A Ketamine Therapy Type, Esketamine, is Used with an Antidepressant

Many people see a psychiatrist for depression, but talk therapy and traditional antidepressants do not always work on their own. Some people have what is known as treatment-resistant depression. These people often need stronger medication to help ease the symptoms of depression. For this reason, many psychiatric professionals are turning to esketamine therapy.

Esketamine therapy and antidepressants

Many times, a psychiatrist will prescribe esketamine treatment in combination with other antidepressants, but it is important to understand how these treatments work together.

Esketamine and SSRIs

Esketamine treatment is safe to use in combination with SSRI medications such as Zoloft, Lexapro, and Paxil, which are used to treat major depressive disorder and anxiety. 

Esketamine and SNRIs

While esketamine is typically safe to use with SNRIs, the medical team will typically monitor blood pressure. This is because SNRIs and esketamine have a side effect of potentially raising blood pressure. If a patient's blood pressure becomes too high, the medical team will not administer the esketamine. SNRI medications include Effexor XR and Cymbalta, among others. They are useful for treating a range of mental health conditions, including major depressive disorder, obsessive-compulsive disorder, and attention-deficit hyperactivity disorder. 

Esketamine and MAOIs

Medical professionals agree that while using esketamine and MAOIs is typically safe, patients should do it with caution since there is not as much research available about combining the two. MAOIs first became available in the 1950s and are often useful for treating social phobia and panic disorders. A psychiatrist does not prescribe them as often due to the wide variety of side effects that may come with taking the medications. Common MAOIs include Marplan, Nardil, and Azilect.

Esketamine and ADHD medications

People who receive medication to treat ADHD should take esketamine with caution. Both types of medications can raise blood pressure, which means receiving the esketamine under strict supervision and with frequent blood pressure monitoring. Some medications used to treat ADHD include Ritalin, Adderall, and Concerta. Wellbutrin is an off-label option as well. 

What is esketamine?

Esketamine, which is also known as Spravato, is a nasal spray provided to patients who have a diagnosis of treatment-resistant depression. Patients only receive it after they try at least two traditional antidepressants without seeing any results after six weeks.

Patients receive esketamine under strict supervision. While the dose varies by patient, it is typically 56 milligrams on day one, followed by either 56 or 84 milligrams twice per week for four weeks. From weeks five through eight, the patient receives 56 or 84 milligrams once a week. From there, the patient receives 56 or 84 milligrams once per week or every other week.

There are side effects to consider when deciding if esketamine is the right treatment. The most common side effects include blurred vision, confusion, drowsiness, lightheadedness, and a sense of detachment from the body. Less common side effects include changes in speech patterns, irregular heartbeat, feeling drunk, vivid dreams, and frequent urination. Rare side effects may include changes in behavior, irritability, and lack of appetite.