Exploring Esketamine’s Dual Role in Treating Comorbid Treatment-Resistant Depression and Psychogenic Non-Epileptic Seizures: A Case Study
Background:
Pseudoseizures, or psychogenic non-epileptic seizures (PNES), mimic epileptic seizures but are psychological in origin, lacking abnormal electrical activity on an electroencephalogram (EEG). Esketamine, a ketamine derivative, is FDA-approved for major depressive disorder (MDD) with suicidal ideations and treatment-resistant depression (TRD). This report examines esketamine’s effects on a patient with TRD and PNES, highlighting its potential benefits beyond antidepressant properties.
Case Presentation:
A 45-year-old Caucasian female with a history of anxiety and depression was admitted for suicidal ideations in November 2023 and again in January 2024. Despite multiple medications, including Prozac and Clonazepam, her depression worsened, and she experienced generalized tonic-clonic seizures. These seizures, treated unsuccessfully with anti-epileptics, were later diagnosed as PNES through a sleep-deprived EEG. After her first hospitalization, pseudoseizures persisted despite psychiatric medication adjustments. In February 2024, she began intranasal esketamine (Spravato) at 56 mg twice a week, later adjusted to 84 mg per week, alongside Prozac and Vraylar. Her Hamilton Depression Rating Scale (HAM-D) score dropped from 23 to 7, and she reported no pseudoseizures since starting esketamine. She has resumed work with significant improvements in daily functioning and quality of life.
Discussion:
This case highlights esketamine’s potential dual efficacy against TRD and PNES. Esketamine’s NMDA receptor antagonism enhances synaptic plasticity and neurogenesis, potentially affecting neurological pathways involved in PNES. The complete resolution of pseudoseizures post-esketamine suggests benefits beyond depression alleviation. Further research is needed to understand esketamine’s mechanisms and validate its efficacy for PNES in patients with comorbid depression, potentially offering a novel therapeutic approach.
