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Major Depressive Disorder (MDD) is the third most common mental disorder in adolescents. MDD causes diminished quality of life, functional impairment, poor socio-economic outcomes, and increases the risk for suicide. Suicidal ideation is present and appears to be a precondition for suicide attempts in patients with MDD, especially in adolescent patient. Around 1.4% of adolescent patient reported that they had suicidal ideation. This emphasizes the need for treatment options with sustained efficacy and long-term tolerability. In recent years, ketamine has received attention as an antidepressant agent, demonstrating promising results as well as having anti-suicidal properties. Esketamine nasal plus an oral antidepressants have demonstrated a statistically significant or clinically meaningful reduction in depressive and showed improvement in measures of depressive symptoms and other efficacy assessments during the induction phase (first 4 weeks of exposure), which appeared to be sustained during the optimization/maintenance phase. As reported in this case, After the first four weeks, patient showed improvement regarding mood and decreasing suicidal ideation as well as successful in decreasing the dosage his of oral medication.
