How to Start Nasal Ketamine Treatment: A Comprehensive Guide
What is Nasal Ketamine Treatment?
Nasal ketamine treatment, particularly intranasal esketamine (Spravato), is a new and effective option for patients with treatment-resistant depression (TRD). Here’s a guide to understanding and starting nasal ketamine treatment, along with a comparison to intravenous (IV) ketamine based on the study,
“Comparative Effectiveness of Intravenous Ketamine and Intranasal Esketamine in Clinical Practice Among Patients With Treatment-Refractory Depression.”
What is Nasal Esketamine?
Esketamine is a derivative of ketamine, primarily used as an anesthetic. In 2019, the FDA approved esketamine as a nasal spray (Spravato) for TRD. This
treatment is typically used alongside an oral antidepressant for patients who haven’t responded to other treatments.
Who Should Consider Nasal Esketamine?
Nasal esketamine is suitable for patients diagnosed with TRD or major depressive disorder with suicidal ideation (MDD-SI). It’s often part of a broader
treatment plan that includes oral antidepressants and psychotherapy. Consult ith your psychiatrist to determine if nasal esketamine is appropriate for your
condition.
How to Start Nasal Esketamine Treatment
- Consultation: Schedule a consultation with a psychiatrist to discuss your
medical history, symptoms, and treatment goals. - Spravato™ REMS Program: Understand the requirements of the Risk
Evaluation and Mitigation Strategy (REMS) program for Spravato. Familiarize
yourself with the medication guide and patient instructions. - Supervised Administration: Esketamine must be administered under
medical supervision in a clinical setting. - Dosage: The starting dose is typically 56 mg on Day 1, followed by 56 or
84 mg twice a week for the first 4 weeks. The dose may then be adjusted as
needed. - Monitoring: After each treatment session, you will be monitored for at
least 2 hours for any adverse effects.
Comparative Effectiveness of IV Ketamine and IN Esketamine
An observational study published in 2023 examined the effectiveness of IV ketamine and IN esketamine for TRD. Here are the key findings:
- Study Parameters: The study included 62 adults with TRD who received
either up to 6 IV ketamine (0.5 mg/kg over 40 minutes) or up to 8 IN esketamine
(56- or 84-mg) treatments. - Measurements: Depressive symptoms were measured using the 16-item
Quick Inventory of Depressive Symptomatology self-report (QIDS-SR) before
and 24 hours after treatment. - Efficacy: Both IV ketamine and IN esketamine showed similar rates of
response and remission. - Time to Remission: IV ketamine resulted in a faster time to remission
compared to IN esketamine (HR = 5.0, P = .02).
What to Expect During a Nasal Esketamine Treatment
Session - Preparation: Avoid eating for at least 2 hours and drinking for at least 30
minutes before treatment. - Administration: The nasal device contains 2 sprays. Follow the
instructions carefully for proper use. - Post-Treatment: You may need to stay in the medical facility for
monitoring to ensure no adverse effects occur.
Side Effects and Precautions
Nasal esketamine can cause side effects such as drowsiness, dizziness, increased blood pressure, and feelings of dissociation. It’s crucial to have
someone drive you home after treatment and avoid operating heavy machines until the next day.
Conclusion
Both IV ketamine and IN esketamine are effective for TRD, with IV ketamine potentially offering faster remission. However, the choice of treatment should be based on individual needs, medical history, and professional guidance. Always consult with a psychiatrist to determine the best treatment plan for you.
Treatment Options at Klearmind
Klearmind offers both intravenous ketamine and intranasal esketamine treatments. This allows patients to choose the most suitable option based on
their specific needs and treatment response. For more detailed information and to discuss treatment options, contact your psychiatrist or visit Klearmind.
Sources:
https://pubmed.ncbi.nlm.nih.gov/36724113/
https://www.mayoclinic.org/drugs-supplements/esketamine-nasal-route/proper-use/drg-20458442