If someone has depression and does not see a reduction in symptoms after taking antidepressants, a psychiatrist may prescribe esketamine or ketamine therapy, which is also referred to as racemic ketamine. Both are a form of ketamine, which is a medication that has been used as an anesthetic for decades. Scientists have discovered that ketamine in lower doses can also be used to treat depression, and the two main types so employed are esketamine and racemic ketamine. Patients should understand the differences between the two.
Esketamine
Esketamine is made up of the S-form of ketamine, and it is supposedly 20% more potent than ketamine. More research has been done on ketamine, but so far studies show that esketamine has a 40% success rate in treating depression, which is higher than the estimated 20% success rate associated with antidepressants.
Uses
A psychiatrist may prescribe esketamine for two reasons. One is severe depression with impending suicide risk. The other is for treatment-resistant depression. This refers to a type of depression in which the patient has tried at least two different antidepressants but seen no reduction in symptoms.
Administration
Esketamine is a nasal spray that the patient administers while a psychiatrist observes and monitors the patient for two hours after administration. It is taken along with an antidepressant, and the initial administration is two times a week for four weeks. Ongoing maintenance is either once a week or once every two weeks.
FDA approval
The Food and Drug Administration approved esketamine in 2019 for use as a treatment for depression.
Ketamine therapy
Ketamine therapy is a racemic mixture made up of both the R- and S- forms of ketamine. Research has shown that it is 70% effective in treating depression symptoms.
Uses
Ketamine therapy is used for treatment-resistant depression, so a psychiatrist will probably first prescribe an antidepressant if a patient has not tried any treatment previously. It is also used for suicidal ideation, anxiety, post-traumatic stress disorder, chronic pain, and obsessive-compulsive disorder. Its original use was as an anesthetic, but the dose used for depression is much lower.
Administration
Ketamine therapy is an intravenous infusion that goes directly into the bloodstream. The IV infusion is administered by a trained healthcare provider. The initial time period for ketamine therapy is two to three weeks, with five to six infusions administered over that period. Ongoing infusions are only as needed.
FDA approval
The FDA approved ketamine in 1970 for use as an anesthetic. Although ketamine therapy has not been approved for depression, it has been used for this and other uses off-label for years.
Conclusion
Both esketamine and ketamine therapy look promising as treatments for depression, especially for those with TRD or severe depression. However, there are side effects, so a psychiatrist will need to do a thorough evaluation of a patient before prescribing either of these for treatment.
Contact our office today if you have severe depression or have had difficulty finding an effective treatment. A psychiatrist can look at your history and conduct an evaluation to determine if esketamine or ketamine therapy is a good option.
Request an appointment or call Future Psych Ketamine Clinics at 843-788-9718 for an appointment in our Myrtle Beach office.
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