What Patients Need to Know About Esketamine and Ketamine Therapy

Depression is a common, but serious, condition. A psychiatrist can diagnose depression by conducting a mental health evaluation on a patient, and there are various treatment methods that he or she might recommend. Antidepressants are commonly prescribed, but they do not always result in the reduction of symptoms. As an alternative, a psychiatrist may prescribe esketamine or ketamine therapy. Understanding the differences between the two may help a patient decide which treatment would be better.

Esketamine vs ketamine therapy

Esketamine and ketamine therapy, also known as racemic ketamine, are versions of ketamine, a drug that has been around for decades and received approval by the Food and Drug Administration for use as an anesthetic. Esketamine contains the "S" molecule, while ketamine therapy is a mixture of both the "S" and "R" molecules.

FDA approval

The FDA approved esketamine for depression treatment in 2019. Ketamine therapy has not received FDA approval, but psychiatrists and other medical doctors still use it off-label for a myriad of conditions, including depression. Both have quick results, compared to antidepressants, which can take weeks or months for patients to see results.

Intended uses

Ketamine therapy is typically not the first treatment method a psychiatrist recommends. Its intent is for treatment-resistant depression, which means that a doctor usually will not prescribe it until a patient has tried at least two antidepressants with no results.

One of the uses for esketamine is also treatment-resistant depression. However, psychiatrists also prescribe it for patients who have major depression with imminent thoughts of suicide. This is because it brings a fast reduction of depression symptoms. 

Administration method

Esketamine is a nasal spray, in which the medication enters via the nasal passages. The patient administers the spray, although a psychiatrist or other trained healthcare professional observes the patient during the administration and for two hours afterward to monitor any side effects. The patient also takes an oral antidepressant while under esketamine treatment.

Ketamine is an intravenous infusion. A trained provider administers the IV and then monitors the patient for side effects.

Frequency of treatments

The initial time period for esketamine administration is four weeks, with administration occurring two times each week. After this period, ongoing maintenance consists of one treatment every week or once every two weeks.

A provider gives an IV infusion of ketamine therapy five to six times a week over a two- to three-week time period. Follow-up visits are only when the psychiatrist feels they are necessary.

Side effects

Side effects can occur with either method, which is why someone monitors the patient after each dose. Side effects may include dissociation, increased blood pressure, dizziness, and sedation.