Exercise no. 318 Esketamine (Spravato°) in depression after failure of several antidepressants or with a high risk of suicide

When well-conducted antidepressant therapy is considered insufficiently effective in an adult experiencing a depressive episode, it is useful to analyse the situation by reconsidering the initial diagnosis, evaluating the impact of the symptoms on quality of life, and identifying any factors responsible for the persistence or worsening of depression. If the disorders are considered to be related to the inefficacy of the antidepressant, the main options are to offer psychotherapy, increase the dose of the antidepressant, switch to an antidepressant from a different pharmacological class, add an "atypical" neuroleptic, such as quetiapine, or consider electroconvulsive therapy.