Two people with severe depression that didn’t respond to other treatments felt better and had fewer thoughts of suicide right after they stopped using a nasal spray called esketamine—even though they felt worse while using it.

In two people with severe depression that didn’t respond to other treatments, a nasal spray called esketamine made them feel better at first, but then their mood got worse again—like a quick high followed by a crash.

Two people with severe depression that didn’t respond to other treatments felt better at first after using a nasal spray called esketamine, but then their depression and suicidal thoughts got much worse—until they stopped using the spray, and then they felt better again.

Taking esketamine through the nose doesn't seem to make suicidal thoughts any better or worse in adults with severe depression that hasn't responded to other treatments, no matter when they checked.

For adults with depression that didn’t respond to other treatments, using a nasal spray called esketamine for six months seemed to help fewer people think about suicide — down from more than half to about one in seven — but how strongly they felt those thoughts didn’t clearly get better.

A nasal spray called esketamine may quickly and lastingly help people with severe depression that hasn’t responded to other treatments — and it might also reduce thoughts of suicide.