Benefits, challenges, and future recommendations of prescribing esketamine for patients diagnosed with depression. A scoping review

Background Depression remains a widespread mental health disorder with significant impacts on individuals’ well-being and social functioning. Traditional treatments often have limited efficacy, especially in treatment-resistant cases. Recently, intranasal esketamine has emerged as a novel therapeutic option, offering rapid symptom relief. This study aims to systematically review the benefits, challenges, and future recommendations regarding the clinical use of intranasal esketamine for patients diagnosed with depression.Method We conducted this scoping review following Arksey and O’Malley’s framework and in accordance with PRISMA guidelines. We performed a comprehensive search of multiple electronic databases to identify relevant studies published between 2018 and 2024. Two reviewers independently extracted and analyzed the data using thematic analysis to ensure reliability, while peer debriefing helped us maintain the rigor of our review process. Additionally, we registered the study protocol in the PROSPERO database (CRD42024629649).Results Forty-seven studies were included, revealing key benefits such as efficacy in reducing depressive symptoms, rapid onset of antidepressant action, safety and tolerability profile, durability of antidepressant effects, comparative effectiveness with other treatments, and impact on suicidal ideation. Challenges identified include regulatory hurdles, lack of clinical experience, long-term safety concerns, insurance coverage issues, patient noncompliance, and adverse psychological reactions. Future recommendations emphasize enhanced provider training, longitudinal safety studies, improved access and coverage, integration into comprehensive treatment plans, patient education, and standardization of protocols.Discussion and Conclusion Intranasal esketamine presents a promising advancement in depression treatment, especially for resistant cases. Addressing regulatory, clinical, and safety challenges is crucial for broader adoption.