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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0835

Intranasal esketamine and trauma memory psychotherapy in treatment-resistant depression: rationale and feasibility protocol

INTRANASAL ESKETAMINE AND TRAUMA-MEMORY PSYCHOTHERAPY IN TREATMENT-RESISTANT DEPRESSION: RATIONALE AND FEASIBILITY PROTOCOL

Combining intranasal esketamine with manualized imagery rescripting during the post-dose window of neuroplasticity appears mechanistically plausible and clinically feasible, but its efficacy has not been established.

The aim of the study is to describe a pragmatic protocol combining esketamine with trauma-focused psychotherapy to address intrusive trauma memories, which are common in treatment-resistant depression (TRD) and interfere with engagement in psychotherapy. Using a narrative review approach, PubMed/MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov were searched, with the search updated through January 25, 2026; randomized trials, observational studies, case series, and case reports were included, with a focus on PTSD symptoms, intrusive memories, flashbacks, trauma-related learning, and psychotherapy integration. Signals from the evidence included rapid reductions in PTSD symptoms with intravenous ketamine in randomized trials, as well as feasibility data from pilot studies and case series pairing ketamine with prolonged exposure, written exposure therapy, and EMDR. The proposed stepwise protocol includes screening for TRD and trauma memory symptoms, an esketamine dosing session, monitoring of blood pressure, dissociation, and suicidality, and a readiness check; imagery rescripting is delivered within 24 to 48 hours after dosing (Option A) or later on the dosing day (Option B). Manualized imagery rescripting follows a sequence of identifying the target memory, rescripting the threat, meaning, and sense of agency, and reinforcing a safety narrative and coping plan, complemented by multidisciplinary review and follow-up. Safety monitoring includes dissociation, blood pressure before, during, and after dosing, assessment of acute suicide risk, and monitoring of transient trauma-related distress. The authors state that the approach is mechanistically plausible and clinically feasible, but that its efficacy has not been established and that standardized feasibility studies and controlled trials are needed to define optimal timing, safety parameters, and patient selection.

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