Trial Outcomes & Findings for A Study to Evaluate the Efficacy, Safety, and Tolerability of Intranasal Esketamine Plus an Oral Antidepressant in Elderly Participants With Treatment-resistant Depression (NCT NCT02422186)

Last Updated: 2025-04-29

Results Overview

The MADRS is a clinician-rated scale designed to measure depression severity and to detect changes due to antidepressant treatment. The scale consists of 10 items (to evaluates apparent sadness, reported sadness, inner tension, sleep, appetite, concentration, lassitude, inability to feel \[interest level\], pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item not present or normal) to 6 (severe or continuous presence of the symptoms), summed for a total possible score range of 0-60. Higher scores represent a more severe condition. Negative change in score indicates improvement.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

139 participants

Primary outcome timeframe

Baseline up to Endpoint (Double-blind Induction Phase[Day 28])

Results posted on

2025-04-29

Participant Flow

Total 139 participants were enrolled, out of which 138 were randomized and 1 participant was excluded due to Good Clinical Practice (GCP) non-compliance.

Participant milestones

Participant milestones
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg plus oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day-Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day-Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day-Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day-Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo plus oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
Double-blind Induction Phase (4 Weeks) STARTED	72	66
Double-blind Induction Phase (4 Weeks) Full Analysis Set (FAS)	72	65
Double-blind Induction Phase (4 Weeks) Safety Analysis Set	72	65
Double-blind Induction Phase (4 Weeks) COMPLETED	62	60
Double-blind Induction Phase (4 Weeks) NOT COMPLETED	10	6
Follow-up Phase (2 Weeks) STARTED	12	3
Follow-up Phase (2 Weeks) COMPLETED	8	3
Follow-up Phase (2 Weeks) NOT COMPLETED	4	0

Reasons for withdrawal

Reasons for withdrawal
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg plus oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day-Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day-Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day-Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day-Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo plus oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
Double-blind Induction Phase (4 Weeks) Lost to Follow-up	1	0
Double-blind Induction Phase (4 Weeks) Protocol Violation	0	1
Double-blind Induction Phase (4 Weeks) Withdrawal by Subject	1	2
Double-blind Induction Phase (4 Weeks) Lack of Efficacy	3	1
Double-blind Induction Phase (4 Weeks) Adverse Event	4	2
Double-blind Induction Phase (4 Weeks) Other	1	0
Follow-up Phase (2 Weeks) Withdrawal by Subject	1	0
Follow-up Phase (2 Weeks) Other	3	0

Baseline Characteristics

A Study to Evaluate the Efficacy, Safety, and Tolerability of Intranasal Esketamine Plus an Oral Antidepressant in Elderly Participants With Treatment-resistant Depression

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) n=72 Participants Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo n=65 Participants Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Total n=137 Participants Total of all reporting groups
Age, Categorical <=18 years	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Age, Categorical Between 18 and 65 years	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Age, Categorical >=65 years	72 Participants n=5 Participants	65 Participants n=7 Participants	137 Participants n=5 Participants
Age, Continuous	70.6 years STANDARD_DEVIATION 4.79 • n=5 Participants	69.4 years STANDARD_DEVIATION 4.15 • n=7 Participants	70 years STANDARD_DEVIATION 4.52 • n=5 Participants
Sex: Female, Male Female	45 Participants n=5 Participants	40 Participants n=7 Participants	85 Participants n=5 Participants
Sex: Female, Male Male	27 Participants n=5 Participants	25 Participants n=7 Participants	52 Participants n=5 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	10 Participants n=5 Participants	5 Participants n=7 Participants	15 Participants n=5 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	59 Participants n=5 Participants	59 Participants n=7 Participants	118 Participants n=5 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	3 Participants n=5 Participants	1 Participants n=7 Participants	4 Participants n=5 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) Asian	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) Black or African American	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) White	66 Participants n=5 Participants	64 Participants n=7 Participants	130 Participants n=5 Participants
Race (NIH/OMB) More than one race	4 Participants n=5 Participants	0 Participants n=7 Participants	4 Participants n=5 Participants
Race (NIH/OMB) Unknown or Not Reported	2 Participants n=5 Participants	1 Participants n=7 Participants	3 Participants n=5 Participants
Region of Enrollment Belgium	2 Participants n=5 Participants	4 Participants n=7 Participants	6 Participants n=5 Participants
Region of Enrollment Brazil	1 Participants n=5 Participants	0 Participants n=7 Participants	1 Participants n=5 Participants
Region of Enrollment Bulgaria	3 Participants n=5 Participants	0 Participants n=7 Participants	3 Participants n=5 Participants
Region of Enrollment Finland	1 Participants n=5 Participants	1 Participants n=7 Participants	2 Participants n=5 Participants
Region of Enrollment France	4 Participants n=5 Participants	3 Participants n=7 Participants	7 Participants n=5 Participants
Region of Enrollment Italy	6 Participants n=5 Participants	3 Participants n=7 Participants	9 Participants n=5 Participants
Region of Enrollment Lithuania	2 Participants n=5 Participants	0 Participants n=7 Participants	2 Participants n=5 Participants
Region of Enrollment Poland	4 Participants n=5 Participants	3 Participants n=7 Participants	7 Participants n=5 Participants
Region of Enrollment South Africa	2 Participants n=5 Participants	5 Participants n=7 Participants	7 Participants n=5 Participants
Region of Enrollment Spain	4 Participants n=5 Participants	4 Participants n=7 Participants	8 Participants n=5 Participants
Region of Enrollment Sweden	8 Participants n=5 Participants	6 Participants n=7 Participants	14 Participants n=5 Participants
Region of Enrollment United Kingdom	1 Participants n=5 Participants	0 Participants n=7 Participants	1 Participants n=5 Participants
Region of Enrollment United States	34 Participants n=5 Participants	36 Participants n=7 Participants	70 Participants n=5 Participants

PRIMARY outcome

Timeframe: Baseline up to Endpoint (Double-blind Induction Phase[Day 28])

Population: The full analysis set (FAS) was defined as all randomized participants who received at least 1 dose of intranasal study medication and 1 dose of oral antidepressant medication during the double-blind induction phase. Here, N (Overall number of participants analyzed) signifies number of participants who were evaluable for this endpoint.

Outcome measures

Outcome measures
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) n=63 Participants Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo n=60 Participants Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
Change From Baseline in Montgomery Asberg Depression Rating Scale (MADRS) Total Score up to Endpoint (Double-blind Induction Phase [Day 28])- Mixed-Effects Model Using Repeated Measures (MMRM) Analysis	-10.0 Units on a scale Standard Deviation 12.74	-6.3 Units on a scale Standard Deviation 8.86

PRIMARY outcome

Timeframe: Baseline and Endpoint (Double-blind Induction Phase [Day 28])

Population: The full analysis set was defined as all randomized participants who received at least 1 dose of intranasal study medication and 1 dose of oral antidepressant medication during the double-blind induction phase. Here, N (Overall number of participants analyzed) signifies number of participants who were evaluable for this endpoint.

Outcome measures

Outcome measures
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) n=71 Participants Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo n=64 Participants Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
Change From Baseline in Montgomery Asberg Depression Rating Scale (MADRS) Total Score to Endpoint (Double-blind Induction Phase [Day 28])- Analysis of Covariance (ANCOVA) Analysis	-9.3 Units on a scale Standard Deviation 12.28	-5.6 Units on a scale Standard Deviation 9.11

SECONDARY outcome

Timeframe: At Endpoint-Double-blind Induction Phase [Day 28]

Percentage of participants with greater than or equal to (\>=50) percent (%) reduction from baseline are reported. MADRS is clinician-rated scale designed to measure depression severity, and to detect changes due to antidepressant treatment. Scale consists of 10 items (apparent sadness, reported sadness, inner tension, sleep, appetite, concentration, lassitude, interest level, pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item is not present or is normal) to 6 (severe or continuous presence of symptoms), summed for a total possible score of 0 to 60. Higher scores represent more severe condition. Missing data was imputed using LOCF method and last post baseline observation during the double-blind induction phase was carried forward as the "End Point" for that phase.

Outcome measures

Outcome measures
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) n=71 Participants Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo n=64 Participants Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
Percentage of Participants Who Achieved >=50% Reduction From Baseline in MADRS Total Score at Endpoint (Double-blind Induction Phase [Day 28]) (LOCF Data)	23.9 Percentage of Participants	12.5 Percentage of Participants

SECONDARY outcome

Timeframe: At Endpoint-Double-blind Induction Phase [Day 28]

Remission was defined as participants who had a MADRS total score of less than or equal to (=\<) 12. MADRS is clinician-rated scale designed to measure depression severity, and to detect changes due to antidepressant treatment. Scale consists of 10 items (apparent sadness, reported sadness, inner tension, sleep, appetite, concentration, lassitude, interest level, pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item is not present or is normal) to 6 (severe or continuous presence of symptoms), summed for a total possible score of 0 to 60. Higher scores represent more severe condition. Missing data was imputed using LOCF method and last post baseline observation during the double-blind induction phase was carried forward as the "End Point" for that phase.

Outcome measures

Outcome measures
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) n=71 Participants Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo n=64 Participants Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
Percentage of Participants in Remission (MADRS<=12) at Endpoint (Double-blind Induction Phase [Day 28]) (LOCF Data)	15.5 Percentage of Participants	6.3 Percentage of Participants

SECONDARY outcome

Timeframe: Baseline and Endpoint (Double-blind Induction Phase [Day 28])

CGI-S provides an overall clinician-determined summary measure of the severity of the participants illness including participants history, psychosocial circumstances, symptoms, behavior, and the impact of the symptoms on the participants ability to function. The CGI-S evaluates the severity of psychopathology on a scale of 0 to 7. Considering total clinical experience, a participant is assessed on severity of mental illness at the time of rating according to: 0=not assessed; 1=normal (not at all ill); 2=borderline mentally ill; 3=mildly ill; 4=moderately ill; 5=markedly ill; 6=severely ill; 7=among the most extremely ill patients. Missing data was imputed using LOCF method and last post baseline observation during the double-blind induction phase was carried forward as the "End Point" for that phase.

Outcome measures

Outcome measures
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) n=71 Participants Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo n=65 Participants Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
Change From Baseline in Clinical Global Impression-Severity (CGI-S) Score to Endpoint (Double-blind Induction Phase [Day 28])- ANCOVA Analysis on Ranks	-1.0 Units on a scale Interval -4.0 to 1.0	0.0 Units on a scale Interval -4.0 to 3.0

SECONDARY outcome

Timeframe: Baseline and Endpoint (Double-blind Induction Phase [Day 28])

EQ-5D-5L is a 2-part instrument for use as a measure of health outcome, designed for self-completion by respondents. It consists of EQ-5D-5L descriptive system and EQ VAS. EQ-5D-5L descriptive system comprises of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each has 5 levels of perceived problems (1-no problem, 2-slight problems, 3-moderate problems, 4-severe problems, 5-extreme problems). Participant selects answer for each of 5 dimensions considering response that best matches his/her health "today". Responses were used to generate a health status index (HSI). HSI ranges from -0.148 (health state value equal to dead) and 0.949 (full health), is anchored at 0 (dead) and 1 (full health).

Outcome measures

Outcome measures
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) n=70 Participants Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo n=64 Participants Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
Change From Baseline in EuroQol-5 Dimension-5 Level (EQ-5D-5L) to Endpoint (Double-blind Induction Phase [Day 28]): Health Status Index	0.081 Units on a scale Standard Deviation 0.2624	0.026 Units on a scale Standard Deviation 0.2235

SECONDARY outcome

Timeframe: Baseline and Endpoint (Double-blind Induction Phase [Day 28])

EQ-5D-5L is a 2-part instrument for use as a measure of health outcome, designed for self-completion by respondents. It consists of EQ-5D-5L descriptive system and EQ VAS. The EQ VAS self-rating records the respondent's own assessment of his or her overall health status at the time of completion, on a scale of 0 (the worst health you can imagine) to 100 (the best health you can imagine).

Outcome measures

Outcome measures
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) n=70 Participants Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo n=64 Participants Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
Change From Baseline in EuroQol-5 Dimension-5 Level (EQ-5D-5L) to Endpoint (Double-blind Induction Phase [Day 28]): EQ-VAS	6.2 Units on a scale Standard Deviation 22.78	4.4 Units on a scale Standard Deviation 20.60

SECONDARY outcome

Timeframe: Baseline and Endpoint (Double-blind Induction Phase [Day 28])

EQ-5D-5L consists of EQ-5D-5L descriptive system and EQ visual analogue scale (EQ VAS). EQ-5D-5L descriptive system comprises of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each has 5 levels of perceived problems (1-no problem, 2-slight problems, 3-moderate problems, 4-severe problems, 5-extreme problems). Participant selects answer for each of 5 dimensions considering response that best matches his/her health "today". Responses were used to generate a Health Status Index (HSI). HSI ranges from -0.148 (health state value equal to dead) and 0.949 (full health). EQ VAS self-rating records the respondent's own assessment of his/her overall health status at time of completion, on a scale of 0 (worst health you can imagine) to 100 (best health you can imagine). Sum score ranges from 0 to 100 where, sum score = (sum of the scores from the 5 dimensions minus 5) \*5. Higher score indicates worst health state.

Outcome measures

Outcome measures
Measure	Intranasal Esketamine Plus Oral Antidepressant (AD) n=70 Participants Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Oral AD Plus Intranasal Placebo n=64 Participants Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase. Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
Change From Baseline in EuroQol-5 Dimension-5 Level (EQ-5D-5L) to Endpoint (Double-blind Induction Phase [Day 28]): Sum Score	-6.6 Units on a scale Standard Deviation 20.53	-1.6 Units on a scale Standard Deviation 16.21

Adverse Events

DB Phase: Intranasal Esketamine + Oral AD (4 Weeks)

Serious events: 3 serious events

Other events: 44 other events

Deaths: 0 deaths

DB Phase: Oral AD + Intranasal Placebo (4 Weeks)

Serious events: 2 serious events

Other events: 22 other events

Deaths: 0 deaths

Follow-up Phase: Intranasal Esketamine + Oral AD (2 Weeks)

Serious events: 0 serious events

Other events: 1 other events

Deaths: 0 deaths

Follow-up Phase: Oral AD + Intranasal Placebo (2 Weeks)

Serious events: 0 serious events

Other events: 1 other events

Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure	DB Phase: Intranasal Esketamine + Oral AD (4 Weeks) n=72 participants at risk Participants self-administered esketamine 28 milligram (mg) or 56 mg or 84 mg intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in DB induction phase. Also, participants initiated titration schedule for open-label oral AD with one of following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with MDT at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine extended release (XR) (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase.	DB Phase: Oral AD + Intranasal Placebo (4 Weeks) n=65 participants at risk Participants self-administered esketamine matched placebo intranasally twice weekly for 4 weeks (Day 1, 4, 8, 11, 15, 18, 22, 25) in double-blind (DB) induction phase. Also, participants initiated titration schedule for open-label oral antidepressant (AD) with one of the following: \[Duloxetine (30 mg/day- Week 1, 60 mg/day- Weeks 2, 3 and 4 with minimum dose for tolerability (MDT) at 30 mg/day); Escitalopram (10 mg/day- Weeks 1-4 with MDT at 5 mg/day); Sertraline (25 mg/day- Week 1, 50 mg/day- Week 2, 100 mg/day- Week 3, 150 mg/day- Week 4 with MDT of 25 mg/Day) or Venlafaxine XR (37.5 mg/day- Week 1, 75 mg/day- Week 2, 150 mg/day- Weeks 3, 4 with MDT of 75 mg/day)\] in DB induction phase.	Follow-up Phase: Intranasal Esketamine + Oral AD (2 Weeks) n=12 participants at risk Participants who withdrew early, before end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal esketamine 28 mg or 56 mg or 84 mg+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.	Follow-up Phase: Oral AD + Intranasal Placebo (2 Weeks) n=3 participants at risk Participants who withdrew early, before the end of DB induction phase, or chose not to participate in ESKETINTRD3004 (NCT02497287) long-term safety and efficacy study, and had received at least 1 dose of intranasal placebo+ oral AD in DB induction phase were continued to follow-up phase for 2 weeks.
General disorders Gait Disturbance	0.00% 0/72 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	1.5% 1/65 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/12 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/3 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.
Injury, poisoning and procedural complications Hip Fracture	1.4% 1/72 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/65 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/12 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/3 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.
Investigations Blood Pressure Increased	1.4% 1/72 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/65 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/12 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/3 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.
Nervous system disorders Dizziness	0.00% 0/72 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	1.5% 1/65 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/12 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/3 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.
Psychiatric disorders Anxiety Disorder	1.4% 1/72 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/65 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/12 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/3 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.
Psychiatric disorders Feeling of Despair	0.00% 0/72 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	1.5% 1/65 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/12 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.	0.00% 0/3 • Up to 13 weeks The population analyzed included safety analysis set- all randomized participants who received at least 1 dose of intranasal study medication or 1 dose of oral antidepressant medication during the double-blind induction phase and follow-up analysis set- all participants who entered the follow-up phase.

Other adverse events

Additional Information

Senior Director

Janssen Research & Development, LLC

Phone: 844-434-4210

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee If an investigator wishes to publish information from the study, a copy of the manuscript must be provided to the sponsor for review at least 60 days before submission for publication or presentation. If requested by the sponsor in writing, the investigator will be withheld such publication for up to an additional 60 days.
Publication restrictions are in place

Restriction type: OTHER