Esketamine—an isomer of ketamine—was developed by Johnson & Johnson Pharmaceuticals, designed to mimic the rapid-acting antidepressant results of ketamine…without some of the dissociative side effects. It was fast-tracked by the FDA for approval in 2016, granted breakthrough status. And a breakthrough depression treatment it is. Or could be.
Esketamine has sailed through all three phases of clinical trials, and the FDA is slated to approve its use as an antidepressant any day now. If approved, it would be the first new antidepressant drug to be introduced in nearly half a century! The medication, unlike ketamine infusions which are administered intravenously, would be administered intranasally.
Esketamine is not without side effects. It can cause blood pressure fluctuations, dissociation or mild hallucinations, and could potentially be abused for recreational use. However, most groundbreaking drugs come with undesirable side effects. Patients need to ask themselves whether the risks of using a prescription drug outweigh the benefits.
Esketamine has received a lot of support along its journey from research & development to FDA approval. Medical experts have voted 14-2 to approve the drug for use. However, there are many critics still out there—and their concerns are valid:
1. Esketamine is most effective when administered 2x/week for the first month of treatment, then 1x/week or bi-weekly during the maintenance phase of treatment. However, there are questions about who will administer the medication, and how it will be monitored.
2. How long should patients receive esketamine, and are there any long-term risks?
3. Do patients have unrealistic expectations? Esketamine—and ketamine, for that matter—has received a huge amount of media attention. It has been hailed as a “wonder drug” and a “miracle treatment.” And for many, it is. But not everyone responds to the treatment, and for those who do respond, it’s generally not an overnight success. These drugs lift the fog of depression, but don’t generate a night-and-day improvement to depressive symptoms.
If esketamine is approved, one of the major benefits would be that insurance companies would begin to cover the cost of the medication. Currently, ketamine infusions are not covered by insurance providers. Ketamine clinics like ours try to keep costs as low as possible to make the treatments affordable to those who truly need them, but average costs in the U.S. range from $500-1,000/infusion.
However, if esketamine is approved and covered by insurance, patients need to understand it’s not a first-line depression treatment. Esketamine, like ketamine, is something that we recommend after all other options have been exhausted. In fact, esketamine is used in conjunction with traditional antidepressants…not in lieu of them.
It’s an exciting time for the world of mental health care—esketamine could forever change the landscape of depression treatment as we know it. While we await answers to these questions, though, ketamine is still the most effective treatment for depression available to the public.
Contact Elev8 MD Wellness Center
Elev8 MD Wellness Center is Charlotte’s leading ketamine clinic and wellness center, offering a wide array of services designed to support you on your journey towards health and happiness. Beyond ketamine infusions, we also offer acupuncture, massage, psychotherapy, IV hydration therapy, and more. Contact us today to learn more about ketamine and other depression treatments, and how they could help you reclaim your life.