Introduction
Adults with treatment-resistant depression (TRD; depression that does not improve with medication) are treated with Esketamine nasal spray in addition to another oral antidepressant. It is also used to treat depression symptoms in people with major depressive disorder (MDD) and suicidal thoughts or behaviors when taken orally in conjunction with another antidepressant. Esketamine belongs to a group of drugs known as NMDA receptor antagonists (inhibit the action of the N-Methyl-D-aspartate receptor). It functions by altering the way some organic compounds in the brain function.
Ketamine, an anesthetic that has also been used for many years to treat depression, is the basic component required to make Esketamine. However, it was not until recently that the Food and Drug Administration (FDA) approved Esketamine, a stronger form of ketamine, for use as a nasal spray for those with depression who were not responding to therapy.
Esketamine is made from a portion of the ketamine molecule. It is more effective than ketamine, so one may use it at a lower dosage with less potential negative effects. It is now available in an intranasal form.
How Should Esketamine Nasal Spray Be Used?
Esketamine is available as a liquid solution that is sprayed into the nose. It is often sprayed into the nose twice a week in weeks one to four, once a week in weeks five to eight, and once a week or once every two weeks in week nine and beyond for the treatment of treatment-resistant depression. It is often administered twice weekly for up to four weeks to treat depression symptoms in individuals with severe depressive disorder and suicidal thoughts or behaviors. Esketamine use is restricted to medical facilities.
Before taking Esketamine nasal spray, refrain from eating for at least two hours and from drinking liquids for at least 30 minutes. There are two sprays available for each nasal spray device, one for each nostril. The gadget displays two green dots when the nasal spray is full, one green dot when just one spray is used, and no green dots when both sprays are utilized in totality.
What Precautions Are to Be Followed While Using Esketamine Nasal Spray?
Provide healthcare professionals with information about allergies and existing medications, including over-the-counter drugs and herbal treatments, before starting Esketamine nasal spray. Take nasal decongestants or corticosteroids at least an hour before Esketamine. Esketamine should not be taken by those who have specific medical disorders, such as blood vessel diseases, a history of bleeding, stroke, heart problems, or elevated intracranial pressure. Individuals who are pregnant or nursing should speak with their physician, and patients who are having surgery need to let the medical staff know. Esketamine may cause a brief increase in blood pressure; it is important to monitor this and get medical assistance if there are symptoms such as chest discomfort, shortness of breath, a strong headache, changes in vision, or seizures.
What Is Esketamine Treatment Like?
Esketamine, similar to ketamine, must be given in a clinical environment since it may cause perceptual distortion in the first two hours following therapy. Esketamine nasal spray therapy is administered as an outpatient procedure.
The patients administer three doses of the nasal spray to themselves, three minutes apart, under the guidance of a physician. Then, stay in the clinic under the care of the doctor until any possible adverse effects subside.
Esketamine needs to be used alongside a traditional antidepressant. Esketamine is intended to relieve symptoms of depression quickly while waiting for the other drug to take action.
Typically, the therapy is administered twice a week for the first month. If all goes well, the dosage and frequency are then adjusted based on the patient's reaction to the treatment, and the medication is continued at a reduced frequency for a few weeks or months during the maintenance phase. This usually translates to fewer treatments weekly, every two weeks, monthly, etc.
How Does Esketamine Treat Depression?
Esketamine and the related medication ketamine are very successful therapies for depression for several reasons.
Unlike other medications, ketamine's antidepressant effects are achieved through an unusual method. Serotonin, norepinephrine, and dopamine are examples of naturally occurring neurotransmitters that are raised in response to conventional antidepressants. These substances function as messengers, facilitating communication between brain cells. Higher levels of these neurotransmitters improve mood by facilitating better brain-cell communication.
Similar mechanisms underlie the action of Esketamine, although, in contrast to other antidepressants, Esketamine elevated glutamate levels, the brain's most prevalent chemical messenger. The outcome is a stronger effect on several brain cells at once.
What Are the Side Effects of Esketamine Nasal Spray?
The nasal spray Esketamine may have adverse consequences. Let the physician know if any of these symptoms are severe or persistent:
- Constipation.
- Dry mouth.
- Diarrhea.
- Nausea.
- Vomiting
- Headache from intoxication.
- A strange or metallic aftertaste.
- Pain in the nose.
- Soreness or discomfort in the throat.
- Toothache.
- Sore muscles.
- Numbness or alterations in the response to pain, heat, cold, or light touch.
- Trouble speaking, trouble sleeping or staying asleep.
- Unusually joyful or enthusiastic attitude.
- Frequent, burning, or painful urination.
- Trouble remembering or thinking.
- Elevated or fast heart rate.
How Should the Physician Determine the Correct Candidate for Esketamine Nasal Spray Therapy?
Esketamine is authorized for use in people with depression that is resistant to therapy, which is characterized by the inability to experience a 50 percent improvement in mood or remission following at least two six-week trials of conventional antidepressants. When used in conjunction with other therapy options, Esketamine can provide hope for patients who have not responded well to traditional antidepressants by enhancing mood and perhaps alleviating depression.
How Should Esketamine Nasal Spray Be Correctly Used?
Use this drug under supervised dosage in a medical institution. To avoid abuse, always adhere to the directions. If required, ask the pharmacist for the medication guide. The number of devices required for the dosage will be recommended by the physician. Before using, wait two hours to eat and thirty minutes to drink. Give the medication just via the nostril. Hold the gadget upright and push it into each nostril as directed after gently blowing through the nose. If required, wait five minutes between devices. When using a tissue to absorb nasal fluids, try not to blow through the nose. After dosage, two hours should be spent under observation. The medical condition determines the appropriate dosage, with special guidelines for depressed symptoms and treatment-resistant depression. Please contact a medical practitioner if a dosage is missed. The medication should be kept out of reach of children, and the heat, moisture, and light should be kept in a closed container at room temperature. As directed by the doctor, dispose of any unused or expired medication.
Conclusion
Esketamine nasal spray is a ground-breaking development in the treatment of depression, in particular for those with depression who are resistant to therapy. Those who have not responded to conventional antidepressant therapy have hope due to its distinct mode of action and quick commencement of effect. Although its clearance represents an important turning point in the treatment of mental illness, safety and effectiveness must be guaranteed by careful patient selection, administration under medical supervision, and adherence to dose standards. Esketamine nasal spray has the potential to transform the treatment of depression and enhance the lives of those who are affected by it.
