Table 5 Patient case of hypertension associated with esketamine nasal spray and its management

• Twenty-three-year-old, morbidly obese male with a history of depression and essential tremors

• Received prior SSRI/SNRI treatment and adjunct therapy with atypical antipsychotics

• Mild-to-moderate response to treatment over a 5-year period, with recurrent relapses and frequent suicidal ideations

• Esketamine nasal spray was initiated while he was receiving sertraline (200 mg), lithium (400 mg) and quetiapine (400 mg at bedtime)

• Prior to the initiation of esketamine nasal spray, the patient had shown mild improvement but no psychosocial progress

• When esketamine nasal spray treatment was initiated, the patient’s SBP increased to 140–150 mmHg

• A beta blocker was prescribed to control blood pressure during and after esketamine administration

• By Week 5, the patient had shown significant improvements in affect and mood

• Over time, the patient had started exercising regularly and lost considerable weight

• The patient showed good tolerance to the maintenance phase; lithium was withdrawn as the suicidal ideations ceased

• The patient was maintained on sertraline (150 mg), quetiapine (100 mg at bedtime) and esketamine nasal spray (once a month)