This study examines if cognitive behavioral therapy (CBT), a type of talk therapy, helps after using esketamine, a medicine for major depression with suicidal thoughts. Patients will either get computer-assisted CBT or usual care (TAU) after esketamine. The study checks if combining esketamine with CBT is more effective than using esketamine and TAU for reducing suicidal thoughts.

Participants must be aged 18-65, diagnosed with major depressive disorder, and recommended for esketamine treatment. They must also follow contraception guidelines if sexually active and agree to all study procedures. People with certain medical or psychiatric conditions, substance use disorders, or previous ineffective esketamine or ketamine treatments are excluded.

• Study Length: Participation in the study requires commitment to follow-up visits and treatment plans.
• Eligibility: Eligibility includes age, medical history, and doctor's recommendation for esketamine.
• Risks: There are specific health conditions that may prevent participation, ensuring safety for all involved.