Esketamine is a new medication licensed for Treatment Resistant Depression (TRD) and is indicated, in combination with an SSRI or SNRI, for adults who have not responded to at least two different treatments with antidepressants. Recent studies suggest that esketamine improves TRD symptoms and suicidal ideation. Treatment with esketamine (Spravato) can lead to rapid and meaningful improvements in the symptoms of depression. Some have been reported as fast as 24 hours after initial dose.

In the UK esketamine is sold by Janssen Pharmaceutical under the name of Spravato, and is classified as a Schedule 2 controlled drug. Esketamine is self-administered by the patient as a nasal spray, medically supervised, in a clinical controlled environment where patients have to remain for 90 minutes after the initial dose to monitor for possible side effects or adverse reactions.

Esketamine is used alongside an antidepressant such us:

SSRIs (Citalopram, Dapoxetine, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vortioxetine), or SNRIs include (Duloxetine, Venlafaxine).

There is an initial 4-week induction phase where patients are dispensed esketamine twice per week at the clinic until they've reached the appropriate dose to improve symptoms. Esketamine (Spravato) treatment is not suitable if you have hypersensitivity to esketamine or ketamine, or you have conditions that make you prone to intracranial hypertension such us: aneurysmal vascular disease (including intracranial, thoracic, or abdominal aorta, or peripheral arterial vessels), history of intracerebral haemorrhage, or recent (within 6 weeks) cardiovascular event, including myocardial infarction.

The risk of misuse is very low because esketamine (Spravato) is not dispensed to patients but to the clinic where is securely stored, for the patient to self-administer under clinical supervision.

 

Treatment for Resistant Depression with esketamine (Spravato) is available at The OAD Clinic.

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