KETAMINE

What is esketamine?

Esketamine is made from a drug called ketamine, an anesthetic that has also been used for many years to treat depression. But it wasn’t until recently that esketamine, a more potent version of ketamine, earned FDA approval specifically for use as a nasal spray for those with treatment-resistant depression.

Esketamine is derived from part of the ketamine molecule,” says Kaplin, who has studied the drug for three years. “Because it’s more potent, you can use it at a lower dose and theoretically have fewer side effects. Now that it’s available in an intranasal version and approved by the FDA, it’s more likely that insurance companies will cover the treatment.

What is esketamine treatment like?

Esketamine, like ketamine, has the potential to distort your perception during the first two hours after treatment, so it has to be administered in a clinic setting. Treatment for esketamine nasal spray is done on an outpatient basis.

With the nasal spray, you give yourself three doses, spaced five minutes apart, under doctor supervision. You remain in the clinic under doctor observation until potential side effects have passed.

Esketamine must be used in conjunction with a conventional antidepressant. The intention is that esketamine provides rapid relief from depression symptoms until the other medication takes effect.

Who is a good candidate for esketamine therapy?

Currently, esketamine is approved for people with treatment-resistant depression. That means you’ve tried at least two other antidepressants (for at least six weeks each) and haven’t experienced remission or at least a 50% improvement in mood.

For people who haven’t had success with other antidepressants, esketamine gives them the chance to see what it’s like to not have depression,” says Kaplin. “It gives them hope that they can feel better with the right treatment.

How does esketamine treat depression?

Esketamine, and its related drug ketamine, are highly effective depression treatments for a number of reasons:

Esketamine’s antidepressant function works through a different mechanism than other drugs. Conventional antidepressants increase levels of naturally occurring chemicals such as serotonin, norepinephrine and dopamine. These chemicals are messengers that relay communication between brain cells. The theory is that having greater quantities of these neurotransmitters allows for better communication between brain cells and positively affects mood.

Esketamine works in a similar fashion, but unlike other antidepressants it increases levels of glutamate, the most abundant chemical messenger in the brain. The result? A greater impact on more brain cells at one time.