More than 17 million adults in the United States are diagnosed with a major depressive disorder each year. That number is expected to be much higher because so many people battle depression, but do not seek treatment. 

There are a number of reasons why a person would not see a doctor for depression, but failed treatments are a common one. Each year, many people, between 10% and 30% of people with depression, abandon treatment out of frustration because they can’t find a medication that works for them. 

Failed antidepressants can be a very serious issue. When a patient has treatment resistant depression, they have tried two or more antidepressant treatments that were not effective, many doctors will introduce Esketamine to the treatment plan. 

Just as with any other medication, antidepressants don’t work for everyone. And for many who suffer from depression, esketamine can be a life-saver. 

What is Esketamine? And What does Esketamine Treat? 

Esketamine is a drug that is derived from the anesthetic ketamine that has a long history of being used to treat depression. 

Esketamine is a more potent form of ketamine and is fairly new to the market having become FDA approved in March 2019. It is a nasal spray, Spravato, that is to be used with an oral antidepressant for adults with treatment-resistant depression. 

Esketamine for depression has had very good results in clinical studies. Many patients who used the drug with an antidepressant found that their depressive symptoms were better managed. 

The FDA approval for Esketamine only covers it as a treatment used in conjunction with an antidepressant and only patients who meet specific criteria can take it: 

  • They have tried at least 2 other antidepressants for a minimum of 6 weeks each, and have not experienced remission, or 
  • Did not have at least a 50% improvement in mood or depressive symptoms 

Esketamine is safe when used as directed under a doctor’s care. However, it does carry a risk of abuse as well as psychological and physical dependence.

This is one of the reasons that it is very important to stay in close contact with your doctor while on the medication. Antidepressants also have a risk of dependence because your body comes to rely on that extra production of dopamine and serotonin. Stopping cold turkey can cause withdrawal symptoms. 

Esketamine vs. Antidepressants: Pros and Cons 

The reason that the drug works when antidepressants do not is because it does not work like an antidepressant.

Typical antidepressants raise the levels of certain chemicals like dopamine, norepinephrine, and serotonin that occur naturally in the brain as neurotransmitters.

It works on the theory that more of these neurotransmitters will encourage enhanced communication between brain cells which in turn improves or boosts the person’s mood. 

Esketamine is similar in operation, but it increases glutamate levels which is the brain’s most prevalent chemical messenger. This results in a greater reach and more substantial impact on brain cells with a single dose. 

This is not to say that antidepressants don’t have a viable place in the treatment of depression. Millions of people each year do get relief from symptoms of depression thanks to these medications.

However, antidepressants can have some unpleasant side effects that don’t go away, such as sexual side effects like impotence which are very common. 

Esketamine does have some side effects for some people, but they tend to only last a few hours and then are gone.

Some patients report drowsiness, dizziness, and feeling of unreality when taking the drug, and the list of potential side effects is rather long, but so is the list of potential side effects for most antidepressants.

The way that a drug will affect a patient, and the side effects they may experience is dependent upon the patient. Not everyone will react the same way. 

Esketamine must be administered by specially trained medical personnel in a certified clinical setting. Most patients receive it as an outpatient and go home in a couple of hours.

This is one of the most significant differences that distinguish this drug from antidepressants which can be self-administered at home. 

Is Esketamine Better than Typical Antidepressants? 

Esketamine with antidepressants is better than antidepressants alone when the patient does not respond well to taking only antidepressants. On the other hand, many people do remarkably well taking only antidepressants. So, the question of which is better depends on the patient. 

The success rate of esketamine is very impressive. One trial found that 70% of patients being treated for depression using esketamine with an antidepressant experienced a 50% or more reduction in their depressive symptoms. Additionally, approximately 50% experienced total remission of their depressive symptoms. 

The bottom line is when you are seeking treatment for depression, look for a psychiatrist who is experienced in treating depression and is willing to work with you to find a treatment plan that is effective and has the least possible negative impact on your life, such as unwanted side effects.

Whether you are on antidepressants, or you take esketamine and antidepressants, you want a doctor who will listen to you and make sure that you are an active participant in your own mental health care. 

When you plug in the search term “psychiatrist near me” you get a massive mixed bag of wildly differing choices. It can be overwhelming. 

If you’ve found your way to Mindful Health Solutions and you are ready to find ways to manage your depression and anxiety, you have come to the right place. If you are searching for a psychiatrist in the Sacramento area, San Francisco Bay area, or Southern California, including Newport Beach, then Contact Us and set up an appointment today.

Take a free mental health quiz
Book an Appointment