Clinical Scorecard: Combined Use of Intranasal Esketamine and Accelerated Intermittent Theta-Burst Stimulation for Severe Treatment-Resistant Depression with Suicidal Thoughts: A Case Study

At a Glance

Key Highlights

• Patient showed improvement in depressive symptoms and suicidal ideation after treatment.
• Combined treatment involved 84 mg of intranasal esketamine and 10 iTBS sessions over 4 days.
• Clinical status remained stable at 2-week follow-up with significant score reductions.

Guideline-Based Recommendations

Diagnosis

• Assessment of treatment-resistant major depressive disorder based on inadequate response to at least two antidepressant trials.

Management

• Consider combined use of intranasal esketamine and accelerated iTBS for severe cases.

Monitoring & Follow-up

• Monitor for clinical improvement and side effects during treatment.

Risks

• Potential for inadequate response to treatment and need for rapid intervention in high-risk patients.

Patient & Prescribing Data

A 29-year-old woman with recurrent major depressive disorder and high-risk suicidal ideation.

Intranasal esketamine and iTBS may provide rapid symptom relief in inpatient settings.

Clinical Best Practices

• Utilize a combination of pharmacotherapy and neuromodulation techniques for treatment-resistant depression.
• Implement safety management protocols during combined treatment approaches.

Related Resources & Content

• Clinical Study on TMS and Ketamine