Care Next Door: Community Outpatient Esketamine Across Urban and Rural Clinics
J. García Jiménez, S. Posik, B. Herrejón, L. Gutiérrez-RojasIntroduction
Treatment-resistant depression (TRD) is highly burdensome. Intranasal esketamine is effective, yet hospital-centric delivery adds travel and continuity barriers that may hinder adherence and outcomes. We hypothesize that community outpatient, patient-proximal delivery —often with the patient’s usual psychiatrist—improves effectiveness, engagement and acceptability, consistent with Spanish implementation experience and expert consensus (Molero et al. XLI Congr Nac Enferm Salud Ment 2024; — —; Ramos-Quiroga et al. Eur J Psychiatry 2025; 39(3) 100313; Young et al. Neurosci Appl 2024; 3 105240).
Objectives
Primary: evaluate the effectiveness of intranasal esketamine for TRD in community outpatient clinics.
Secondary: trajectories of functioning, suicidality, well-being and treatment satisfaction; engagement/continuity and tolerability; exploratory association between proximity/continuity and outcomes.
Methods
Multicentre, prospective, pragmatic cohort across urban and rural public community mental-health clinics; consecutive recruitment. Adults with TRD (≥2 adequate antidepressant failures) initiated esketamine per routine care. Assessments: baseline; weeks 2, 4, 8, 16, 24; program discharge; and 3/6-month post-discharge. Outcomes: MADRS (primary; response ≥50%; remission ≤10), SDS , C-SSRS , SHS , SWLS , TSQM-9 ; engagement (retention, attendance, continuity with the same psychiatrist); safety/tolerability. Planned analyses: mixed-effects models and time-to-event.
Results
Preliminary subset (n = 7, single site); median age 55 years. MADRS means: 44.1 (baseline) → 35.1 (wk-2) → 32.3 (wk-4) → 26.4 (wk-8) → 24.4 (wk-12); last-observation mean 19.0 ; mean absolute change −25.1 (≈ −56.6% ). Response 4/7 (57.1%); remission 2/7 (28.6%). SDS mean: 28.1 (baseline) → 16.0 (last); mean change −12.1 . C-SSRS median: 4 (baseline) → 0 (last). Mean exposure 4.9 months ; at cut-off: 5/7 in treatment, 1/7 suspended for lack of efficacy, 1/7 discharged with 4-month post-discharge stability. No discontinuations for safety recorded; adverse-event monitoring ongoing.
Conclusions
Early real-world signals indicate that near-patient outpatient delivery yields rapid, clinically meaningful improvements in symptoms, functioning and suicidality with good feasibility and retention. Findings support the hypothesis that proximity and relational continuity act as outcome amplifiers in TRD, aligning with Spanish implementation experience and expert recommendations on practical delivery and adequate duration (Molero et al. XLI Congr Nac Enferm Salud Ment 2024; — —; Ramos-Quiroga et al. Eur J Psychiatry 2025; 39(3) 100313; Young et al. Neurosci Appl 2024; 3 105240).
Disclosure of Interest
None Declared