Intranasal Esketamine – Psychopharmacology, Side effects and Clinical Application

Posted on:August 19, 2020
Last Updated: October 5, 2022
Time to read: 14–16 minutes

Antidepressants such as SSRIs and SNRIs can be limited by their 3-6 weeks delay before a therapeutic effect is observed that can result in the need for multiple medication trials.

Research suggests that approximately 30% of patients are resistant to antidepressant treatment. [Rush et al. 2006]; [Trivedi et al. 2006]

Treatment resistant depression (TRD) is defined as the failure of at least two trials and is characterised by severe morbidity in addition to higher rates of hospitalisation, suicidal ideation, and serious medical complications.

We had previously covered ketamine and esketamine. 

The U.S. Food and Drug Administration in 2019 approved esketamine nasal spray (Spravato) in conjunction with an oral antidepressant, for TRD. [Kim et al. 2019]

In 2020, the FDA approved Esketamine nasal spray to treat depressive symptoms in adults with major depressive disorder (MDD) and acute suicidal ideation or behaviour.

The Australian TGA approved intranasal Esketamine  (SPRAVATO) for TRD in 2021. According to the TGA:

Spravato is indicated for treatment resistant depression (Major Depressive Disorder in adults who have not responded adequately to at least two different antidepressants of adequate dose and duration to treat the current moderate to severe depressive episode).

Spravato is to be initiated in conjunction with a newly initiated oral antidepressant.