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Do you suffer from depression? Have you tried several treatments without success? In March 2019, the US Food and Drug Administration (FDA) approved a new treatment.
Esketamine is a nasal spray that you can use with an oral antidepressant. Studies have also shown that patients benefitted from ketamine infusion. Continue reading to learn more about this new approach to treating resistant depression.
What Is Ketamine?
This drug provides anesthesia in humans and animals. It creates dissociative-type anesthesia. This means that the patient doesn’t lose consciousness.
The patient enters a trance-like state with a loss of sensation. They also don’t remember what happens while during the treatment.
Ketamine is now used for resistant depression that has failed other treatment regimens. It blocks NMDA receptors which, when overexcited, can cause degeneration in the brain. Glutamate receptor stimulation also has links with long-term depression.
The Rationale for Ketamine Infusion for Depression
Long term depression, anxiety, pain, or any form of stress harms the brain. In particular, the communication system becomes damaged. This impacts memory, learning, and higher cognitive processes.
Studies conducted at Yale research labs found that ketamine anesthesia triggered glutamate production. Upon further review, they discovered that glutamate starts a series of events in the brain. The result is the formation of new neural connections.
Study participants with severe depression received low doses of ketamine via IVs. These individuals had failed standard antidepressant treatment. In several studies, over half of the participants reported significant symptom improvement in 24 hours.
The theory is that the brain becomes more adaptable. This allows patients to develop positive thoughts and behaviors. Ketamine therapy stimulates neuron growth that enhances the brain’s communication system.
How Is Ketamine Administered?
Ketamine is most often given via one of two routes to treat severe depression. Racemic ketamine is often administered into the blood by an intravenous (IV) infusion. This formulation contains “R” and “S” ketamine molecules.
Most of the research has focused on this route of giving the medication. These studies have examined using different doses and documenting their effects. At this time, there is no specific prescribed dosing recommendation.
As of 2019, the nasal spray form, esketamine, gained FDA approval for clinical use. This form only contains the “S” molecule.
The nasal spray treatment should be in addition to oral antidepressant medications. During the induction phase, the spray is given twice a week for 1 to 4 weeks.
On weeks 5 to 8, the spray is taken once a week. From week 9 and after, it may be prescribed either once a week or every 2 weeks.
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