Nasal Esketamine Therapy for Treatment Resistant Depression

Ketamine and esketamine work for depression through a different mechanism than other antidepressant drugs. Conventional antidepressants increase levels of naturally occurring chemicals such as serotonin, norepinephrine and dopamine. Increasing these chemicals allows for better communication between brain cells, which positively affects mood. Ketamine and Esketamine block NMDA receptors in the brain and thereby increase levels of glutamate, the most abundant chemical messenger in the brain. Blocking NMDA receptors also activates AMPA receptors to release other molecules that help brain cells communicate with each other along new pathways. In turn, this process improves mood, thought patterns, and cognition. Esketamine must be used in conjunction with a conventional antidepressant. The intention is that esketamine provides rapid relief from depression symptoms until the other medication takes effect. Usually, the treatment is given twice a week for the first month, and then if it is successful it is continued at decreased frequency in a maintenance phase for a few weeks or months with dosing and frequency determined by treatment response. Typically, this might mean a decrease to weekly treatments, then every two weeks, then monthly. Based on weekly depression scales we use to monitor you progress we will then recommend how often you should continue. https://youtu.be/nW21-AYY_fs?si=EUk3RkjEvOD_c-vN

Our office offers nasal esketamine (Spravato) , a form or ketamine, that has been FDA approved since 2019 for adults (over 18) with treatment-resistant depression as well as adults with major depressive disorder with suicidal thoughts. You will take nasal esketamine nasal spray yourself, under the supervision of our healthcare provider while resting in a recliner in our office. Our healthcare provider will show you how to use the SPRAVATO® nasal spray device. While resting in the recliner we will periodically monitor your blood pressure as well as for any other side effects. It should be noted that nasal esketamine should be taken with your current antidepressant. Together you will have a greater chance of results regarding your current depressive symptoms. https://static.wixstatic.com/media/b97322_6543a8279e7f40f6bb0b1a7f8452d704~mv2.png

You may be familiar with ketamine as an anesthetic that was commonly used on battlefields or as a veterinary drug. A much lower dose of ketamine is given for depression compared with the dose necessary for anesthesia. Esketamine (brand name Spravato) is a different version of ketamine that can be administered intranasally and also produces rapid, effective results. Esketamine is the S form of Ketamine. It is a new development, making pharmaceutical companies more likely to endorse clinical trials supporting the use of it. In 2019, the FDA approved the use of esketamine (Spravato) in adults for the treatment of treatment resistant depression TRD and major depression with suicidal ideation when used in conjunction with an oral antidepressant. Up to 33% of people with depression don’t respond to multiple kinds of conventional antidepressants. Esketamine reduces depression symptoms in a majority of these people in clinical trials. https://static.wixstatic.com/media/b97322_9f1305cf09d64720ae4426d125203d9c~mv2.jpg

The safety and efficacy of esketamine (Spravato) is supported by at least 3 short-term and 2 long term studies. A 2020 study by Papakostas studied the use of esketamine in 774 subjects who were involved in 5 trials and showed that patients with MDD or MDSI who received the intranasal esketamine treatments had a better outcome than those who received placebo. Conventional antidepressants may actually increase suicidal thoughts at the beginning of treatment, especially in children and young adults. Esketamine (Spravato) is the only drug besides lithium that is proven to decrease suicidal thoughts. Research also suggests that untreated depression causes long-term brain damage and is a risk factor for dementia. Studies show that people with depression have up to 20% shrinkage of the hippocampus, a region of the brain critical for memory and learning. But esketamine may counteract the harmful effects of depression. Animal studies indicate that connections between brain cells diminish under chronic stress, but esketamine reverses these stress-related changes. https://static.wixstatic.com/media/b97322_9d85084f2f0c453ab3a47dfda219683e~mv2.jpg

Esketamine (Spravato) is more potent than ketamine, which allows for lower doses and potentially less side effects Both ketamine and esketamine have to be administered by a doctor. Ketamine must be administered intravenously up to 3 times a week. This can be inconvenient, expensive and painful as patients have to continue to return to the doctor’s office and receive a new IV injection each time. Ketamine is expensive as it is not covered by insurance. Esketamine (Spravato) is administered in an outpatient setting in a comfortable recliner under doctor supervision. You receive 3 doses of the medication spaced about 5 minutes apart and then you remain under doctor supervision for 2 hours until any potential side effects have passed. https://static.wixstatic.com/media/b97322_f24ba754f0c046958bdb36e3020e0a29~mv2.png

The side effects for both esketamine and ketamine can include: • Nausea • Drowsiness • Increased blood pressure • Dissociation (sometimes called out-of-body experiences) • Headache The side effects tend to peak at 40 minutes and wear off within two hours of treatment. You can expect the most intense side effects during the first two treatment sessions. Our team will closely monitor you during you treatments to ensure your safety. https://static.wixstatic.com/media/b97322_565276e9353c4092b27ea8bb49d4bafb~mv2.jpg .

Ketamine treatments are not covered by insurance companies because it’s experimental and not FDA approved. Therefore, you have to pay out of pocket for it. Esketamine (Spravato) is almost always covered by insurance, because it is FDA approved and well-studied to be effective and safe. To be considered eligible for insurance coverage for Esketamine (Spravato), a person has to have tried at least two other antidepressants without benefit. Our clinic currently accepts the following insurances for Esketamine treatments: AETNA Ambetter Anthem Baylor Scott & White Beacon/Value Options BCBS CIGNA ComPsych Humana HealthSmart Magellan MHN OPTUM United Healthcare UMR If your insurance is not listed above , it may still be possible we can get a single case agreement (SCA). Single Case Agreement (SCA) is a one-time contract between an insurance company and an out-of-network provider so the patient can see that provider using their in-network benefit. Call today for further information and to schedule a consultation at 682-422-3101. https://static.wixstatic.com/media/b97322_9a0868c6c0e14d0199ca30a3b7c22783~mv2.jpg

Call our office us today at (682) 422-3101 to get more information and to see if you qualify for esketamine treatments. After thorough review of your medical and psychiatric history, our medical director will determine medical necessity and pursue preauthorization with your insurances company. If you chose private pay option we will be happy to discuss this further as well. Regardless is you use insurance or private pay, we only use Esketamine therapy for individuals age 18 and older for safety purposes. "Unlike conventional antidepressants that may take 4-6 weeks to work, ketamine can work in hours and most patients will see benefits with a week." -Dr. Germaine Hawkins, DO Psychiatrist & Esketamine Medical Director Regain Your Daily Quality of Life you DESERVE!! https://static.wixstatic.com/media/b97322_476e7989267b4a95a5a6f4ee749f4870~mv2.jpg