This Month in Psychopharmacology

FDA Approves Esketamine Nasal Spray for Treatment-Resistant Depression

Treatment-resistant depression (TRD -the failure to respond to 2 or more antidepressant medications) is a serious issue in mental health. Unfortunately, standard oral antidepressants (e.g., SSRIs, SNRIs) can take weeks before becoming fully effective; this time lag can have dire consequences for patients, especially if suicidality is a factor. We have known for quite a while that the NMDA receptor antagonist, ketamine, has rapid antidepressant effects; however, these effects are typically not long-lasting and, given the intraveneous route of administration, ketamine is not commonly used as an antidepressant. This may be changing: the FDA has just approved a nasal spray formulation of esketamine (the s-enantiomer of ketamine) for use as an adjunct to oral antidepressant medication in patients with TRD. Given the abuse potential and side effect risks (sedation, difficulty with attention, dissociation), the drug must be patient-administered at a certified medical office where the patient can be monitored during and after inhaling the drug. Despite these regulations, given that esketamine nasal spray is typically effective within 2 days (rather than weeks as with oral antidepressant medications), this new medication is a welcome addition to our armamentarium for treating patients with TRD.


>> FDA Press Release


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