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The diagnosis of treatment-resistant depression (TRD) is becoming more and more common. This means the combination of therapy and antidepressants hasn’t reduced depression symptoms. Right now, TRD patients make up about 30% of those with major depressive disorder. Unfortunately, there have been few new treatment options to choose from in the past 30 years. 

Finding relief for people with TRD is a huge concern in the psychiatric community. These patients experience higher risks for more serious depression symptoms. For instance, people with TRD are twice as likely to attempt suicide than their peers, and 80% will have a relapse.

You may have heard about esketamine (or its brand name Spravato) since it emerged as a breakthrough depression treatment in 2019. Keep reading to learn more about esketamine therapy and find out if this new treatment is right for you.

The basics of esketamine therapy

Esketamine, or Spravato, is a nasal spray that patients take under close supervision at a REMS-certified treatment center. It’s an augmentation, so patients should only use it along with regular antidepressants. Most antidepressants affect serotonin and norepinephrine. Unlike these, esketamine works by increasing the brain’s most plentiful neurotransmitter, glutamate.

During esketamine therapy, it’s common to feel disconnected from yourself, your thoughts, your feelings, or space and time. Many patients have positive experiences. Some describe feelings of intense relaxation, detachment from their worries, or heightened empathy. Others relax into a deep, restful sleep. 

Treatments may come with a few minor side effects like sleepiness and dizziness. You should not drive after you take esketamine, so you’ll need to arrange transportation in advance. 

Who can benefit from esketamine therapy?

Esketamine’s parent compound ketamine has also caused a big media buzz. This drug was developed in 1962 and approved for use as an anesthetic in 1970. But the two medications don’t compare, either in potency or delivery method. If you’re considering esketamine vs. ketamine as treatment options, there are some things you should know. Intravenous ketamine is not approved by the FDA for psychiatric uses or covered by insurance plans. But esketamine has both of these benefits. (To be clear, Active Path Mental Health does not offer IV ketamine treatment.)

Ideal candidates for esketamine therapy are adults aged 18 to 65 who have tried two or more trials of antidepressants and still take one. Transcranial magnetic stimulation (TMS) is another treatment that your doctor might recommend. Esketamine can be a better option for those who can’t receive this treatment because of a metal implant or another health condition. We don’t recommend esketamine for patients who are pregnant or breastfeeding, have substance use disorder, vascular malformation, or uncontrolled hypertension. 

The benefits of esketamine therapy

Clinical studies show that most people who fit the profile for esketamine therapy see fast and dramatic improvements. Close to 70% of Spravato patients achieve a response, and of those, 52% went into remission at week 4. Patients should continue taking Spravato with their oral antidepressant to maintain good mental health. Many stay well for longer periods of time with this combination of treatment.

Spravato is only available at REMS-certified outpatient healthcare settings like Active Path Mental Health. It’s covered by most insurance plans, including Medicare and Medicaid. Active Path Mental Health is making esketamine therapy more convenient for our communities in Oregon and Washington

Esketamine has a few common side effects. They’re usually minor, and if they show up at all, it usually happens within the first 40 minutes and lasts less than 24 hours. Your healthcare provider will discuss potential side effects in detail during your evaluation.

The most common side effects of esketamine are:

  • Dissociation.
  • Sleepiness.
  • Sedation.
  • Dizziness.
  • Nausea.
  • High blood pressure.

During your consultation, you should disclose:

  • Medications you’re taking regularly, both prescription and over the counter.
  • Any supplements you’re taking or other alternative treatments you’re undergoing.
  • Any medical conditions, including pregnancy.
  • History of hypertension or aneurysm.

Is esketamine therapy right for you? Active Path Mental Health can help you decide

At Active Path Mental Health, we’ve seen how esketamine therapy can reduce treatment times for major depressive disorder patients from years (with therapy and antidepressants) to months or weeks. Are you hoping that esketamine therapy can help you “get back to you”? Our team of specialists can help you determine if esketamine is the next best step in your depression treatment plan. 

Contact our team today for more information or to schedule an initial appointment.

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