Esketamine, or the brand name is called Spravato is a really new medication, and there has been a lot of interest and hype behind it. It was initially discovered in 1997. It's been around for a while and has since gained a popularity as a Depression Treatment. What's unique about Spravado is that it is a Johnson and Johnson produced nasal spray of Esketamine to be used as an antidepressant. It's a newly approved medication for treatment resistant depression. Treatment resistance means you've felt several attempts at first line treatments for anxiety or depression, such as SSRIs and SNRIs.
The thing with Esketamine, though, is it can have a lot of serious side effects. It's something that's usually used later down the line, and it's also very, very expensive because there's no generic available yet.It is brand new. Again, this is an option for people who have not been able to find relief from anything else. Ketamine, though, is a chemical relative. Ketamine and Esketamine are very similar and work essentially the same in the brain.
Ketamine has been around and used for a long time. It is a generic and can be obtained cheaper and is, I believe, to be as effective as Esketamine, if not even more so than Esketamine. This does work on an entirely different system of signaling in the brain than what your SSRIs act on, which is serotonin. The SNRIs also act on norepinephrine, and we call this the monoamine system. The monoamine system involves dopamine, serotonin, norepinephrine, and epinephrine. What Esketamine works on is called the glutamate system.
It works on glutamatergic signaling. There's a big word for you. What it does is it blocks or modulates a receptor that can get out of whack with things like anxiety and depression and it can become overstimulated. Esketamine brings that excitation down, and that excitation itself can be related to depressive symptoms.
One thing that's really beneficial about Esketamine is that its effects can be felt quite quickly. It doesn't take very long. You can feel it within a day, sometimes within 30 minutes, or a couple hours after the treatment. It all kind of just depends on the person. It's helpful in preventing acute suicidal ideation. It can help bring somebody who's in a crisis out.
Esketamine does carry some risks. It is a schedule III-controlled substance. That means it has even higher addictive potential than your benzodiazepines like your Xanax, Ativan, or your Klonopin. It has a higher addictive potential than those. It also has some serious side effects like dissociation, dizziness, sedation, nausea, vomiting, vertigo, numbness, anxiety, lethargy, and increased blood pressure. Long Term use of Esketamine has been associated with bladder disease.
While this may be a good option, it should be considered a last line of defense. It's expensive, it's new, and it's not used a lot. You have cheaper options like Ketamine and a slew of other things that you can use before you need to jump to Esketamine. It is good to know that it is an option, that it's out there. The way Esketamine is administered is at the doctor's office. It's not a medication you take home. You have to go to the doctor's office. They give you the nasal spray, they watch you, they make sure you're safe, you're okay, before sending you home, because it can create side effects, such as dissociation.
A person in a dissociative state is not safe, and so they need to be monitored to make sure that they are able to return home. I really think that the mechanism behind Esketamine is very interesting, as well as behind Ketamine.
There needs to be a lot more research here. And it is great to know that this is a safety net, that it's an option way down the line if you really need to get there. However, we should do more research. We should find ways to reduce these side effects from using psychotropic agents such as Ketamine and Esketamine in a way that is productive and helpful and minimize the harmful effects as much as possible.
There is a lot of research going into these kinds of medications now. There's a lot of medications that are out there that are being researched by pharmaceutical companies, although there have been some that have failed so far and have not made it through to production.