The introduction of esketamine (branded as Spravato) has marked one of the most significant advances in the treatment of TRD in decades. Unlike medications that require weeks or months to slowly adjust monoamine levels, esketamine works on a completely different system: the glutamate pathway.
Esketamine is an S-enantiomer of ketamine and acts as an N-methyl-D-aspartate (NMDA) receptor antagonist. By blocking the NMDA receptor, esketamine is thought to trigger a cascade of events that rapidly increase glutamate release in the brain. This flood of glutamate then stimulates new synaptic connections in areas of the brain affected by chronic stress and depression, such as the prefrontal cortex and hippocampus.
Rapid Action and Unique Administration
One of the most compelling aspects of esketamine is the speed of its effect, often producing symptom improvement within 24 to 48 hours, a stark contrast to traditional antidepressants.
Due to its mechanism and potential for abuse or transient side effects, esketamine is administered only under a strict program called the Risk Evaluation and Mitigation Strategy (REMS). This means:
- It is administered as a nasal spray in a certified healthcare setting (clinic or office).
- The patient must be observed by a healthcare provider for at least two hours following administration to monitor for potential side effects, such as dissociation, sedation, or blood pressure elevation.
- Esketamine must always be used in combination with a new or existing oral antidepressant to sustain its effects.
Esketamine offers a powerful, fast-acting option, fundamentally altering the therapeutic landscape for those who have exhausted traditional lines of defense against depression.
Esketamine treatment is available at Light-tunnel Behavioral Health Services, most insurance payers are accepted, we also treat private-pay patients. Inquire within