Esketamine nasal spray (spravato) for treatment-resistant depression in a transgender veteran with borderline personality disorder
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The high prevalence (15%) of depression with suicidality among active duty and veterans is concerning, considering the increased risk from exposure to military environments. Managing this deadly disease is complicated by resistance to traditional antidepressants and limited FDA-approved indications for the use of intranasal esketamine - the S-enantiomer of ketamine - an N-methyl-D-aspartate (NDMA) antagonist with a rapid-acting antidepressant (RAAD). This poster presentation highlights the RAAD effects of the off-label use of intranasal esketamine in a transgender veteran with long-standing treatment-resistant depression and multiple suicidal attempts with a primary diagnosis of borderline personality disorder. This veteran demonstrated declining PHQ-9 scores and reported significant improvement in mood and a reduction of suicidal thoughts and self-harming behaviors. These findings accentuate the need for more research to validate these results and expand the FDA-approved indications for using intranasal esketamine. Keywords: treatment-resident depression (TRD), esketamine, transgender veterans, borderline personality disorder (BPD), suicidality, self-harm.
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License.