ArticleBMC psychiatry2026
Repeated intranasal esketamine augmentation in treatment-resistant obsessive-compulsive disorder with comorbid major depressive disorder: a prospective case series.
Article in BMC psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPatients with obsessive–compulsive disorder (OCD) and comorbid major depressive disorder (MDD) represent a severe subgroup with increased treatment resistance, greater functional impairment, and limited therapeutic options. Intranasal esketamine is a rapidly acting treatment for resistant depression, with emerging interest in potential anti-obsessional effects. However, prospective data in this comorbid population remain lacking.
methodsWe present eight adult cases (mean age 47.3 ± 8.8 years) with treatment-resistant OCD (TR-OCD) and comorbid MDD treated at Bellvitge University Hospital. All patients had failed at least two adequate SSRI trials, clomipramine, cognitive-behavioral therapy with exposure and response prevention, and at least one pharmacological augmentation strategy. Intranasal esketamine (56–84 mg/session) was administered according to the standard antidepressant protocol over 12 weeks. Response was defined as ≥ 35% reduction in Y-BOCS and ≥ 50% reduction in MADRS.
resultsDepressive symptoms improved substantially, with MADRS scores decreasing by 48.8% at Week 12 (p = 0.0026). Obsessive-compulsive symptoms showed a more modest and heterogeneous reduction, with a 30.3% decrease in Y-BOCS scores (p = 0.0037). Four of the eight participants (50.0%) achieved depression response, including two (25.0%) remissions, and four of the eight participants (50.0%) met OCD response criteria. Depressive symptoms improved earlier, whereas OCD symptoms followed a slower and more variable trajectory.
conclusionsRepeated intranasal esketamine may offer a therapeutic window for patients with severe TR-OCD and comorbid MDD. These preliminary findings support further controlled studies to clarify its role, optimal administration, and integration with psychotherapy.
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