Use of intranasal sketamine hydrochloride in patient with treatment-resistant depression and suicide risk: case report

Introduction:  Treatment-Resistant Depression (TRD) is the lack of response to ≥2 consecutive treatments with antidepressant medication at an adequate dosage and duration. In this context, Intranasal Sketamine has appeared as a new treatment alternative.

Case report:  A 28-year-old male patient with acute suicide risk using different medications, without the relief of symptoms. Diagnosed with Treatment-Resistant Depression and treated with Intranasal Sketamine in combination with drugs the patient was already using. After 4 weeks of using Sketamine, he presented remission of clinical symptoms and was discharged from the hospital, remaining without new hospitalizations.

Discussion:  the patient in the report had several comorbid disorders, as well as a traumatic life history, factors that act as predictors of poor response to treatment with conventional antidepressants. In addition, conventional therapies have a prolonged response time to treatment, which creates difficulty in managing patients with acute risk of suicide. Intranasal Sketamine acts more quickly on the central nervous system, reducing the risk of suicide within a few hours of the first application.

Conclusion:  early application of intranasal Sketamine hydrochloride can chance the outocome of patients that don't respond to conventional treatment, reducing the recurrence of new attempts of suicide.

KEYWORDS
Intranasal Sketamine; Suicidal Risk; Severe Depression; Treatment-Resistant Depression