Open label study with oral esketamine for treatment-resistent depression

In this open label study, we provide off-label treatment with oral esketamine to patients who have exhausted all conventional treatment steps according to the Dutch guideline for treatment of depression, including monoamine oxidase inhibitors and electroconvulsive therapy. Oral administration of esketamine might be  less invasive, more patient friendly and potentially less costly than alternatives such as intravenous ketamine or intranasal esketamine.

The oral esketamine is administered twice weekly over the course of six weeks, in a liquid formulation. The treatment is provided in an inpatients or day clinic setting, with nurses providing (emotional) support and monitoring the acute effects of esketamine. After an elaborate evaluation after six weeks, optional maintenance treatment is based on shared decision making between the patient and clinician. Three specialized depression treatment centers offer this oral esketamine treatment protocol; the University Center of Psychiatry in Groningen, Pro Persona in Nijmegen and PsyQ / Parnassia Groep in the Hague. Together they collect data on effectiveness and side effects, to increase knowledge on this innovative treatment option.