Ketamine Nasal Spray

Ketamine nasal spray is sometimes referred to as intranasal esketamine. Generally, it is used as a nasal spray to treat patients with treatment-resistant depression (TRD) and major depressive disorder (MDD).

Who can have ketamine nasal spray?

Ketamine nasal spray is used to treat patients with treatment-resistant depression (TRD) and major depressive disorder (MDD) who have chronic suicidal ideation and:

• A defined depression diagnosis

• Have not found relief from at least 3 initial treatment therapies

• Are seeking an alternative to electroconvulsive therapy (ECT)

• Have well-controlled blood pressure

• Can commit to biweekly visits with a support person for transportation

• Have an established provider managing their care

• Additional screening criteria

While there is no formal definition of treatment-resistant depression currently exists, TRD is commonly a failure of depressive symptoms to respond to both psychological and psychopharmacological interventions such as therapy or antidepressants. TRD represents the highest direct and indirect medical costs among those with MDD. Individuals with TRD are twice as likely to be hospitalized as those with MDD and have an almost 14% lifetime risk of suicidal behavior compared to 10% for those with MDD.

Those who would not benefit from ketamine as a form of outpatient therapy and would instead be recommended for alternative non ketamine therapies include:

• Patients who have depression due to bipolar disorder, schizophrenia, or other psychotic disorders

• Patients with active substance abuse (alcohol or drugs)

• Patients with ketamine allergies or insensitivities

• Patients with uncontrolled hypertension due to ketamine’s blood pressure-raising effects

• Patients with a known history of aneurysmal vascular disease, arteriovenous malformations, or intracranial hemorrhages

How does ketamine nasal spray work?

The full spectrum of ketamine’s antidepressant and antisuicidal effects has no full explaination. However, we do know that this novel approach to therapy works with the brain’s NMDA receptors, which play a role in several neurological functions like memory, learning, movement, and more. This is an alternative to SSRIs (Prozac, Paxil, Zoloft), which work with serotonin receptors.

We also know that ketamine affects other receptors and pathways in the brain, which creates a combination of positive effects that help combat depression.

Benefits and risks of ketamine nasal spray

Over the last 2 decades, several studies have shown that ketamine produces antidepressant and anti-suicidal effects.

Risks for patients eligible for ketamine therapy are generally minor. Monitor patients immediately after administration of the spray to check for side effects such as:

• Allergic reaction

• Anxiety or panic

• Blood pressure elevation

• Burning/discomfort

• Dissociation, including out-of-body experience

• Drowsiness/grogginess

• Nausea and vomiting (uncommon)

Most of these side effects wear off quickly and patients usually experience them less frequently as they progress with treatment. Keep patients under close observation for up to 2 hours after the administration of ketamine nasal spray to ensure safety.