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

Middle East Current Psychiatry

Table 1 Clinical conditions in patients with TRD that require precaution when initiating esketamine nasal spray [22]

Clinically significant or unstable cardiovascular or respiratory conditions
COPD or other significant pulmonary insufficiency
Sleep apnoea with morbid obesity^a
Uncontrolled bradyarrhythmias or tachyarrhythmias, leading to haemodynamic instability
History of MI
Haemodynamically significant valvular heart disease or heart failure^b
Other comorbidities
Presence or history of psychosis
Presence or history of mania or bipolar disorder
Hyperthyroidism that has not been sufficiently treated
Conditions associated with increased intracranial pressure^c

BMI body mass index, COPD chronic obstructive pulmonary disease, MI myocardial infarction, NYHA New York Heart Association, TRD treatment related depression
^aBMI ≥ 35 kg/m²
^bNYHA Class III–IV
^cIncluding history of brain injury, hypertensive encephalopathy and intrathecal therapy with ventricular shunts