Esketamine
Esketamine is a medication derived from ketamine, primarily used for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal thoughts. It is marketed under the brand name Spravato and is administered as a nasal spray
Esketamine : Uses, Benefits, and Risks
Esketamine is a medication derived from ketamine, primarily used for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal thoughts. It is marketed under the brand name Spravato and is administered as a nasal spray under medical supervision.
1. Uses & Mechanism of Action
Esketamine is an NMDA receptor antagonist, meaning it works differently from traditional antidepressants like SSRIs or SNRIs. It increases glutamate levels, promoting rapid brain plasticity, which can lead to fast relief from depressive symptoms.
Indications:
• Treatment-Resistant Depression (TRD): For patients who have failed to respond to at least two different antidepressants.
• Major Depressive Disorder (MDD) with Acute Suicidal Ideation: Provides rapid symptom relief, though it must be used alongside conventional antidepressants.
2. Benefits of Esketamine
Rapid Onset of Action – Works within hours to days, unlike traditional antidepressants that take weeks.
Effective for Severe Depression – Helps patients with suicidal ideation where other treatments fail.
Potential Neuroprotective Effects – May help in brain repair and regeneration.
3. Risks and Side Effects
Dissociation & Hallucinations – Patients may experience temporary disconnection from reality.
Sedation – Can cause dizziness and drowsiness.
Abuse Potential – Due to its similarity to ketamine, it is a Schedule III controlled substance.
Blood Pressure Spikes – Can increase blood pressure temporarily.
Common side effects include dizziness, nausea, headache, and fatigue.
4. Administration & Regulations
• Esketamine is not a take-home drug; it must be administered in a certified healthcare setting.
• Patients are monitored for two hours after administration due to potential side effects.
• It is used alongside a traditional antidepressant like an SSRI or SNRI.
5. Esketamine vs. Ketamine: What’s the Difference?
Feature Esketamine (Spravato) Ketamine
Administration Nasal Spray IV Infusion
FDA Approval Yes (for TRD) No (used off-label)
Setting Medical Supervision Only Some clinics allow at-home use
Effect Stronger NMDA receptor blockade General anesthetic & antidepressant
6. Availability in India
Esketamine is not yet widely available in India. However, IV ketamine therapy is offered in some mental health clinics for depression treatment. If you are considering esketamine therapy, consult a psychiatrist or a licensed mental health professional for guidance.