Social Psychiatry, Vol. 54 No. 2, 2026.
Meeting abstract
https://doi.org/10.24869/spsih.2026.284
From Treatment-Resistant Depression to Return to Work: Experience With Esketamine Treatment – A Case Report
Ivana Maligec
; General Hospital Varaždin, Ulica Ivana Meštrovića 1, 42000 Varaždin, Croatia
*
Javor Vouk-Kamenski
; General Hospital Varaždin, Ulica Ivana Meštrovića 1, 42000 Varaždin, Croatia
* Corresponding author.
Abstract
Objectives: To present the effect of intranasal esketamine
on symptoms and functional recovery
in a patient with treatment‑resistant depression.
Materials and methods: We present the case of
a 37‑year‑old man with a diagnosis of recurrent
depressive disorder, severe depressive episode
without psychotic symptoms (F33.2), continuously
present for approximately 15 years. The
patient had been treated on an outpatient basis
with numerous antidepressants (escitalopram,
fluvoxamine, duloxetine, venlafaxine, vortioxetine,
mirtazapine, and bupropion) and augmentation
strategies including aripiprazole and pregabalin,
without achieving a satisfactory therapeutic
response. After worsening of depressive
and anxiety symptomatology during a period of unemployment, treatment with intranasal esketamine
was initiated. The first two applications
were administered at a dose of 56 mg, after which
treatment was continued at a dose of 84 mg. Clinical
response, adverse effects, and functional outcome
were monitored. Results: The initial score on
the Montgomery–Åsberg Depression Rating Scale
(MADRS) was 37 points. After the eighth application,
a significant improvement was recorded,
with a reduction of the score to 12 points, while
after the twelfth application, the MADRS score
was 17 points. During treatment, the patient actively
sought employment and, after many years
of unemployment, found a job and started working.
In total, he received 17 applications of esketamine.
Recorded adverse effects included transient
dizziness, mild dissociative experiences, and
a mild drop in blood pressure, without the need to
discontinue treatment. Despite the favorable therapeutic
response, the patient independently discontinued
treatment due to employment and relocation.
During subsequent telephone follow‑up,
he reported maintained improvement in mental
state and satisfactory occupational functioning.
Conclusion: The presented case confirms the importance
of esketamine as a therapeutic option in
the treatment of treatment‑resistant depression.
In addition to a significant reduction in depressive
symptomatology, a clinically relevant functional
recovery was achieved, including re‑entry into
the labor market after long‑term unemployment.
Functional outcomes should represent an important
indicator of treatment success alongside standard
symptom assessment measures.
Keywords
treatment‑resistant depression; esketamine; Spravato; functional recovery; employment
Hrčak ID:
352968
URI
Publication date:
15.6.2026.
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