visit (including physician visit and monitoring) was $215 (SD=$106), and the vast majority of this was paid by patients’ primary insurance (mean=$202, SD=$44).

Conclusions: Esketamine appears to be well tolerated and effective in improving depression and anxiety as measured by the PHQ-9 and GAD-7 survey instruments.