Esketamine (Spravato) Nasal Spray
Esketamine is a prescription nasal spray used to help patients with treatment-resistant depression. Esketamine treatment is rapidly acting and can offer relief to patients who haven’t had success with other antidepressant medications. Side effects may include a transient increase in blood pressure, disassociation, and sedation.
Because of the potential side effects, patients must complete the treatment in a certified clinic under the supervision of medical staff, and they cannot drive after treatment, therefore it is required to have a ride to and from treatments. The total treatment and observation time is two hours. Patients complete two treatments weekly for the first month, followed by weekly treatments for the next month. After that, a physician in the clinic will determine a maintenance treatment schedule individualized to each patients’ results. Most commercial insurances, as well as Medicare, cover esketamine treatment.
How it works
Research indicates that esketamine’s antidepressant actions are due to a different mechanism than other antidepressants. Traditional antidepressants increase the levels of naturally occurring chemicals, called neurotransmitters (e.g. serotonin, norepinephrine, and dopamine), in the central nervous system. Esketamine instead binds to the glutamate NMDA receptor in the brain, and through complex downstream mechanisms, ultimately activates brain pathways that promote brain cell growth, the connection between these cells, and neuroplasticity, or the brain’s ability to reorganize and adapt to new experiences. These effects are thought to contribute to esketamine antidepressant properties.
Treatment Experience
During each esketamine treatment, you will self-administered the nasal spray for two to three doses, spaced five minutes apart, under the supervision of a health care provider. You will remain in the clinic under observation by the health care team with regular monitoring of vital signs and treatment effects for a total of two hours until potential side effects have passed.
Esketamine has the potential to distort your perception of time and place, a side effect known as “dissociation.” This effect occurs within the first one to two hours after initiating treatment, and thus is administered in a clinic setting for safety purposes. Esketamine nasal spray treatments are done on an outpatient basis.
Eligibility & Potential Side Effects
Esketamine is FDA-approved for people with treatment-resistant depression. Treatment-resistant depression is generally defined as having tried at least two other antidepressants at an adequate dose and for an adequate duration of time, without expected relief of symptoms. Side effects may include a transient increase in blood pressure, dissociation (feeling disconnected from yourself or reality), perceptual disturbances (distortion in the perception of time and space), and sedation (drowsiness). You may also experience dizziness, headaches, or nausea. You will be monitored for these potential side effects during your treatment. Side effects typically peak in the first hour and wear off by two hours after treatment administration.
Contraindications to receiving esketamine treatment include history of aneurysm, arteriovenous malformation, intracerebral hemorrhage, arrhythmia, uncontrolled hypertension, unstable angina, complex cardiovascular disease, pregnancy or breastfeeding, or active or untreated substance use disorder.