Significance for the field
TRD
REMISSION
This study addresses several important gaps in the literature. To date, substantive studies of efficacy and safety in TRD are available for intranasal esketamine but not racemic ketamine. The largest previous RCT of racemic ketamine, involving 81 participants,In this study, adequately dosed racemic ketamine was shown to have superior antidepressant efficacy to an active control drug, with the proportional increase in remission comparing favourably to that of studies of intranasal esketamine tested against a non-active placebo.