Esketamine is a revolutionary medication that can bring relief from significant depression within hours for those suffering from severe treatment resistant depression. A new antidepressant therapy that isn’t just a spinoff of current medications for the first time in 60 years. Esketamine therapy is revolutionary for some patients, allowing them to live a life free of Ādepression for the first time in decades.
Why ‘S’ ketamine?
Esketamine is the N-methyl-D-aspartate (NMDA) glutamate receptor’s preferred agonist compared to R-ketamine, which is the S-enantiomer of ketamine. Ketamine induces the development of new neural connections by acting through the NMDA receptor to have antidepressant effects (synapses). This is one of the reasons the business that created esketamine chose the S-enantiomer over the R-enantiomer.
Esketamine R-ketamine?
Many medical professionals are curious about the therapeutic efficacy of esketamine in comparison to racemic ketamine, which is made up of a 50/50 mixture of S- and R-ketamine. The quick answer is that we don’t know a lot of things.
Esketamine administered intravenously is not inferior to ketamine administered intravenously in patients with TRD. However, the sample size for this non-inferiority study was relatively small (63 patients), and it only assessed patients 24 hours after a single dose. Based on the findings of this study, it does not appear that there is a significant difference between the two medications when administered intravenously, at least in this situation.
Rapid Improvement
The potential to alleviate mood and other depressive symptoms on a much shorter time scale than traditional antidepressants, such as selective serotonin-reuptake inhibitors, is one of the exciting things about ketamine and esketamine. In early ketamine studies, a sizable percentage of patients would notice a significant improvement just 4 hours after dosing.
A key enhancement over conventional antidepressants is the potential to assist patients experiencing significant improvement after just one treatment, as illustrated in the accompanying clinical vignette. However, some individuals may require multiple treatments before results are perceptible. Esketamine may not have the same immediate effects as ketamine, but it still has a different mode of action, making it better than other treatments, according to some specialists.
What is Esketamine?
Esketamine is derived from the anaesthetic ketamine, which has long been used to treat depression. However, it wasn’t until recently that esketamine, a more potent variant of ketamine, received FDA permission for use as a nasal spray for people suffering from treatment-resistant depression.
“Esketamine is derived from a portion of the ketamine molecule. You can use it at a lower dose with fewer side effects. Now that it’s available in an intranasal version and approved by the FDA, it’s more likely that insurance companies will cover the treatment.
What is Esketamine Treatment Like?
Esketamine must be administered in a clinical setting since, like ketamine, it has the potential to impair your perception for the first two hours following treatment. Esketamine nasal spray therapy is provided on an outpatient basis.
Under a doctor’s supervision, administer the nasal spray in three doses, each five minutes apart. Until any potential side effects subside, you stay in the clinic under a doctor’s supervision.
Esketamine must be taken along with an established antidepressant. The idea is that esketamine will quickly relieve depressive symptoms while the other medicine works.
Who is an Ideal Patient for Esketamine Treatment?
For those with depression who are unresponsive to treatment, esketamine is currently authorised. This indicates that you’ve taken at least two other antidepressants (for at least six weeks each) but haven’t seen remission or at least a 50% mood improvement.
Esketamine offers those who have struggled with other antidepressants the chance to experience what it’s like to be depression-free. It offers them hope that, with the correct care, they can get better.
How is Depression Treated with Esketamine?
Esketamine and the related medication ketamine both work well to treat depression for a variety of reasons. Esketamine’s ability to treat depression employs a different mechanism than other medications. Serotonin, norepinephrine, and dopamine are examples of naturally existing neurotransmitters that conventional antidepressants raise levels of. These substances serve as messengers for the transmission of information between brain cells. According to the theory, having more of these neurotransmitters enhances communication between brain cells and improves mood.
Similar mechanisms govern how esketamine clinic treatment works, but unlike other antidepressants, it boosts levels of glutamate, the brain’s most prevalent chemical messenger. The outcome? has a bigger effect on a greater number of brain cells at once.
People with Depression Quickly Heal
Antidepressants are typically sluggish acts. A noticeable change in how people with depression feel frequently takes several weeks. On the other hand, esketamine has an instantaneous effect on brain cells and provides hours of relief from depressive symptoms.
Esketamine Reduces Thoughts of Suicide
Particularly in children and young people, conventional antidepressants have been shown to promote suicidal thoughts at the beginning of therapy. Lithium, a medication that is frequently prescribed for people with bipolar disorder, is not the only medication that has been shown to reduce suicidal thoughts. The FDA is considering approving esketamine for this use even though it is not currently permitted.
It’s Effective for Treatment-Resistant Depression
A variety of traditional antidepressants fail to help up to 33% of depressed individuals. In clinical trials, the majority of these individuals experience fewer depressive symptoms thanks to esketamine.
Combining fluoxetine and the antipsychotic drug olanzapine is the only other medication approved for the treatment of depression that has not responded to other treatments. The long-term effects of this treatment, however, are significant and include significant weight gain, metabolic changes, diabetes, and high blood pressure.
Esketamine Aids in the Formation of New Brain Connections
According to research, untreated depression raises the risk of dementia and causes long-term brain damage. Studies have shown that the hippocampus, a part of the brain important for memory and learning, shrinks by up to 20% in persons with depression. However, esketamine might offset the negative consequences of depression.
According to animal research, persistent stress weakens the connections between brain cells; however, esketamine rescues these stress-related alterations. Esketamine differs from other antidepressants in that it appears to have a growth-promoting effect in addition to preventing the neurotoxic effects of depression on the brain.
Does Esketamine Have Side Effects?
Esketamine medication can have a variety of negative side effects on patients. The most dramatic are hallucinations and a sense of being cut off from reality or yourself. However, side effects typically reach their peak 40 minutes into treatment and subside two hours later.
The first two treatments are when you should expect the most severe side effects. After that, symptoms typically get better. Some additional negative effects include:
- Nausea
- Drowsiness
- Increased blood pressure
- Feeling drunk
- Headache
Speak with your psychiatrist about esketamine therapy if you believe your current depression treatment isn’t working for you.
Exploring the Risks
Esketamine has a number of hazards despite its potential benefits. A black box warning about esketamine’s potential for abuse is present on the FDA label for the drug. The fact that patients shouldn’t drive on the days they receive treatment is crucial information for clinicians. After receiving esketamine, cognition is temporarily impaired, but this usually passes within 60 to 90 minutes.
Although a longer-term study found a detrimental impact on cognition, a potential risk of long-term and permanent cognitive impairment has been observed in those who misuse ketamine regularly. For each patient, these risks should be carefully evaluated against any potential benefits. It shouldn’t be administered to patients who haven’t had enough time to try oral antidepressants.
The bottom line
This is a cutting-edge therapeutic strategy that helps hasten the recovery of depressed people. While it may be used to treat depression in the long term, there are still considerable logistical obstacles that limit its widespread use.
