How Ketamine Therapy, Esketamine, is Different than Previous Depression Medications

When a psychiatrist diagnoses a patient with depression, a commonly recommended treatment is one of the various antidepressants. However, there are some drawbacks to these traditional medications. Esketamine, on the other hand, is an alternative treatment method for those who have not had good results with antidepressants. It offers some benefits that antidepressants do not.

Potential issues with traditional depression medications

There are a number of available antidepressants for a psychiatrist to choose from, and it can be challenging to know which one is going to be the most effective. According to Scientific American, numerous studies show that the majority of antidepressants have limited clinical efficacy for many patients with depression.

This means that many patients who take an antidepressant will not notice much, if any, improvement in symptoms. It also takes weeks or months for an antidepressant to take effect, so patients will not know if a medication is effective for some time after beginning to take it.

Information about esketamine

Esketamine contains a molecular form of ketamine, which is a medication that has been around for years. Esketamine is a lower dose of ketamine that is used as an anesthetic, and it has shown such promise at successfully treating depression symptoms that the Food and Drug Administration approved it as a depression treatment in 2019.

How it works

One of the ways that esketamine is different from previous depression medications is how it targets the brain. Both esketamine and antidepressants alter brain chemicals, but esketamine focuses on the neurotransmitter glutamate, while other antidepressants focus on dopamine and serotonin. A psychiatrist will often prescribe an oral antidepressant along with ketamine so that all three neurotransmitters are stimulated.   

Benefits

One of the benefits that esketamine has over antidepressants is that it works quickly. Many patients describe a reduction in symptoms after only two or three sessions. Another benefit of esketamine is that it is more effective than antidepressants alone.

Administration method and frequency

Esketamine is a nasal spray that the patient administers in front of a psychiatrist or other healthcare professional. Sessions are two hours long and take place twice a week for a month, and then follow-up visits are once a week or twice a month.

Good candidates

Esketamine is generally not recommended as a first-line treatment. A good candidate is someone who has tried at least two antidepressants for a minimum of six weeks and had less than a 50% reduction in symptoms.

Side effects

Another difference between the two are the side effects. Side effects of antidepressants may include low sex drive, headaches, weight gain, and sleep problems, and they do not go away. Side effects of esketamine may include dissociation, increased blood pressure, and dizziness, but they only last a few hours after the treatment and then disappear.