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What is esketamine
Spravato is a nasal spray medication containing esketamine that was approved by the FDA for treatment of persistent depression in adults. It is the first of its kind and the only NMDA receptor antagonist to receive FDA approval. Ketamine infusions are a successful treatment option for 70% of patients with treatment-resistant Major Depressive Disorder.
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Esketamine mechanism of action
Esketamine is a drug that treats depression differently than traditional antidepressants. It works by blocking NMDA receptors in the brain and increasing levels of glutamate, which is the most abundant chemical messenger in the brain. This activates AMPA receptors, releasing other molecules that help brain cells communicate with each other along new pathways, likely affecting mood, thought patterns, and cognition.
Benefits and Risks of Esketamine Nasal Spray
Potential Benefits of Esketamine Nasal Spray
Esketamine nasal spray has been shown to be an effective treatment for TRD in adults. It works quickly and can alleviate symptoms of depression within hours or days, compared to traditional antidepressants that can take weeks to start working. It can also improve suicidal ideation and help people with TRD maintain symptom relief.
Difference between ketamine and esketamine
Esketamine (Spravato) is a more potent version of ketamine used to treat depression. It allows for lower doses and potentially fewer side effects. Both are controlled substances and can be highly addictive. Ketamine must be given intravenously up to three times per week, which can be inconvenient and painful. In contrast, Esketamine (Spravato) is administered in an outpatient setting under supervision, with three doses spaced five minutes apart. Patients remain under supervision for two hours to monitor potential side effects.
Esketamine side effects include:
- Increased blood pressure
- Dissociation (sometimes called out-of-body experiences)
The side effects tend to peak at 40 minutes and wear off within two hours of treatment. You can expect the most intense side effects during the first two treatment sessions.
Esketamine Nasal Spray Frequently Asked Questions
Who should NOT take esketamine Nasal Spray ?
Do not use Esketamine Nasal Spray if you are allergic to esketamine, ketamine, or any of its ingredients, or if you have an aneurysm, arteriovenous malformation, or history of bleeding in the brain. Inform your healthcare provider if you have heart, brain, or liver problems, psychosis, or are pregnant or planning to become pregnant. You should not take SPRAVATO® if pregnant or breastfeed while taking it. Inform your healthcare provider of all medications you take, including vitamins and herbal supplements.
How will I know if esketamine working?
Your healthcare provider will regularly ask about your depression symptoms, side effects, and improvement while taking SPRAVATO®. They use a standardized rating scale to track your progress. It’s important to ask your provider how they will evaluate your response to treatment and how you can assist with that. If you switch providers, ensure they are communicating with your referring provider about your progress.
What to expect after taking Esketamine Nasal Spray ?
Esketamine therapy can produce various side effects, including hallucinations and feeling detached from oneself or reality. These effects typically reach their maximum intensity within 40 minutes of treatment, but usually subside within two hours.
What are some rules regarding Esketamine Nasal Spray ?
You will use Esketamine Nasal Spray twice a week for four weeks while taking another antidepressant. Do not stop without talking to your healthcare provider. Continuing treatment will be decided after four weeks. Possible side effects include prolonged drowsiness, mental changes, and high blood pressure.
What happens when you stop taking Esketamine Nasal Spray ?
Esketamine withdrawal symptoms include craving, fatigue, poor appetite, and anxiety. Dependence should be monitored post-treatment. Patients may feel excessively sleepy after receiving esketamine treatment.
How long does Esketamine Nasal Spray stay in your system?
It rapidly declines in your system after the first 2-4 hours but it can take 6-12 hours before it or its metabolites are completely out.
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