Treatment-resistant depression and intranasal esketamine: Spanish consensus on theoretical aspects

Introduction Depression is a highly prevalent disease that severely impacts the life of patients. Inadequate response to at least two antidepressants despite adequacy of treatment and adherence is known as treatment-resistant depression (TRD), which entails a higher social and economic burden than n...

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Autores: Mora, Fernando, Ramos-Quiroga, Jose Antoni, Baca-Garcia, Enrique, Crespo, Jose Manuel, Gutierrez-Rojas, Luis, Madrazo, Aranzazu, Perez Costillas, Lucia, Saiz, Pilar A., Tordera, Vicente, Vieta, Eduard
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p19368
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/19368
Access Level:acceso abierto
Palabra clave:intranasal esketamine
definition
therapeutic inertia
Spain
consensus
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repository_id_str
spelling Treatment-resistant depression and intranasal esketamine: Spanish consensus on theoretical aspectsMora, FernandoRamos-Quiroga, Jose AntoniBaca-Garcia, EnriqueCrespo, Jose ManuelGutierrez-Rojas, LuisMadrazo, AranzazuPerez Costillas, LuciaSaiz, Pilar A.Tordera, VicenteVieta, Eduardintranasal esketaminedefinitiontherapeutic inertiaSpainconsensusIntroduction Depression is a highly prevalent disease that severely impacts the life of patients. Inadequate response to at least two antidepressants despite adequacy of treatment and adherence is known as treatment-resistant depression (TRD), which entails a higher social and economic burden than non-resistant major depression. The lack of consensus on the definition of TRD and other aspects complicates management of the disease. Intranasal esketamine has a novel mechanism of action that differs from that of traditional antidepressants by improving neuroplasticity and synaptogenesis.Material and methods A scientific committee comprising ten psychiatrists, experts in TRD in Spain, reviewed the literature (grey literature and articles or scientific communications published between January 2014 and January 2024 in PubMed) and developed statements on theoretical and conceptual aspects of TRD. Statements were developed in a first meeting following a discussion group approach, refined in a second meeting following a nominal group technique, and consensus was finally drafted in a third meeting.Results A series of statements and recommendations were developed. Definitions for TRD and clinical response were proposed. The impact of therapeutic inertia was highlighted, identifying its causes and consequences. The role of intranasal esketamine in the TRD therapeutic treatment landscape was reviewed, and a treatment algorithm was developed, including specifics on evaluation of response to avoid therapeutic inertia and ensure an adequate treatment.Conclusions This is the first consensus developed in Spain regarding theoretical aspects of TRD and the role of intranasal esketamine in TRD therapeutic approach. A definition of TRD was proposed, together with a treatment algorithm.FRONTIERS MEDIA SA2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/19368Frontiers in PsychiatryISSN: 16640640reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p193682026-06-11T12:45:17Z
dc.title.none.fl_str_mv Treatment-resistant depression and intranasal esketamine: Spanish consensus on theoretical aspects
title Treatment-resistant depression and intranasal esketamine: Spanish consensus on theoretical aspects
spellingShingle Treatment-resistant depression and intranasal esketamine: Spanish consensus on theoretical aspects
Mora, Fernando
intranasal esketamine
definition
therapeutic inertia
Spain
consensus
title_short Treatment-resistant depression and intranasal esketamine: Spanish consensus on theoretical aspects
title_full Treatment-resistant depression and intranasal esketamine: Spanish consensus on theoretical aspects
title_fullStr Treatment-resistant depression and intranasal esketamine: Spanish consensus on theoretical aspects
title_full_unstemmed Treatment-resistant depression and intranasal esketamine: Spanish consensus on theoretical aspects
title_sort Treatment-resistant depression and intranasal esketamine: Spanish consensus on theoretical aspects
dc.creator.none.fl_str_mv Mora, Fernando
Ramos-Quiroga, Jose Antoni
Baca-Garcia, Enrique
Crespo, Jose Manuel
Gutierrez-Rojas, Luis
Madrazo, Aranzazu
Perez Costillas, Lucia
Saiz, Pilar A.
Tordera, Vicente
Vieta, Eduard
author Mora, Fernando
author_facet Mora, Fernando
Ramos-Quiroga, Jose Antoni
Baca-Garcia, Enrique
Crespo, Jose Manuel
Gutierrez-Rojas, Luis
Madrazo, Aranzazu
Perez Costillas, Lucia
Saiz, Pilar A.
Tordera, Vicente
Vieta, Eduard
author_role author
author2 Ramos-Quiroga, Jose Antoni
Baca-Garcia, Enrique
Crespo, Jose Manuel
Gutierrez-Rojas, Luis
Madrazo, Aranzazu
Perez Costillas, Lucia
Saiz, Pilar A.
Tordera, Vicente
Vieta, Eduard
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv intranasal esketamine
definition
therapeutic inertia
Spain
consensus
topic intranasal esketamine
definition
therapeutic inertia
Spain
consensus
description Introduction Depression is a highly prevalent disease that severely impacts the life of patients. Inadequate response to at least two antidepressants despite adequacy of treatment and adherence is known as treatment-resistant depression (TRD), which entails a higher social and economic burden than non-resistant major depression. The lack of consensus on the definition of TRD and other aspects complicates management of the disease. Intranasal esketamine has a novel mechanism of action that differs from that of traditional antidepressants by improving neuroplasticity and synaptogenesis.Material and methods A scientific committee comprising ten psychiatrists, experts in TRD in Spain, reviewed the literature (grey literature and articles or scientific communications published between January 2014 and January 2024 in PubMed) and developed statements on theoretical and conceptual aspects of TRD. Statements were developed in a first meeting following a discussion group approach, refined in a second meeting following a nominal group technique, and consensus was finally drafted in a third meeting.Results A series of statements and recommendations were developed. Definitions for TRD and clinical response were proposed. The impact of therapeutic inertia was highlighted, identifying its causes and consequences. The role of intranasal esketamine in the TRD therapeutic treatment landscape was reviewed, and a treatment algorithm was developed, including specifics on evaluation of response to avoid therapeutic inertia and ensure an adequate treatment.Conclusions This is the first consensus developed in Spain regarding theoretical aspects of TRD and the role of intranasal esketamine in TRD therapeutic approach. A definition of TRD was proposed, together with a treatment algorithm.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/19368
url https://fisabio.portalinvestigacion.com/publicaciones/19368
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv FRONTIERS MEDIA SA
publisher.none.fl_str_mv FRONTIERS MEDIA SA
dc.source.none.fl_str_mv Frontiers in Psychiatry
ISSN: 16640640
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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