Esketamine for treatment-resistant depression

Depression is a serious medical condition that is more common than people realize. In fact, according to the National Institute of Mental Health (NIMH), major depressive disorder (MDD) affects over 8 percent of U.S. adults per year.

There are many ways that depression is treated, varying from talk therapy to medication – and treatment options are often combined to improve results. If patients are unresponsive to two or more of these treatments, an intranasal spray, known as esketamine, is a relatively new treatment option that care teams can consider.

Esketamine, which was approved by the Food & Drug Administration (FDA) in 2019, is a safe, very low dose of ketamine — a powerful anesthetic — proven to reduce symptoms of severe depression. It is also known under the brand name Spravato™.

“Esketamine is considered for patients who may not respond positively to traditional treatments, such as oral antidepressants and talk therapy,” says Dr. Brian Miller, medical director for Sharp Grossmont Hospital for Behavioral Health.

How does it work?

The fast-acting drug is thought to affect neurotransmitters in the brain, restoring synapse connections in the brain that are disrupted during major depressive disorder.

Research has shown that supervised use of esketamine may also help reduce suicidal thoughts. The effects are felt almost immediately, as opposed to the several weeks it may take to feel significant relief from antidepressant medications.

Who is eligible for the treatment?

The intranasal spray can be prescribed to patients with major depressive disorder who have not responded positively to at least two other antidepressant treatments. You may not be eligible, and should talk to your doctor, if you are pregnant, had a previous negative response to esketamine, have hyptertension or heart disease or have a history of substance abuse or psychosis.

How is it administered?

Esketamine is not administered by patients, it is available at approved and certified treatment centers, under the supervision of a clinician.

Why is it controversial?

Esketamine in higher doses has been known to be used as a recreational drug and can produce hallucinations and other potentially harmful side effects. However, the approved therapeutic dose of esketamine (the FDA-approved intranasal spray) is much smaller, although not without side effects, which can include dizziness, drowsiness and elevated blood pressure.

The most serious side effects include dissociative or “out-of-body” episodes very shortly after taking the drug, which is why it will be administered under supervision in a licensed facility.

Is esketamine addictive?

While clinical trials tested the safe use of esketamine for depression for up to one year, its effect over a longer period was not tested.

Call or text the 988 Suicide & Crisis Lifeline at 988 if you are having thoughts of suicide and need help. Learn more about mental health services at Sharp HealthCare.