Esketamine is an FDA approved medication for severe depression. Treatments are administered under supervision in office. This intervention is very useful for fast improvement of suicidal ideations. It is best used in conjunction with other psychotropic medications and psychotherapy for sustained improvement and potential remission from depression.
Most patients find the experience pleasant. Disassociation is a side effect but it is not usually upsetting or frightening. Psychotherapy is supportive in nature and provided as patient is monitored during administration.
Most insurances cover this procedure for severe depression with prior-authorization and a least 1 failed anti-depressant medication trial in the past.
This treatment when compared to IV ketamine is near equivalent in efficacy for depression, although some data suggests IV administration works faster.
Patients self-administer intranasally with the device under supervision. This is very similar to administration of steroids for allergies in over the counter preparations.
Effects of medication usually kick in within about 15 minutes. Peak effects around 40 minutes after administration. Short term effects of the medication tend to subside after about 75 minutes. Patients are monitored for 2 hours and evaluated for safety prior to discharge from office.
Data suggests improvements in mood last about 7 days.
Standard dosing is 2 administrations per week for the first 4 weeks. Then once a week for 4 weeks. All patients are evaluated at each session for individualized treatment planning. This includes psychotherapy and medication management as needed.