Esketamine Nasal Spray: Understanding its Purpose, Side Effects, Dosage, and Precautions

Introduction: Esketamine nasal spray, a groundbreaking treatment derived from ketamine, has emerged as a promising option for individuals struggling with treatment-resistant depression (TRD). This medication stands out for its rapid and significant effects in alleviating depressive symptoms and suicidal thoughts, offering renewed hope to those who have experienced limited success with conventional antidepressants.

What is Esketamine Nasal Spray? Esketamine is a potent NMDA (N-methyl-D-aspartate) receptor antagonist known to alleviate depressive symptoms rapidly. This medication is specifically designed as a nasal spray for administration and is intended to be used alongside selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).

Esketamine's Approval: Esketamine nasal spray has been approved by the U.S. Food and Drug Administration (FDA) for adults aged 18 and older with TRD. This approval marks a significant breakthrough in the treatment of depression, especially for individuals who have not found relief from traditional antidepressant medications.

Clinical Evidence: - Short-Term Studies: Two key short-term studies demonstrated esketamine's rapid onset of action in reducing depressive symptoms in individuals with TRD. - Maintenance Study: A maintenance study further revealed that esketamine consistently reduced relapse rates in individuals with TRD, suggesting its potential for long-term benefits.

Precautions and Contraindications: While esketamine offers hope for individuals with TRD, certain precautions and contraindications must be considered before initiation of treatment.

• Contraindications: Esketamine is not suitable for individuals allergic to esketamine or ketamine. It is also not appropriate for individuals with certain medical conditions, such as blood vessel diseases, brain abnormalities, or particular heart conditions.
• Precautions: Individuals with a history of depression, substance abuse, brain injuries, heart conditions, liver disease, or mental illness should discuss these conditions with their doctor before using esketamine.

Alternative Treatment Options: For individuals who are not candidates for esketamine treatment or who do not experience satisfactory results, alternative treatment options may be considered:

• Different antidepressant medications
• Psychotherapy or counseling
• Electroconvulsive therapy (ECT)
• Vagus nerve stimulation (VNS)
• Repetitive transcranial magnetic stimulation (rTMS)

Esketamine Dosage: The recommended dosage regimen for esketamine nasal spray in TRD is as follows:

• Induction Phase: The medication is administered twice a week during the first four weeks. The initial dose is 56 mg, and subsequent doses are either 56 mg or 84 mg, adjusted based on individual tolerance and response.
• Maintenance Phase: From week five onwards, the medication is administered once a week, either as 56 mg or 84 mg. Starting from week nine, the frequency can be adjusted to every two weeks or once weekly, depending on the individual's response.

Side Effects of Esketamine: Like any medication, esketamine nasal spray can cause side effects. Common side effects include:

• Anxiety
• Dizziness
• Extreme tiredness (lethargy)
• Feeling disconnected from mind and body (dissociation)
• Feeling drunk
• Increased blood pressure
• Nausea
• Reduced sense of touch and sensation
• Sedation
• Spinning sensation (vertigo)
• Vomiting

Severe side effects, though rare, include changes in mood or behavior, extreme drowsiness, hallucinations, suicidal thoughts, and worsening depression. Seek emergency medical attention if any severe side effects occur.

Warnings and Interactions: Esketamine can interact with a number of medications and supplements. It is crucial to inform your doctor about all medications, over-the-counter drugs, vitamins, herbs, or supplements you are taking or plan to take. Concomitant use of alcohol with esketamine may increase the severity of side effects.

Conclusion: Esketamine nasal spray offers a promising treatment option for individuals with TRD who have not responded adequately to conventional antidepressants. It is a potent medication with rapid onset of action, but its use should be carefully considered in consultation with a healthcare professional. Understanding the uses, side effects, dosages, and precautions associated with esketamine is essential for ensuring safe and effective treatment.