What is Esketamine?

Esketamine (Spravato) is a novel, FDA-approved nasal spray indicated for treatment-resistant depression in adults in conjunction with oral antidepressant therapy. Esketamine is derived from the anesthetic medication, ketamine, and works by modulating certain receptors of the neurotransmitter, glutamate, in the brain, although the mechanisms of its antidepressant effects are not yet fully determined.

Benefits of Esketamine Treatment for depression:

Esketamine is fast acting compared to conventional antidepressants. While traditional oral antidepressant therapy may take weeks to demonstrate full therapeutic effects, esketamine has been reported to show antidepressant effects as early as 24 hours. Studies have shown that patients taking esketamine observe both short term and long term improvements in depressive symptoms.

What to expect with Esketamine:

Esketamine is administered in clinical settings on an outpatient basis. Esketamine cannot be taken home. Under clinical supervision, you will administer two or three doses of the nasal spray spaced five minutes apart at each visit. Afterwards, you will remain under observation at the clinic for at least two hours. Treatment is given twice a week for four weeks, followed by once a week for four weeks, after which ongoing treatment course is determined in conjunction with your psychiatrist.

Side effects of Esketamine:

The most common side effects of Spravato are sedation and disassociation. These side effects wear off within two hours following administration, which is why the two hour observation period after treatment is required. Patients are not allowed to drive home after receiving Spravato.  Other common side effects include anxiety, nausea, increased blood pressure, feeling “drunk,” and lethargy.