Case Report: Intranasal esketamine and accelerated intermittent theta-burst stimulation for severe treatment-resistant depression with suicidal ideation

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A 29-year-old woman with severe treatment-resistant depression and suicidal ideation was treated with intranasal esketamine and accelerated iTBS.
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The patient showed improvement in depressive symptoms and suicidal ideation during the acute treatment course.
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Baseline symptom severity scores included PHQ-9: 15, HAMD: 27, and BDI: 41, indicating significant depressive symptoms.
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At a 2-week follow-up, the patient's scores improved to PHQ-9: 8, HAMD: 17, and BDI: 23, reflecting sustained clinical improvement.
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The case suggests the feasibility of combining intranasal esketamine with accelerated iTBS for high-risk patients, warranting further research.

Frontiers In Psychiatry

by Chun-Hung Chang, Yu-Der Hsia, Wen-Chun Liu, Chien-Ho Lin, Jianjung Ying, Hsin-Chi Tsai
July 1, 2026

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