Can esketamine treat depression?

Esketamine is a type of ketamine that has originally been used as a general anesthetic. Recently, it was approved by the FDA for use as a medication for treatment-resistant depression (TRD). It is the first FDA-approved psychedelic medicine and the second drug approved to treat TRD.

What is esketamine treatment like?

Esketamine must be administered as a nasal spray in a Janssen-certified clinic. In order to receive esketamine, patients must also be taking another antidepressant. Patients will self-administer the nasal spray under supervision of a provider and be monitored for at least two hours after they administer the spray. After two hours pass, patients must be driven home.

This treatment is split up into two phases: the induction period and the maintenance period. The induction period is the first four weeks of treatment where patients receive esketamine two times each week. After four weeks have passed, the provider will evaluate the patient’s progress. Should the patient need to continue treatment, they will administer esketamine once a week in the clinic. Nine weeks after the patient has started treatment, the provider will adjust the esketamine frequency to what best fits the patient’s needs.

How do I choose between ketamine and esketamine treatment?

Esketamine treatment has more regulation than ketamine treatment because it is an FDA-approved medicine for TRD. It can also have different effects than ketamine treatment. It is important to talk with your provider to see whether ketamine or esketamine is a better fit.

Osmind has patient guides as well as interviews with people who have undergone ketamine treatment that can help to give you a better idea of what treatment might look like.

Several factors can be important when deciding what is best for you.

• Cost is a very large factor to consider because ketamine treatments are generally out-of-pocket cash payments for treatment. These can cost in the thousands of dollars for the equivalent “induction phase.” Esketamine may be partially covered by insurance because it is FDA-approved for TRD. Check with your insurance plan and provider to see how much esketamine may cost for you.
• Type of treatment is also important to consider. Esketamine treatment does not include psychotherapy, whereas ketamine treatment can. If you want to combine your therapy and medication appointments, ketamine treatment may be preferable for you.
• While ketamine is an FDA-approved anesthetic, it is prescribed off-label for mood disorders such as major depressive disorder and TRD. It has not undergone formal FDA efficacy and safety studies for these conditions. However, real-world studies point to the effectiveness of this treatment for depression (e.g. American Journal of Psychiatry study).