When you think of antidepressants, what comes to mind? Small pills? Uncomfortable side effects? Hopefully relief for whatever symptoms they are trying to treat? Well, research, studies, and trials in recent years have begun to create a different vision of antidepressants. With new, innovative treatments available for patients, we can start to reimagine how antidepressants function and help those struggling to find relief from their symptoms. One such innovative treatment is esketamine nasal spray.
What is esketamine nasal spray?
Esketamine is a drug that is derived from the anesthetic ketamine, which has a long history of being used to treat depression. In 2019, esketamine nasal spray (with the brand name “Spravato”) became FDA-approved for treatment-resistant depression in adults. At that time, it was also the only FDA-approved psychiatric drug for major depressive disorder (MDD) with acute suicidal ideation in adults.
What does esketamine treat?
While esketamine is only FDA-approved for adult treatment-resistant depression and MDD with acute suicidal ideation, it can also help with other mental health conditions. Many people who get esketamine for their depression also experience other conditions like OCD, anxiety, or an eating disorder.
Our Director of Psychedelic Medicine, Dr. Jennifer Guo, explains, “In my experience, it is sort of a ‘rising tide lifts all boats’ kind of thing. As your depression gets better, other aspects of your mental health get a little bit better as well.”
Again, esketamine is only approved for depression. However, it is possible that you may experience relief in other areas of your mental health when going through esketamine treatments.
How does esketamine work?
Esketamine works at treating depression differently than antidepressants. Antidepressants traditionally target certain neurotransmitters in the brain, such as dopamine, serotonin, and norepinephrine. However, esketamine uniquely targets the glutamate system. Glutamate is the major excitatory neurotransmitter in the brain.
With the dosage used to treat depression, esketamine binds to the inhibitory neurons in your brain. The result causes net excitation in the areas of the brain that are part of the depression circuit. While this is all very scientific, esketamine basically targets and treats the area of the brain responsible for your depression symptoms.
How successful is esketamine?
Our studies have shown that 69% of patients show improvement in their depression symptoms with esketamine after just eight treatments. If you’ve been trying antidepressants with no relief from your symptoms or have experienced bad side effects, don’t lose hope. Maybe esketamine could work better for your brain or body.
Are there any negative side effects?
There are some side effects to be aware of when it comes to esketamine nasal spray. After spraying esketamine into your nasal passages, it will drip down your throat somewhat and patients have complained that it tastes bad. However, that is an easy problem to fix with a glass of water and breath mint.
There are also more serious short-term side effects, which is the reason why we only do in-clinic treatments. Esketamine nasal spray is not available for at-home treatments. One of these more serious short-term side effects is an elevation in blood pressure. For most people, their blood pressure remains the same or is only minimally elevated. To be safe, we check your blood pressure before you administer the spray as well as at the drug’s peak in your session. We also monitor you for two hours after you take the spray to make sure you are safe and well.
After treatment, some people feel a little out of it. You will not be able to drive after, and you may not be able to go to work or school directly after.
As for long-term side effects, we unfortunately don’t really know. Since esketamine nasal spray has only been out for 3 years, we don’t have any hard evidence on the long-term impact of the treatment. However, there are studies going on now.
An added benefit of esketamine nasal spray
Another side effect, which we like to see as a benefit of esketamine, is its dissociative effects. Because many people think of it as a trauma response, the word “dissociation” can have a negative meaning. However, when talking about esketamine, the word takes on a different meaning.
During treatment, you may feel removed from yourself and experience a distortion in your senses. For example, some people say they feel like they’re watching themself in a video game or they see themself in a field. Or it looks like one hand is larger than the other or that it feels like two hours went by in 15 minutes. Everyone’s experiences can be unique. This effect doesn’t cause delusions or hallucinations but an expanded state of consciousness, as most people still feel very grounded in where they actually are.
When tapping into this expanded state of consciousness through dissociation, it’s common for people to access and experience prior memories. These memories can be good ones, but they can also be bad ones that might have been walled off in some way as a defense mechanism. When this happens, people can work through those memories and process those events in a way they haven’t been able to before.
Dr. Guo shares, “I think dissociation is not really a side effect but a desired effect to truly heal from earlier traumas and move through things that people were afraid to or didn’t want to before.” Dr. Guo has witnessed patients work through very painful memories during their sessions and experience immense relief afterward. She believes this factor is one of the bigger esketamine benefits.
Ultimately, esketamine functions differently in the brain compared to medications and antidepressants. If you’re looking for relief for your depression symptoms and you think esketamine could be right for you, it is worth getting an evaluation or consultation. Call us today to see if we can help you get treatments.