Depression is a challenging, and often debilitating, disease that needs to be diagnosed and treated as soon as possible to achieve the best results.
To begin the process, it’s important to check in with yourself. If you are undergoing stress and/or emotional changes, which is not uncommon in this day and age, ask yourself these important questions:
- How are you coping with the stress? What coping skills do you have?
- Is your daily routine (sleep, appetite, energy, motivation) being affected in any way?
- Are you seeing changes in your grades, work performance, relationships, or social interactions?
More specific questions that you can ask yourself are:
- Are you staying in your room/home all/most of the day and/or avoiding social interactions?
- Do you cry more days than not?
- Do you have a change in your appetite or weight?
- Are you no longer interested in hobbies or activities that used to bring them joy?
- Are you quick to anger or agitation?
- Do you hurt yourself?
- Are you not taking care of your physical appearance?
- Are you participating in risky behavior?
You could also complete this Depression Screen for a more detailed and thorough check.
If the answers to the above questions or if their results from the Depression Screen are concerning, then your radar for depression should be high.
The next step is to seek professional assistance from a psychologist or psychiatrist to clarify the diagnosis. Depending on the diagnosis, the doctor can work with you to come up with an individualized treatment plan that works for you and your needs. This treatment plan can consist of psychotherapy, medication management, and/or TMS therapy.
The sooner you get treatment, the more likely you will achieve remission in this episode, which decreases your risk for future episodes as well.
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 as it became FDA-approved in March 2019.
Esketamine treatments come in the form of a nasal spray, which has a brand name called Spravato. The nasal spray is to be used with an oral antidepressant to treat more severe cases of depression that are categorized as treatment-resistant depression (TRD).
Like antidepressants, esketamine raises the levels of certain chemicals like dopamine, norepinephrine, and serotonin that occur naturally in the brain as neurotransmitters. However, esketamine is different than antidepressants as it increases the brain’s most prevalent chemical messenger: glutamate levels. This results in a greater reach and more substantial impact on brain cells with a single dose compared to antidepressants.
Because esketamine is considered a controlled substance, it 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.
Esketamine is used on top of antidepressants to treat treatment-resistant depression. The reason the esketamine works when antidepressants alone 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 naturally occur in the brain as neurotransmitters. Many experts believe that depression and other mental health conditions are linked to an imbalance of these neurotransmitters. Ideally, antidepressants work to restore the balance of these neurotransmitters, resulting in fewer depression symptoms and improved mental health.
Esketamine works similarly to antidepressants, but it increases the brain’s most prevalent chemical messenger: glutamate levels. Increased glutamate levels result in a greater reach and more substantial impact on brain cells with a single dose compared to antidepressants alone.
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, they don’t work for everyone. Esketamine can be an additional treatment that helps people suffering from TRD find relief.
Esketamine treatments are an office-based, outpatient procedure. Patients will self-administer the nasal spray under the supervision of a healthcare provider and in a comfortable, safe setting. The patient will be monitored during and after the treatment for two hours.
A typical course of esketamine treatment consists of twelve sessions over two months. Your physician will also help you to determine maintenance treatments based on your unique needs.
Esketamine is an alternative form of treatment for those with Major Depressive Disorder (MDD) who have tried medications without success. Treatment-resistant depression (TRD) is a hard condition to manage and trying to find a medication that works well for each patient can be a difficult and time consuming task. With esketamine, patients have been finding relief from their symptoms that they couldn’t find from antidepressants alone.
The FDA approval for esketamine only covers it as a treatment used together with an antidepressant and only patients who meet specific criteria can take it. The criteria include:
- Patients have tried at least two other antidepressants for a minimum of six weeks each, and have not experienced remission, or
- Patients did not have at least a 50% improvement in mood or depressive symptoms.
Esketamine only gets incorporated into the patient’s customized treatment plan if:
- A patient fits into one of those two criteria listed above.
- Their provider believes that esketamine could work for them and their unique needs.
- The patient is comfortable with trying esketamine.
If all the pieces fit, esketamine can be a great treatment option to find relief from depression symptoms.
Excitingly, the FDA recently approved esketamine to treat people who are indicating warning signs of committing suicide.
Also, Ketamine, which is similar to esketamine, has been used off-label to treat ADHD, anxiety, bipolar disorder, OCD, substance use disorders, pain, PTSD, and other mental health conditions. However, the data has not been strong enough to receive FDA approval for the treatment of these conditions. We are looking forward to seeing where the research takes the use of esketamine, and we hope to utilize it in more of our treatment programs in the future.
Esketamine is safe when used as directed under a doctor’s care. Esketamine can only be administered in a certified treatment clinic that has medical staff trained to prescribe and dispense esketamine. The medical staff also has to be certified in Risk Evaluation and Mitigation Strategy (REMS). However, the nasal spray itself is simple and safe enough for patients to self-administer under supervision in the clinic.
While it is safe to use under a doctor’s care, esketamine does carry a risk of abuse as well as psychological and physical dependence. This risk 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 your use of esketamine or antidepressants cold turkey can cause withdrawal symptoms.
Self-administering esketamine nasal spray does not hurt, but there are some common side effects, including:
- Sleepiness
- Nausea
- Increased blood pressure
- Bad taste in the mouth
- Dissociation
These side effects usually only occur within one to two hours after the nasal spray has been administered. To help ensure the safety of patients, there is a two-hour window of supervision at the clinic following the administration before patients can leave and head home.
After treatment, patients may experience some of the side effects listed above. However, some side effects decrease with repeated treatments. Regardless, patients need to arrange for post-treatment transportation home to make sure they get home safely.
Esketamine is used on top of antidepressants to treat treatment-resistant depression. The reason the esketamine works when antidepressants alone 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 naturally occur in the brain as neurotransmitters. Many experts believe that depression and other mental health conditions are linked to an imbalance of these neurotransmitters. Ideally, antidepressants work to restore the balance of these neurotransmitters, resulting in fewer depression symptoms and improved mental health.
Esketamine works similarly to antidepressants, but it increases the brain’s most prevalent chemical messenger: glutamate levels. Increased glutamate levels result in a greater reach and more substantial impact on brain cells with a single dose compared to antidepressants alone. While most antidepressants take weeks to work, esketamine can work as quickly as the first few hours or days after starting treatment.
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, they don’t work for everyone. Esketamine can be an additional treatment that helps people suffering from TRD find relief, and it could result in having the patient take fewer antidepressants in the future.
Antidepressants are invaluable aids in the treatment of clinical depression and other mood disorders, but they’re not for everyone. According to the World Journal of Psychiatry, antidepressants don’t improve symptoms in 10–15 percent of people with depression and only partially improve symptoms in 30–40 percent. Also, many people experience side effects from antidepressants that can impact their overall well-being.
On the other hand, esketamine has shown significantly better results when used alongside antidepressants. Based on the pivotal trial for the treatment of depression in the clinical setting, which used esketamine with an antidepressant, about 70% of patients have at least a 50% reduction in symptoms. In the same trial, about 50% of patients have complete remission of symptoms, which means that their depression symptoms were no longer present at all.
While some patients begin to show improvement after just one treatment, it usually takes the full course of treatments (12 sessions over a two-month period) to achieve the maximum benefits.
It is important to understand that mental health treatment plans are not a one-size-fits-all situation. Because of this situation, treatment plans may take longer or require different treatment option combinations in order to work best for certain patients. It is important for patients to communicate clearly with their provider about how their treatment plan is working. Collaboration between patient and provider can greatly impact the results of a patient’s wellness journey.
The FDA just approved esketamine for the indication of suicidality this month. Ketamine, which is similar to esketamine, has been used off-label for anxiety, OCD, substance use disorders, pain, PTSD, among others. However the data has not been strong enough to receive FDA approval for these other indications.
Any side effects tend to occur only within the 1 to 2 hours after the drug is administered. Some side effects decrease with repeated treatments. Patients need to arrange for post-treatment transportation home.
We’ll work directly with your insurance provider on your behalf to help you get covered as insurance acceptance for esketamine is growing. We also offer several out-of-pocket packages for esketamine.
Insurance Accepted – Mindful Health Solutions
