{"id":"doi:10.1016/j.euroneuro.2026.112907","kind":"article","title":"Clinical guidance on the use of esketamine nasal spray for patients with treatment resistant depression: A European Delphi consensus report","authors":["Young AH","Baune BT","Benatti B","Bennabi D","Estercam S","Gorwood P","Gutiérrez-Rojas L","Martiadis V","Molero P","Normann C","Perry R","Pitchot W","Reif A","Rosso G","Vieta E","Fagiolini A"],"author_count":16,"year":2026,"published":"2026-07-17","venue":"European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology","cited_by":0,"doi":"10.1016/j.euroneuro.2026.112907","arxiv_id":null,"nct_id":null,"source_url":"https://doi.org/10.1016/j.euroneuro.2026.112907","archive_url":"https://space-kitty.com/papers/doi:10.1016/j.euroneuro.2026.112907","updated":null,"pmid":"42468081","pmcid":null,"openalex_id":null,"pdf_url":null,"abstract":"Esketamine nasal spray (NS) is an established treatment for patients with treatment resistant depression (TRD). To further optimise real-world outcomes, consensus is needed regarding strategies to enhance patient outcomes and decision-making factors for pivotal timepoints in esketamine NS treatment. This modified Delphi panel (3 rounds) established expert consensus (≥80% agreement) from 30 European psychiatrists experienced in management of patients with TRD receiving esketamine NS. During the acute phase (4-12 weeks), modest/subjective reductions in core symptoms important to both patients and physicians supported esketamine NS continuation, especially with long disease course/resistance to multiple therapies. Consensus was reached that such a modest improvement during the acute phase should justify esketamine NS continuation (and supplementation of other treatment modalities with esketamine NS). Esketamine NS dose/frequency maximisation (84 mg weekly) was advocated for, to enhance acute phase outcomes, alongside strategies reflective of individual clinical characteristics. Monitoring in the continuation phase (6-9 months) should prioritise residual/fluctuating symptoms, changes in symptom severity, functional recovery status and comorbidity management/emergence. Should residual symptoms persist, dose/frequency escalation, among other all-phase options, were supported. Prolonging maintenance phase treatment (≥12 months) depended on the degree of clinical worsening when tapering, the risks/consequences of relapse, chronicity of the last depressive episode, residual symptoms and recurrence history. Across all phases, recommended treatment plans included integration of psychotherapy, optimisation of concomitant antidepressants/augmentation strategies, comorbidity management and strengthening support networks. Overall, the consensus advocated for an approach reflective of TRD complexities, prioritising meaningful outcomes for individual patients.","abstract_license":"CC-BY (article license as recorded by Europe PMC; abstract reproduced unmodified apart from markup removal)","license":"CC-BY","is_open_access":false,"retracted":false,"peer_reviewed":null,"categories":[],"details":null,"provenance":"europepmc","attribution":"Abstract of \"Clinical guidance on the use of esketamine nasal spray for patients with treatment resistant depression: A European Delphi consensus report\" by Young AH, Baune BT, Benatti B et al., https://doi.org/10.1016/j.euroneuro.2026.112907, used under its Creative Commons Attribution license (CC-BY); markup removed, otherwise unmodified.","topics":[{"slug":"psychiatric-therapeutics","name":"Novel Psychiatric Therapeutics","domain_slug":"neuroscience"}],"cited_in_dossiers":[]}