Esketamine in treatment-resistant depression
Esketamine has a mechanism of action distinct from traditional antidepressants, acting on NMDA receptors and neuroplasticity processes. Its use may be considered in specific cases of treatment-resistant depression, always after careful medical evaluation.
Intrador primarily uses parenteral esketamine in an off-label context, supported by scientific evidence and CFM Opinion No. 20/2024, and in selected cases also uses the intranasal route (Spravato®).
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The use of esketamine may involve off-label use. According to CFM Opinion No. 20/2024, this practice is ethically permitted when conventional treatments have failed, there is scientific rationale, proper medical record documentation, and a free and informed consent form.
This content is informational and does not replace an in-person medical consultation.
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Advanced therapies require careful medical evaluation, individualized indication, and monitoring when needed. Benefits, risks, and contraindications should be discussed in consultation.
Clinically Reviewed by:
Dr. Helio Widson Alves Pinheiro
Pain Medicine | Acupuncture
CRM/PE 21167 | RQE 2217, 2808
This content is informative and does not replace individual medical evaluation.
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Fundador da Clínica Intrador, médico especialista em Medicina da Dor e Acupuntura, com atuação em tratamentos intervencionistas e neuromodulação.
Note: This content is for educational and informational purposes only. The information is based on scientific evidence and the clinical practice of the Intrador team, but it does not replace individualized medical evaluation. Conduct, indications, and treatments must be defined after medical consultation.
Clinical reviewer: Dr. Helio Widson Alves Pinheiro · Pain Medicine | Acupuncture · CRM/PE 21167 | RQE 2217, 2808
Published on: January 17, 2026
Reviewed on: January 29, 2026
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