Should I Try Esketamine for Depression?
Should I try Esketamine for Depression?
Treatment-resistant depression is one of the most challenging disorders to treat in all of psychiatry. Characterized by an often-disabling degree of depression, which responds poorly to different medication combinations, treatment-resistant depression can erode quality of life and reduce functional capacity in those who are afflicted. Recent trials have demonstrated impressive results when Ketamine is used as a clinical intervention for treatment resistant depression. Ketamine, which is a form of anesthesia, has been shown to produce robust and rapid responses for depression when given in small, sub-anesthetic doses. There are now newer techniques and forms of ketamine administration also demonstrating promising results. These include the new FDA approved drug Esketamine (brand name Spravato), a nasal spray containing a medication patterned after Ketamine.
How effective is Spravato (Esketamine) for Treatment-resistant depression?
Recent clinical trials have demonstrated very promising results with Esketamine for depression, so much so that it received a FDA indication specifically for treatment-resistant depression under the brand name Spravato. Esketamine is the “S” isomer of Ketamine, which usually is a mix of both the “S” and “R” molecules (mirror images of each other on a molecular level). Spravato (Esketamine) has shown to be effective in treating very difficult cases of Major Depressive Disorder (MDD).
How is Spravato (Esketamine) administered for depression treatment?
Spravato is a nasal spray that has to be administered in a medical office, while under observation. Patients cannot administer Spravato in their own homes. The desired effect is a pronounced uplift in mood, while still fully awake and alert. The patient is monitored in the office to ensure they can tolerate the medication, and to monitor blood pressure. In some patients, blood pressure can elevate temporarily following administration of Spravato. At our office in Boca Raton, patients receiving Esketamine for depression receive medical clearance before starting treatment, are continually monitored during the dosing and observation period, and receive follow-up appointments with our psychiatrists.
How long does a Spravato (Esketamine) dose last?
We have found that the mood elevation with Esketamine is significant, and can last for weeks after just one administration. Most cases will require subsequent Esketamine doses with some regularity that may be weekly or bi-monthly. Most cases maintain a very strong clinical response with ongoing treatment.
The high effectiveness in treating some of the hardest depression cases has given both Ketamine and Esketamine a certain level of distinction in psychiatry. Some patients with treatment-resistant depression, that have been written off as hopeless, have found their lives restored after a series of successful Esketamine or Ketamine treatments. Aside from its rapid onset, Esketamine is also well tolerated with very few side effects. Positive response rates are high and can be achieved quickly. The few patients who did not respond immediately to the initial dosage can still achieve a positive response if the dose of Spravato is adjusted correctly. Some patients experience a response lasting four weeks after the first administration. Many patients continue to receive weekly Esketamine administrations to maintain that strong initial response.
The Spravato (Esketamine) nasal spray and Ketamine intravenous infusions are powerful tools available for those with non-responsive Major Depression. All candidates for Esketamine therapy must first receive a psychiatric evaluation, after which all of the different treatment recommendations are discussed. The Spravato (Esketamine) nasal spray and Ketamine intravenous infusions may be appropriate options in treatment resistant cases of Major Depressive Disorder, but the best results we see are when they are paired with a comprehensive approach that includes individual and group psychotherapy, optimized nutrition, and exercise.
