Understanding the Benefits of Esketamine Nasal Spray

Several medications can help people with depression find relief from their symptoms. Sometimes, however, first-line treatments don’t work, and patients may need to seek out additional strategies to help reduce symptoms. This scenario—where adults who have tried at least two medications don’t find any relief from their symptoms—is called treatment-resistant depression (TRD). One option for those with TRD is esketamine nasal spray for depression. Here’s what you should know about the benefits of this ketamine-based depression treatment. 

What is Esketamine Nasal Spray?

Esketamine is a form of ketamine, a medication that has been around for decades. Ketamine is given as an anesthetic and pain reliever, but it’s been used as an off-label treatment for depression for years. Unlike traditional antidepressants, ketamine works within hours or days, making it a promising short-term treatment for patients who find no relief from other forms of antidepressants. In March of 2019, the FDA approved SPRAVATO® as the first esketamine nasal spray for resistant depression.

While esketamine nasal spray works similarly to ketamine, there’s a key difference between the two medications. Ketamine is a racemic mixture of “S” and “R” mirror-image molecules, whereas esketamine consists only of the “S” molecule. This difference means that esketamine is more potent than ketamine but with fewer side effects. In addition, esketamine for depression is thought to work more quickly than ketamine to relieve symptoms of depression.

Because it is a Schedule III Controlled Substance, esketamine nasal spray can only be given to patients at certified clinics under the supervision of a medical professional. The provider will tell patients how much esketamine to use and instruct them on how to spray it up their own nostrils. After self-administering the prescribed number of sprays, patients will remain under observation for two hours.

How Does Esketamine Nasal Spray Work?

Esketamine for depression works by initiating activity in the glutamatergic system of the brain. This activity then helps to quickly restore neural pathways that had previously been lost as a result of treatment-resistant depression. 

The results of depression treatment nasal spray typically become apparent within hours. Patients may notice a renewed sense of hopefulness, along with a decrease in anxiety and depressive symptoms. The results can last from one to two weeks, depending on the patient and the situation. The provider will know how much esketamine nasal spray to prescribe and how often it should be administered. 

Patients return to the clinic twice per week for their treatment during the first four weeks. After that, they typically continue treatment once per week for a while, and then, depending on how they’re doing, less often after that.

It’s important to note that esketamine for depression should be taken along with an antidepressant. Side effects typically last less than two hours after the dose of esketamine is given and may include drowsiness, dissociation, dizziness, nausea, and lightheadedness.

Who is Esketamine Meant For?

Depression treatment nasal spray is meant for people who struggle with treatment-resistant depression. In order to qualify for SPRAVATO®, patients with TMD must have tried two previous oral antidepressants with unsatisfactory results. 

Esketamine nasal spray is also approved to treat people who have major depressive disorder with acute harmful behaviors. One of the major benefits of using esketamine nasal spray is that it works rapidly to treat symptoms. Many patients feel substantial relief within hours.

Ketamine IV treatment can also provide rapid relief, but in many patients, it takes at least three separate IV infusions before symptoms begin to improve. Unlike SPRAVATO® nasal spray, ketamine IV treatment is not approved by the FDA for treatment of depression. Because of this, insurance does not cover the cost of ketamine IV treatment.

Is Esketamine FDA Approved?

Esketamine is FDA approved for two indications: treatment-resistant depression and major depressive disorder with acute harmful behaviors. SPRAVATO® is monitored as a Schedule III drug. This means that in order to receive treatment, you will need to visit a certified clinic and administer the medication to yourself under the supervision of a medical provider. Because it is FDA approved, esketamine is covered by insurance.

Schedule Your No-Cost Consult with Greenbrook Centers

If you have TRD or MDD with acute harmful behaviors, schedule your no-cost consult with Greenbrook TMS NeuroHealth Centers. We are a certified SPRAVATO® treatment center, and we are also FDA-cleared to provide transcranial magnetic stimulation (TMS) therapy. Our care team can help you discover which treatment is right for your situation.