{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:37:10Z","timestamp":1785436630627,"version":"3.56.0"},"reference-count":0,"publisher":"PCP Academic Media Ltd","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychiatry and Clinical Psychopharmacology"],"abstract":"<jats:p>This case report describes the clinical response and safety of intranasal esketamine (Spravato\u00ae) in a 61-year-old female with treatment-resistant depression (TRD), a history of electroconvulsive therapy (ECT) poor response, and structural brain abnormalities secondary to left frontal lobe tissue loss from traumatic brain injury in 2008. Despite multiple antidepressant trials, atypical antipsychotic augmentation, and 6 ECT sessions since 2019, the patient achieved only partial remission. In 2024, she received four 56 mg doses of Spravato over 2 weeks while maintaining duloxetine, fluvoxamine, and clozapine therapy. Montgomery-\u00c5sberg Depression Rating Scale (MADRS) scores improved from severeto-mild depression, with resolution of suicidal ideationand symptom stabilization.Anxiety symptoms decreased and nightmares ceased post-treatment. Transient dizziness occurred approximately 10 minutes post-administration in allsessions,resolving with 90 minutes of bed rest. No severe adverse events (dissociation, psychosis, or hypertensive crises) were observed. Although limited by an abbreviated treatment regimen and a single-case design, this case suggests that esketamine may be considered in carefully selected TRD patients withstructural brain abnormalities and prior ECT poor response, pending validation from larger studies.\n\nCite this article as: Shen Y, Hung C. Intranasal esketamine for treatment-resistant depression with structural brain abnormality: A case report. Psychiatry Clin Psychopharmacol. Published online November 13, 2025. doi:https:\/\/doi.org\/10.5152\/pcp.2025.251248.<\/jats:p>","DOI":"10.5152\/pcp.2025.251248","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T14:13:47Z","timestamp":1763043227000},"source":"Crossref","is-referenced-by-count":0,"title":["Intranasal Esketamine for Treatment-Resistant Depression with Structural Brain Abnormality: A Case Report"],"prefix":"10.65801","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3503-5778","authenticated-orcid":false,"given":"Yu-Chih","family":"Shen","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/030k6vb67","id-type":"ROR","asserted-by":"publisher"}],"name":"Hualien Tzu Chi Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7036-0914","authenticated-orcid":false,"given":"Chien-Chen","family":"Hung","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/030k6vb67","id-type":"ROR","asserted-by":"publisher"}],"name":"Hualien Tzu Chi Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"55342","published-online":{"date-parts":[[2025,11,13]]},"container-title":["Psychiatry and Clinical Psychopharmacology"],"original-title":[],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T19:57:20Z","timestamp":1768247840000},"score":1,"resource":{"primary":{"URL":"https:\/\/psychiatry-psychopharmacology.com\/en\/intranasal-esketamine-for-treatment-resistant-depression-with-structural-brain-abnormality-a-case-report-133381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,13]]},"references-count":0,"URL":"https:\/\/doi.org\/10.5152\/pcp.2025.251248","relation":{},"ISSN":["2475-0581"],"issn-type":[{"value":"2475-0581","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,13]]}}}