At Acute Pain Therapies we offer ketamine treatment for depression, anxiety, and PTSD. Even patients who are on other medications such as Benzodiazepines, Lamotrigine, Memantine may benefit from various ketamine formulations including Esketamine, or Spavato nasal spray.
What is Esketamine Nasal Spray?
Ketamine is a mirror image molecule, or enantiomer. This means it has a right handed molecule and a left handed molecule, each of which is found in a 50:50 mixture in generic Ketamine. Esketamine is the left handed molecule derived from generic ketamine. On March 5, 2019, the US Food and Drug Administration (FDA) approved intranasal esketamine for treatment-resistant depression only available at a certified doctor’s office or clinic. It hasn’t yet approved ketamine which also contains the right handed molecule, but generic ketamine is used off-label for treatment resistant depression, PTSD, and anxiety to great effect. It is unclear if the FDA will ever approve ketamine for the same indications as esketamine nasal spray despite superior efficacy because ketamine is very cheap and it is not worth it for pharmaceutical companies to submit studies to the FDA in support of generic ketamine as these studies cost millions of dollars.
How is Esketamine Taken?
Esketamine nasal spray is normally used along with another antidepressant, which is taken by mouth, to manage treatment-resistant depression (TRD; depression that does not improve with treatment) in adults. When Esketamine nasal spray is taken in tandem with oral antidepressants under medical supervision, it has shown positive outcomes in patients, easing depression systems over the course of several treatments. Esketamine nasal spray is not a treatment that can be self-administered at home, but rather currently requires self-administration at an approved medical facility after which point the patient is required to be monitored for 2 hours at the same facility.
Does it work?
Esketamine nasal spray reaches peak concentrations in the body in between 20 and 40 minutes. It works may work more rapidly than traditional antidepressants and is preferred for use in someone with a history of major depressive episode or even thoughts of self-harm.
We have found ketamine infusions to be more effective than esketamine, but given esketamine nasal spray does not require an IV, it may be ideal for some patients.
SPRAVATO® (esketamine nasal spray) showed overall consistent safety across indications. TRD=treatment-resistant depression in adults. MDSI=depressive symptoms in adults with MDD with acute suicidal ideation or behavior. *At any dose and at a greater rate than patients treated with placebo nasal spray and an oral antidepressant.