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esketamine
Also known as: Spravato, intranasal esketamine
Facts (18)
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The Montreal model: an integrative biomedical-psychedelic ... frontiersin.org 16 facts
claimRegulatory approvals for treatment-resistant depression (TRD) are limited to a small number of specific treatments, including transcranial magnetic stimulation (such as the Stanford Accelerated Intelligent Neuromodulation Therapy), the combination of olanzapine and fluoxetine, and intranasal esketamine.
claimThe National Institute for Health and Care Excellence (NICE) committee cited a lack of evidence for esketamine's efficacy compared to standard therapies, uncertainty regarding the sustainability of its benefits, and high costs as reasons for recommending against its public-payer adoption.
claimIntranasal esketamine requires in-person administration due to the United States Risk Evaluation and Mitigation Strategy (REMS).
referenceThe Canadian Agency for Drugs and Technologies in Health (CADTH) issued a recommendation in 2020 regarding the use of esketamine (Spravato) for the treatment of major depressive disorder in adults.
claimEsketamine is utilized in clinical protocols that feature gradually less-frequent dosing, similar to the protocols used for intravenous ketamine.
referenceBrendle et al. (2022) analyzed the cost-effectiveness of esketamine nasal spray compared to intravenous ketamine for patients with treatment-resistant depression in the United States, utilizing clinical trial efficacy and real-world effectiveness estimates.
referenceCeban et al. (2021) reviewed the prevention and management of common adverse effects associated with ketamine and esketamine treatment in patients with mood disorders.
claimIntranasal esketamine, the s-enantiomer of ketamine, is dosed to minimize psychoactive effects and has received regulatory approval in multiple countries for unipolar treatment-resistant depression when used with conventional oral antidepressants.
claimThe Canadian Agency for Drugs and Technologies in Health and the United Kingdom’s National Institute for Health and Care Excellence (NICE) have recommended against public-payer adoption of intranasal esketamine.
referenceBozymski et al. published a review on esketamine as a novel option for treatment-resistant depression in the Annals of Pharmacotherapy in 2020.
referencePapakostas et al. (2020) conducted a meta-analysis published in the Journal of Clinical Psychiatry regarding the efficacy of esketamine augmentation in major depressive disorder.
claimThe use of calm, de-medicalized rooms reduces the distress associated with altered states of consciousness induced by serotonergic psychedelics and esketamine.
referenceBahr et al. (2019) discussed the use of intranasal esketamine (Spravato) in conjunction with oral antidepressants for the treatment of treatment-resistant depression in the journal P&T.
referenceThe National Institute for Health and Care Excellence (NICE) issued clinical guidance in 2022 recommending the use of esketamine nasal spray for treatment-resistant depression.
claimBoth intravenous racemic ketamine and intranasal esketamine are currently used in various models of care for treatment-resistant depression (TRD) due to meta-analytic evidence of their antidepressant effects and the high demand for novel treatments.
claimClinical use of ketamine or esketamine has not been associated with iatrogenic dependence, cognitive decline beyond transient memory disruption, or toxic bladder effects.
Published Studies — Johns Hopkins Center for Psychedelic and ... hopkinspsychedelic.org 1 fact
referenceMathai, D. S., Nayak, S.M., Yaden, D. B., and Garcia-Romeu, A. published 'Reconsidering “dissociation” as a predictor of antidepressant efficacy for esketamine' in Psychopharmacology in 2023.
Ancient Roots of Today's Emerging Renaissance in ... link.springer.com 1 fact
referenceSalahudeen, Wright, and Peterson (2020) conducted a narrative review evaluating esketamine as a potential treatment for treatment-resistant depression.