Intranasal esketamine for depression: Transforming psychiatric treatment or a temporary solution?

Treatment-resistant depression (TRD) represents one of the most pressing challenges in psychiatry, as a substantial proportion of patients do not respond to conventional antidepressants. The introduction of intranasal esketamine, a glutamatergic modulator with rapid onset of action, has reshaped the therapeutic landscape. Unlike traditional monoaminergic treatments, esketamine demonstrates measurable improvement in mood and suicidal ideation within hours to days, offering a new option for individuals with limited alternatives. Clinical trials and real-world studies highlight significant short-term benefits, improved quality of life, and reduced relapse rates with ongoing use. However, these advantages are often contingent on continuous administration, as discontinuation frequently leads to a return of symptoms. Safety data suggest that side effects such as dissociation, sedation, and blood pressure elevation are generally transient and manageable, while the risk of misuse appears low under supervised conditions. Despite its promise, high costs, logistical demands of in-clinic administration, and questions regarding long-term efficacy temper enthusiasm. Intranasal esketamine therefo