{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:14:37Z","timestamp":1785417277669,"version":"3.56.0"},"reference-count":70,"publisher":"Royal College of Psychiatrists","issue":"1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec id=\"S2056472425109502_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Treatment-resistant depression (TRD) poses a significant clinical challenge, with limited evidence guiding long-term pharmacological strategies. Esketamine, a glutamatergic modulator, has demonstrated short-term efficacy in TRD, but data on its extended use in real-world settings remains scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472425109502_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to evaluate the long-term effectiveness and side-effects of intranasal esketamine in adults with TRD over more than 100 treatment sessions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472425109502_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a retrospective, single-arm, pre\u2013post study of 20 patients with TRD at a psychiatric out-patient clinic in the United Arab Emirates. All participants received \u2265100 sessions of intranasal esketamine alongside oral antidepressants. Depression and anxiety symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7) scales. Side-effects were monitored through blood pressure, sedation, dissociation, urinary symptoms and psychiatric symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472425109502_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After an average of 129 esketamine sessions (mean duration 2.5 years), PHQ-9 and GAD-7 scores significantly decreased (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001). A total of 85% of patients improved in depressive severity, with 25% achieving remission; 65% improved in anxiety severity, and 20% reached remission. Esketamine was generally well tolerated; side-effects were mild and transient, with no serious adverse events. However, urinary symptoms suggestive of cystitis occurred in 20% of patients, highlighting the need for ongoing monitoring in long-term treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472425109502_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intranasal esketamine demonstrated sustained effectiveness and an acceptable side-effect profile in a real-world TRD cohort with extensive psychiatric comorbidity. These findings support its long-term use in complex clinical populations, and underscore the need for further prospective, multi-site studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2025.10950","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:31:08Z","timestamp":1769157068000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Long-term effectiveness and side-effects of intranasal esketamine in treatment-resistant depression: real-world, single-arm study of over 100 sessions"],"prefix":"10.1192","volume":"12","author":[{"given":"Nawfel","family":"Ayad","sequence":"first","affiliation":[{"name":"Al Reem Neuroscience Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7609-7756","authenticated-orcid":false,"given":"Karim","family":"Abdel Aziz","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01km6p862","id-type":"ROR","asserted-by":"publisher"}],"name":"United Arab Emirates University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer","family":"Makhoul","sequence":"additional","affiliation":[{"name":"Al Reem Neuroscience Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ban","family":"Abbas","sequence":"additional","affiliation":[{"name":"Al Reem Neuroscience Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6467-8150","authenticated-orcid":false,"given":"Syed Fahad","family":"Javaid","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01km6p862","id-type":"ROR","asserted-by":"publisher"}],"name":"United Arab Emirates University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"S2056472425109502_ref24","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"S2056472425109502_ref19","doi-asserted-by":"publisher","DOI":"10.1038\/s41386-023-01577-5"},{"key":"S2056472425109502_ref19","doi-asserted-by":"publisher","DOI":"10.1038\/s41386-023-01577-5"},{"key":"S2056472425109502_ref13","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12102283"},{"key":"S2056472425109502_ref31","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2019.1189"},{"key":"S2056472425109502_ref30","volume-title":"Spravato (Esketamine) Label","year":"2025"},{"key":"S2056472425109502_ref23","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"S2056472425109502_ref33","doi-asserted-by":"publisher","DOI":"10.3390\/ph18020173"},{"key":"S2056472425109502_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.08.050"},{"key":"S2056472425109502_ref26","first-page":"244","article-title":"Validity and reliability of the Observers Assessment of Alertness\/Sedation Scale: study with intravenous midazolam","volume":"10","author":"Chernik","year":"1990","journal-title":"J Clin Psychopharmacol"},{"key":"S2056472425109502_ref32","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2018.17060720"},{"key":"S2056472425109502_ref32","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2018.17060720"},{"key":"S2056472425109502_ref2","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2024.266"},{"key":"S2056472425109502_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.lpm.2016.02.002"},{"key":"S2056472425109502_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/ijnp\/pyaf027"},{"key":"S2056472425109502_ref15","doi-asserted-by":"publisher","DOI":"10.1177\/07067437241245384"},{"key":"S2056472425109502_ref16","volume-title":"Practice Guideline for the Treatment of Patients with Major Depressive Disorder","year":"2020"},{"key":"S2056472425109502_ref1","doi-asserted-by":"publisher","DOI":"10.1590\/1516-4446-2020-0650"},{"key":"S2056472425109502_ref31","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2019.1189"},{"key":"S2056472425109502_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.04.119"},{"key":"S2056472425109502_ref11","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.2006.163.11.1905"},{"key":"S2056472425109502_ref16","volume-title":"Practice Guideline for the Treatment of Patients with Major Depressive Disorder","year":"2020"},{"key":"S2056472425109502_ref1","doi-asserted-by":"publisher","DOI":"10.1590\/1516-4446-2020-0650"},{"key":"S2056472425109502_ref33","doi-asserted-by":"publisher","DOI":"10.3390\/ph18020173"},{"key":"S2056472425109502_ref15","doi-asserted-by":"publisher","DOI":"10.1177\/07067437241245384"},{"key":"S2056472425109502_ref35","doi-asserted-by":"publisher","DOI":"10.52965\/001c.38247"},{"key":"S2056472425109502_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2011.10.004"},{"key":"S2056472425109502_ref4","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S29716"},{"key":"S2056472425109502_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S0193-953X(05)70283-5"},{"key":"S2056472425109502_ref27","doi-asserted-by":"publisher","DOI":"10.1023\/A:1024465317902"},{"key":"S2056472425109502_ref34","doi-asserted-by":"publisher","DOI":"10.1093\/ijnp\/pyz039"},{"key":"S2056472425109502_ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-007-0061-3"},{"key":"S2056472425109502_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-3223(03)00088-X"},{"key":"S2056472425109502_ref2","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2024.266"},{"key":"S2056472425109502_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-3223(03)00088-X"},{"key":"S2056472425109502_ref11","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.2006.163.11.1905"},{"key":"S2056472425109502_ref25","doi-asserted-by":"publisher","DOI":"10.2466\/pr0.1962.10.3.799"},{"key":"S2056472425109502_ref24","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"S2056472425109502_ref26","first-page":"244","article-title":"Validity and reliability of the Observers Assessment of Alertness\/Sedation Scale: study with intravenous midazolam","volume":"10","author":"Chernik","year":"1990","journal-title":"J Clin Psychopharmacol"},{"key":"S2056472425109502_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.02.023"},{"key":"S2056472425109502_ref17","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2019.19020172"},{"key":"S2056472425109502_ref12","doi-asserted-by":"publisher","DOI":"10.1093\/ijnp\/pyy094"},{"key":"S2056472425109502_ref20","doi-asserted-by":"publisher","DOI":"10.9758\/cpn.2022.20.1.70"},{"key":"S2056472425109502_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.08.050"},{"key":"S2056472425109502_ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-007-0061-3"},{"key":"S2056472425109502_ref22","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-023-02113-1"},{"key":"S2056472425109502_ref4","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S29716"},{"key":"S2056472425109502_ref17","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2019.19020172"},{"key":"S2056472425109502_ref12","doi-asserted-by":"publisher","DOI":"10.1093\/ijnp\/pyy094"},{"key":"S2056472425109502_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2011.10.004"},{"key":"S2056472425109502_ref35","doi-asserted-by":"publisher","DOI":"10.52965\/001c.38247"},{"key":"S2056472425109502_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.02.023"},{"key":"S2056472425109502_ref22","first-page":"40","article-title":"Assessment of health-related quality of life and health status in patients with treatment-resistant depression treated with esketamine nasal spray plus an oral antidepressant","volume":"21","author":"Jamieson","year":"2023","journal-title":"Health Qual Life Outcomes"},{"key":"S2056472425109502_ref20","doi-asserted-by":"publisher","DOI":"10.9758\/cpn.2022.20.1.70"},{"key":"S2056472425109502_ref25","doi-asserted-by":"publisher","DOI":"10.2466\/pr0.1962.10.3.799"},{"key":"S2056472425109502_ref3","doi-asserted-by":"publisher","DOI":"10.1177\/0269881115581093"},{"key":"S2056472425109502_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S0193-953X(05)70283-5"},{"key":"S2056472425109502_ref23","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"S2056472425109502_ref30","volume-title":"Spravato (Esketamine) Label","year":"2025"},{"key":"S2056472425109502_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/ijnp\/pyaf027"},{"key":"S2056472425109502_ref18","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.19m12891"},{"key":"S2056472425109502_ref3","doi-asserted-by":"publisher","DOI":"10.1177\/0269881115581093"},{"key":"S2056472425109502_ref9","doi-asserted-by":"publisher","DOI":"10.1177\/070674371005500303"},{"key":"S2056472425109502_ref34","doi-asserted-by":"publisher","DOI":"10.1093\/ijnp\/pyz039"},{"key":"S2056472425109502_ref13","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12102283"},{"key":"S2056472425109502_ref27","doi-asserted-by":"publisher","DOI":"10.1023\/A:1024465317902"},{"key":"S2056472425109502_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.04.119"},{"key":"S2056472425109502_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.lpm.2016.02.002"},{"key":"S2056472425109502_ref9","doi-asserted-by":"publisher","DOI":"10.1177\/070674371005500303"},{"key":"S2056472425109502_ref18","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.19m12891"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056472425109502","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:31:08Z","timestamp":1769157068000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056472425109502\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":70,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["S2056472425109502"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2025.10950","relation":{},"ISSN":["2056-4724"],"issn-type":[{"value":"2056-4724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e48"}}