Management of treatment-resistant depression with esketamine nasal spray: clinical questions for daily practice in Gulf Cooperation Council countries

There is a high unmet need among patients with treatment-resistant depression (TRD) as treatment with standard therapies is associated with low response and remission rates and high rates of relapse. Esketamine nasal spray, an N-methyl-D-aspartate receptor antagonist, is a novel, fast-acting treatment option for TRD. This article addresses common questions in Gulf Cooperation Council (GCC) countries regarding esketamine nasal spray by discussing the latest clinical evidence and by providing expert opinions. Six expert psychiatrists from the GCC region with clinical experience in TRD reviewed and critically appraised published evidence on esketamine nasal spray for TRD and considered clinical guidelines, expert opinions and consensus statements. Consensus views were reached on clinical questions pertinent to implementing esketamine nasal spray for TRD in the GCC region. Clinical questions on patient identification, selection of serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors, treatment duration, management of adverse events and clinical requirements for the safe administration of esketamine nasal spray were addressed. Esketamine nasal spray represents a new treatment paradigm for TRD. This article provides clinical guidance based on the latest evidence and clinical experience to help mental health practitioners implement esketamine nasal spray into everyday clinical practice.