Treating Major Depressive Disorder with a Ketamine Therapy: Esketamine

Major depressive disorder is a serious mental health disorder that affects millions of people. Someone with MDD should see a psychiatrist as soon as possible, as suicide is a major risk. Although antidepressants are common treatment methods, not only are they ineffective up to 80% of the time, but they also take weeks to months until results begin to appear. As an alternative, esketamine works fast and has been approved by the Food and Drug Administration to treat major depressive disorder with imminent suicide risk.

Major depressive disorder symptoms

Other names for MDD are major depression and unipolar depression. Major depressive disorder occurs more commonly in women, possibly because they have more hormonal fluctuations related to puberty, childbirth, and menopause. Common symptoms and signs associated with MDD include:

• Negative thoughts with the inability to think positively
• Irritability and agitation
• Sadness and crying for no reason
• Sleep issues
• Withdrawal from people and activities
• Suicidal thoughts

A psychiatrist will often recommend a variety of treatment methods for someone with major depression. These include antidepressants, talk therapy, and somatic therapies. However, if a patient is having suicidal thoughts or is a danger to himself or herself, a doctor may prescribe a quicker-acting treatment, such as esketamine.

Information about esketamine

Esketamine is made up of the S-form of ketamine, which is a medication that has been used for decades as an anesthetic. Although researchers are still working on it, the theory of how esketamine works is that it restores the glutamate neurotransmitter in the brain, which helps to balance other neurotransmitters and molecules to restore brain function.

Uses

The FDA approved esketamine for two main uses. One is major depressive disorder with acute suicidal behavior or ideation. In this situation, esketamine may be the first-line treatment method. The other use is for treatment-resistant depression. This condition is depression that has not responded to other treatment methods. A psychiatrist will generally only prescribe esketamine after a patient has tried at least two antidepressants and noticed no symptom reduction.

Administration

Esketamine is an intranasal spray that is absorbed directly into the nasal passages. The initial timeline for administration is twice per week for four weeks. After this, a patient will come in every week or two.

A patient administers the spray, although it is done while being observed by a psychiatrist or other trained healthcare provider. This observation occurs for two hours after the patient administers the spray, and its purpose is to monitor side effects.

Side effects

As with any medication, esketamine has potential side effects that patients should be aware of. One is dissociation, which is also known as out-of-body experiences. Other potential side effects that a healthcare provider will be monitoring include sedation, dizziness, and high blood pressure.