Esketamine

When might Esketamine be appropriate?

Esketamine is FDA-approved to treat major depressive disorder in adults who have not benefitted from at least two previous antidepressant medications. It is indicated to be used in combination with an oral antidepressant.

What is a typical course of esketamine treatments?

Esketamine treatments are performed as an outpatient. A recommended course of treatment lasts six months in total. This includes 4-weeks of twice weekly sessions at the beginning, and gradually decreasing to once weekly, once every two weeks and ultimately once a month, depending on a patient’s response.

Each appointment is two-hours long to allow for appropriate monitoring. Reliable transportation to and from each appointment is required.

What are the benefits and risks of Esketamine treatment?

Studies have shown that esketamine is an effective treatment for depression that has not responded to previous treatments and may have benefit in reducing suicidal thoughts related to depression. The mechanism of action is different from traditional antidepressant medications and patients may notice significant improvement in their depressive symptoms within the first several days or weeks of treatment.

Esketamine is psychoactive and can produce several effects on the mind and body. Common side effects include sedation, dissociation, nausea, dizziness, or feelings of numbness. Additionally, esketamine may cause temporary increases in blood pressure and heart rate.

Most of these effects are short-lived, peaking 15-45 minutes after administration of the drug and usually subside completely within two hours.  For this reason, appointments are 2-hours long to allow for careful monitoring, Patients should not drive or operate heavy machinery until they have had a good night’s sleep.

Who would not be appropriate for Esketamine?

Because of the effects on blood pressure, esketamine is not recommended for patients who have been diagnosed with conditions that weaken the blood vessels, such as aneurysms or arteriovenous malformations, or have a history of bleeding in the brain. Esketamine is not recommended for women who are pregnant or breastfeeding.

Does insurance cover Esketamine treatment?

Esketamine is covered by most medical insurances for patients who have failed to benefit from at least two antidepressant medications.