Esketamine for Treatment-Resistant Depression

How does esketamine work for depression?

Esketamine is a prescription nasal spray approved by the U.S. Food and Drug Administration (FDA) for treatment-resistant depression. Many traditional antidepressants act on serotonin and related chemicals. Esketamine works differently by increasing glutamate, your brain’s most abundant neurotransmitter. Glutamate helps form new connections between brain cells involved in mood and learning. For some people, this different mechanism leads to faster and more noticeable symptom relief.

We offer esketamine as SPRAVATO^® through a risk evaluation and mitigation strategy (REMS) program. The FDA and Drug Enforcement Administration (DEA) require this program to ensure safe prescribing, administration, and monitoring.

What’s the difference between ketamine and esketamine?

Ketamine and esketamine are closely related medications, but they aren’t the same. Ketamine contains two components that affect the brain in slightly different ways. One of them is esketamine. Research suggests that the esketamine component is effective for treating depression.

Providers primarily use ketamine as an anesthetic medication. You typically receive it by IV or an injection directly into your bloodstream. More recently, some providers have prescribed ketamine to treat depression, though it doesn’t have FDA approval for this purpose.

Is esketamine right for me?

We conduct a thorough evaluation to review your diagnosis, treatment history, and current medications. Esketamine may be a good fit if you:

• Have major depressive disorder
• Have tried therapy and antidepressant medications without improvement
• Continue to experience symptoms that interfere with daily life, work, or relationships

What happens during an esketamine treatment session?

Esketamine is self-administered as a nasal spray during a clinic visit. You’ll take the medication under medical staff supervision.

Each session lasts about two hours. During this time, a medical technician or nurse will monitor your side effects and check your vital signs. Because esketamine can temporarily affect mental alertness and motor coordination, patients remain on-site until it’s safe to leave. You won’t be able to drive after treatment, so plan to have someone take you home.

Treatment schedule

SPRAVATO^® treatment follows an eight-week schedule. Visits are more frequent at first, with twice-weekly sessions during the first month. Sessions drop once per week during the second half of the program.

At the end of the eight weeks, you’ll meet with your provider to check in on your progress. Together, you’ll decide whether continuing treatment makes sense.

Integrated group psychotherapy

To support treatment progress, you’ll have access to an esketamine group therapy program at Montage Health. We encourage participation in at least four group sessions, with up to 12 sessions available.

A nurse practitioner and therapist co-lead the groups. Sessions include discussion, education, and time to reflect with others in treatment. Many people find that combining esketamine with group therapy helps them get the most benefit from their care.

Is a referral required for esketamine treatment?

Yes. You’ll need a referral from a psychiatrist or another mental health provider to begin esketamine therapy. If you’re interested in learning more, our team can answer questions and coordinate with your existing provider.

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