Introducing Esketamine (Spravato) Nasal Spray

Background
Esketamine is one of the latest treatments for treatment resistant depression. Approximately 60% of people who experience an episode of depression will get better after using 1-2 antidepressants and or with psychological treatment. People who have not responded to two anti-depressants are considered “treatment resistant”.
People who suffer from treatment resistant depression (TRD) will take a longer time to recover and will carry significant functional, emotional and social difficulties unless treated effectively.
The clinical evidence available so far indicates that adding a third anti-depressant, combining antidepressants or enhancing the activity of an antidepressant (augmentation) with Lithium would only benefit 15% of people with treatment resistant depression.
Benefits
Treatment with Esketamine in combination with an antidepressant has shown to increase the chance of getting better with treatment resistant depression by approximately 53% and achieving remission by approximately 40%.
Treatment with Esketamine also has shown faster results, compared to other treatments which are available for treatment resistant depression. It is an NMDA receptor antagonist that is believed to work differently by acting on a pathway in the brain that affects glutamate, thus providing faster results.
In a short-term study, more patients using Esketamine plus oral antidepressant demonstrated rapid and superior reduction in depressive symptoms at four weeks compared to those who received placebo plus an oral antidepressant
Most of the reduction in depressive symptoms was seen at 24 hours. The rapid resolution of symptoms will help people who get better with treatment to return to their work, family and social activities faster.
Cost of treatment
Esketamine is currently not under the Medicare Benefits Scheme. Treatment for 1 month may cost approximately $6000 and treatment for 6 months may cost approximately $18000. However, the cost of admission to a hospital and loss of productivity due to ill health overall is likely to cost more than the cost of treatment with Esketamine. The Insurance companies or other organisations such as DVA may support to cover the cost of the treatment which provides a significantly higher change of getting better and alleviating the suffering, risks and loss of productivity.


Treatment
Esketamine Nasal Spray is delivered at Best Brains and Minds Clinic under the supervision of a nurse, twice a week for the first month. After receiving the treatment, the person must stay in the clinic premises for approximately 2 hours, under the supervision of the nurse. This is to monitor blood pressure and for any other side effects from the treatment.
The person who receives treatment, will need to arrange transport to return home. He or she can drive after having a restful sleep overnight.
The doctor will decide on the starting dose and when to increase the dose if required. For most adults the starting dose is Esketamine 56mg. After the first 4 weeks of treatment, the person will receive treatment on a once-a-week basis.
Contraindications
Esketamine is contraindicated for people who;
- have blood vessel (aneurysmal vascular) disease (including in the brain, chest, abdominal aorta, arms and legs)
- have an abnormal connection between your veins and arteries (arteriovenous malformation)
- have a history of bleeding in the brain
- are allergic to esketamine, ketamine, or any of the other ingredients in SPRAVATO®.
Side Effects
- Dissociation
- (Dissociation-feeling disconnected from yourself, your thoughts, feelings and things around you.)
- Dizziness
- Nausea
- Sedation
- Sedation-feeling sleepy.
- Spinning sensation
- Numbness
- Feeling anxious
- Lack of energy
- Increased blood pressure
- Vomiting
- Feeling drunk
- Feeling very happy or excited Dissociation
- (Dissociation-feeling disconnected from yourself, your thoughts, feelings and things around you.)
- Dizziness
- Nausea
- Sedation
- Sedation-feeling sleepy.
- Spinning sensation
- Numbness
- Feeling anxious
- Lack of energy
- Increased blood pressure
- Vomiting
- Feeling drunk
- Feeling very happy or excited
If side effects occur, they usually happen right after taking Esketamine and go away the same day.
Less than 7% of patients stopped treatment due to side effects in short- and long-term clinical studies

Tolerability
Esketamine plus oral antidepressant offers a similar safety profile to previous trials with a minimal risk for sexual dysfunction compared to placebo plus oral antidepressant
- Sexual dysfunction was not seen in more than 2% of patients in the Esketamine clinical trials
Safety
Esketamine is a scheduled medication in Australia. (S8). It must be taken under the supervision of a nurse at the clinic who will also physical health checks before and after the treatment. It is not possible to carry the medication or use the medication at home. Esketamine is a scheduled medication in Australia. (S8). It must be taken under the supervision of a nurse at the clinic who will also physical health checks before and after the treatment. It is not possible to carry the medication or use the medication at home.
Comfortability
There is a dedicated comfortable and modern clinic room with a reclining chair to receive treatment, rest and relax pre and post treatment. The nurses and doctors are trained to support, monitor and intervene if necessary, during the administration of medication and monitoring period.
How to access treatment
If you have been treated with more than two anti-depressant medications and you are still suffering from depression, discuss with your GP and arrange a referral to see a psychiatrist at Best Brains and Minds. The appointments will be prioritised if the GP has informed that the referral is to consider treatment with Esketamine.