Intranasal esketamine as therapeutic option: a case report of an adolescent with treatment resistant depression.

Depression is among the most common mental health disorders worldwide and treatment resistant depression (TRD) represents a major challenge for both patients and clinicians. In recent years ketamine has received attention as an antidepressant agent, demonstrating promising results in TRD in adults. To date, few attempts have been made in treating adolescent TRD with ketamine and none have used intranasal application. This paper discusses a case of a 17-year-old female adolescent suffering from TRD who underwent treatment with intranasal esketamine application (Spravato 28 mg). As symptoms showed clinically insignificant improvement despite modest gains in objective assessments (GAF, CGI, MADRS), treatment was prematurely discontinued. However, the treatment was tolerable and side effects were scarce and mild. Although this case report does not demonstrate clinical effectiveness, ketamine may nonetheless be a promising substance in treating TRD in other adolescents. Questions regarding the safety of ketamine use in the rapidly developing brains of adolescents still remain unanswered. To further explore the potential benefits of this treatment method a short term RCTs for adolescents with TRD is recommended.

Use of Antipsychotic Medications for Nonpsychotic Children: Risks and Implications for Mental Health Services.

Antipsychotic medications, especially second-generation antipsychotics, have increasingly been prescribed to children under age 18 in the United States. They are approved to treat pediatric bipolar and psychotic disorders and aggressive behaviors among patients with autism, but they are often used off label to control disruptive behaviors of children without autism and treat mood problems of children without bipolar disorder. The most vulnerable children, such as those in foster care, are the most likely recipients. Common known risks are potentially serious, and suspected long-term developmental risks to the brain and body are largely unstudied. Safer and equally efficacious therapies, both psychosocial and pharmacological, are available. Critical implications for mental health services include implementing prevention activities, training and monitoring prescribers and other clinicians, increasing efforts to protect children as the most vulnerable patients receiving these medications, increasing access to safer medications and evidence-based psychosocial interventions, educating all stakeholders, and enhancing shared decision making.