PMC9373837_01
Case 4 timeline for longitudinal course of treatment response. Patient 4 is a woman in her 40's with a current diagnosis of treatment-resistant unipolar depression with physical co-morbidity of congenital glaucoma and bilateral complete vision loss. Brexpiprazole was initiated at the dose of 0.5 mg and titrated to a maximum of 1mg in combine with intranasal esketamine 84 mg fortnightly. Co-medications include mirtazapine 30 mg, agomelatine 50 mg. Her mood stability and functionality improved with the combination of brexpiprazole and esketamine in her pharmacological regime and Acceptance and Commitment Therapy (ACT)-based psychotherapy.
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F4
Her mood stability and functionality improved with the combination of brexpiprazole and esketamine in her pharmacological regime and Acceptance and Commitment Therapy (ACT)-based psychotherapy (Figure 4).
Case 5 timeline for longitudinal course of treatment response. Patient 5 is a Chinese female in her late 50's with a current diagnosis of treatment-resistant unipolar depression with physical co-morbidity of sacral fracture. She was on IVI ketamine since 2012 with symptomatic remission as reported in another published case series. IVI ketamine was witheld on July 2020 in view of patient's concern of contacting with COVID-19 cases during hospital visit. Her depression relapsed on Dec 2020 where IVI ketamine was restarted and subsequently reduction of QIDS-SR16 score. Co-medications include esketamine 56mg fortnightly, agomelatine 50 mg, quetiapine 800 mg, mirtazapine 45 mg, lorazepam 1 mg BD, zolpidem 10 mg, and clonazepam 2 mg PRN. Her depressive symptoms and functioning improved after 3 months on intranasal esketamine.
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F5
Since February 2022, she has been tolerating esketamine 56 mg od well with no adverse events (QIDS SR16 score = 9, mild depression) in combination with agomelatine 50 mg ON, quetiapine extended release 800 mg ON, mirtazapine 45 mg ON, lorazepam 1 mg BD, zolpidem 10 mg ON, and clonazepam 2 mg PRN (Figure 5).