Depression affects millions of people around the world, often disrupting daily life and diminishing quality of living. While many find relief through traditional antidepressants, some individuals don’t respond well to these medications. For those with treatment-resistant depression (TRD), a new and innovative option has emerged: nasal spray treatments—most notably, esketamine.
Approved by the FDA in 2019 under the brand name Spravato, esketamine is changing how doctors and patients approach difficult-to-treat depression.
What Is Esketamine?
Esketamine is a close relative of ketamine, a medication that has long been used for anesthesia and, more recently, studied for its fast-acting antidepressant properties. Unlike traditional antidepressants that can take weeks to start working, esketamine nasal spray can begin to reduce symptoms within hours or days.
Esketamine works on the glutamate system in the brain, which is different from how SSRIs and SNRIs (the most common antidepressants) function. This alternate mechanism may explain why it helps when other treatments have failed.
How Is It Used?
The treatment is administered as a nasal spray in a certified clinic or hospital setting. It’s not something patients take home. After receiving a dose, patients must stay under medical supervision for at least two hours due to potential side effects like dizziness or dissociation.
Esketamine is typically prescribed in combination with a traditional oral antidepressant. The initial phase of treatment usually involves twice-weekly sessions for four weeks, followed by weekly or biweekly maintenance doses as needed.
Who Can Use It?
Esketamine is specifically approved for:
Adults with treatment-resistant depression (TRD)
Adults with major depressive disorder (MDD) and acute suicidal thoughts or behavior
Because of the potential for misuse and the need for close monitoring, esketamine is not available over the counter and must be prescribed and administered by trained professionals in certified treatment centers.
Benefits of Nasal Spray Treatment
Fast-Acting Relief: Unlike conventional antidepressants, esketamine may work within hours to days.
Alternative Pathway: It targets a different brain system, which is beneficial for people unresponsive to other treatments.
Reduces Suicidal Thoughts: In some cases, it has been shown to provide rapid relief from suicidal ideation.
Potential Side Effects
As with any medication, esketamine is not without risks. Common side effects may include:
Dizziness or lightheadedness
Nausea
Drowsiness
Dissociation (feeling disconnected from reality)
Increased blood pressure
Because of these effects, patients are monitored closely after each session and must arrange transportation home.
Cost and Accessibility
Esketamine treatment can be expensive, and while some insurance plans may cover part of the cost, coverage varies. Patients should speak with their provider and insurance company to understand the financial aspects before beginning treatment.
Final Thoughts
For people who have struggled with treatment-resistant depression, nasal spray therapy using esketamine offers new hope. It’s not a first-line treatment, but for those who have exhausted other options, it may be life-changing. As research evolves and accessibility improves, nasal spray treatments could become a more common part of personalized mental health care.
If you or someone you know is dealing with depression and standard treatments haven’t worked, it may be worth discussing this option with a qualified mental health professional.
