Is Ketamine Therapy or Esketamine for Depression FDA Approved?

Nearly 3 million people experience treatment-resistant depression and see a psychiatrist for help. When depression does not respond to traditional treatments, such as talk therapy or antidepressants, some professionals are suggesting a new treatment option for their patients. Research shows that many patients experience relief from depression within 24 hours when using ketamine as a treatment option.

Ketamine therapy and FDA approval

There are two types of ketamine that are used for depression treatment. One of them, IV ketamine, is not approved by the FDA for depression treatment. However, a nasal spray version, known as esketamine or Spravato, has been approved for use by the FDA since 2019. When it was approved, it was the first major antidepressant option approved in several decades.

What patients need to know about esketamine

Before talking to a psychiatrist about esketamine treatment, it is important to understand what it is and what to expect during treatment. Esketamine is created using part of the ketamine molecule. It is more potent than traditional ketamine, which means that patients can use less of the drug and experience fewer side effects. 

What to expect during esketamine treatment

The first thing a patient should know about esketamine treatment is that, like ketamine, there is the potential for the treatment to cause perceptual disturbances, especially during the first two hours of treatment. Time may feel as if it is speeding up or slowing down, colors may seem brighter, and music may sound different. For this reason, esketamine treatment is provided in a clinic setting for the first time. The treatment is outpatient, however, so the patient can leave after a couple of hours. 

The nasal spray is provided in three doses, each spaced five minutes apart. It is important to note that esketamine is not a replacement for other antidepressants. Rather, it works in conjunction with them. The esketamine provides rapid relief while the traditional antidepressants work to help for long-term relief. 

The right candidate for esketamine therapy

Not everybody is a good candidate for esketamine therapy. Currently, the treatment is approved for people who have been specifically diagnosed with treatment-resistant depression. Patients are usually only diagnosed with TRD after they have tried at least two other antidepressants for at least six weeks each.  

How esketamine works for treatment-resistant depression

Esketamine works differently than other drugs. Traditional antidepressants work because they increase levels of chemicals such as serotonin and dopamine. However, they do not work for all patients. That is where esketamine comes in. It works in a similar way as other antidepressants. However, it increases levels of glutamate instead. Glutamate is the most common chemical messenger in your brain, which means that esketamine has a greater impact on the brain in one dose.