189. EXPLORING THE SUBJECTIVE EXPERIENCE OF PATIENTS WITH TREATMENT-RESISTANT DEPRESSION ON THE EFFECTS OF ESKETAMINE NASAL SPRAY

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Abstract Background Multiple clinical trials and real-world studies support the effectiveness of Esketamine Nasal Spray (ESK-NS) in treating patients with Treatment-Resistant Depression (TRD) [1]. However, the assessment of treatment outcomes predominantly relies on clinician’s judgment and data integrating patient’s perspectives are still limited [2, 3]. Aims & Objectives Exploring the subjective experience with ESK-NS might allow for a comprehensive understanding of the multidimensional effects of treatment on patients' mental health, daily lives, and overall wellbeing. Thus, in this multicentric Italian study, we aimed to assess experiences with ESK-NS in TRD patients focusing on perceived therapeutic effects and satisfaction. Method A self-report survey was administered to 150 patients with a diagnosis of TRD (55.1% females, 54.1±14.1 years), treated for at least three months with ESK-NS in combination with selective serotonin/serotonin-norepinephrine reuptake inhibitors. Based on satisfaction levels, participants were classified as 'unsatisfied' (10.2%), 'partially satisfied' (19.1%), 'satisfied' (44.4%), and 'very satisfied' (26.3%). Sociodemographic, clinical characteristics, and feedback on perceived benefits were compared across groups. ANOVA and contingency tables/Chi-square test/Fisher’s Exact Test were used for continuous and dichotomous variables, respectively. A significance level of p<0.05 was applied for each test. Recurring topics reported by participants in their responses to the open-ended question were analyzed and categorized through Artificial Intelligence (OpenAI). Results Beneficial effects were reported within the first month by 40.3% of participants, with improvements in quality of life (88.4%) and absence of significant side effects (30%). The earliest self-perceived benefits and the effects rated as most significant significantly differed among groups. The reduction of suicidal thoughts was considered among the most relevant effects by very satisfied patients (p=0.003). Only this group noted improvements across all functional domains, including the academic-occupational functioning (p<0.001). OpenAI identified experiences of personal growth and rediscovery (like a sense of reconnecting with the inner self, retrieving what is meaningful, setting new personal goals) as well as the desire for more tailored setting and approaches as topics frequently reported by patients. Discussion & Conclusions Although preliminary, these results highlight that the greater part of the sample reported positive effects of ESK-NS treatment and that most satisfied participants noted significant benefits on depressed mood, suicidality, and socio-occupational functioning. Assessing the subjective experience of patients could help clinicians to better understand the benefits across different psychopathological dimensions and provide a more accurate evaluation of treatment's impact on functional outcomes and quality of life [4]. Integrating patients' perspectives into clinical practice might assist treatment personalization, improving adherence, satisfaction, and overall effectiveness.

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