An Implementation Science Assessment of Intranasal Esketamine's Limited Integration into Mainstream Psychiatric...

Area of Science:

• Psychiatry
• Pharmacology
• Implementation Science

Background:

• Major Depressive Disorder (MDD) is a prevalent global mental illness.
• Treatment-resistant depression (TRD) describes patients unresponsive to standard antidepressant therapies.
• Intranasal esketamine received FDA approval in 2019 for TRD, offering a new therapeutic avenue.

Purpose of the Study:

• To analyze the limited real-world implementation of intranasal esketamine for TRD.
• To identify barriers to esketamine's adoption in psychiatric settings.
• To propose strategies for enhancing treatment accessibility.

Main Methods:

• Review of intranasal esketamine's real-world effectiveness studies.
• Application of the Consolidated Framework for Implementation Research (CFIR).
• Analysis of factors influencing clinical practice adoption.

Main Results:

• Despite proven efficacy, intranasal esketamine is not widely available in psychiatric settings.
• Implementation barriers exist across various domains, including policy, organizational, and individual levels.
• Limited accessibility hinders treatment for patients with TRD.

Conclusions:

• Addressing implementation barriers is crucial for equitable access to intranasal esketamine.
• Strategic interventions are needed to integrate esketamine into routine psychiatric care.
• Improved access can significantly benefit patients suffering from treatment-resistant depression.