What Is Esketamine Therapy?
Esketamine is a medication that's been used safely in medicine for over 50 years, primarily as an anaesthetic. In recent years, research has discovered that esketamine (at much lower doses than used for anaesthesia) can produce rapid and significant improvements in depression symptoms, even in people who haven't responded to other treatments.
Unlike traditional antidepressants that work on serotonin or norepinephrine systems and take weeks to show effects, esketamine works differently. It affects the glutamate system and promotes neuroplasticity, essentially helping your brain form new neural connections and break out of the stuck patterns associated with depression.
Here's what makes esketamine therapy different:
Rapid Onset: While traditional antidepressants can take 4-6 weeks to work (if they work at all), many people notice improvements from esketamine within hours to days. For someone who has been suffering for months or years, this speed can be life-changing.
Works When Other Treatments Haven't: Research shows that esketamine can be effective for a significant portion of people with treatment resistant depression who've already tried multiple antidepressants without success.
Different Mechanism: Because esketamine works through a completely different pathway than traditional antidepressants, it can help even when those medications haven't. It's not just "another antidepressant". It's a fundamentally different approach.
Promotes Brain Healing: Beyond just reducing symptoms, esketamine appears to promote neuroplasticity, helping your brain repair and form new connections. This may contribute to lasting improvements, especially when combined with therapy.
Who Is Esketamine Therapy For?
Esketamine therapy is primarily used for treatment resistant depression, meaning depression that hasn't responded adequately to at least two different antidepressant medications tried at appropriate doses and durations.
You might be a candidate for esketamine therapy if:
You've tried at least two antidepressants without finding adequate relief
Side effects from traditional antidepressants have been intolerable
You're struggling with severe depression and need faster relief than traditional medications can provide
You've been diagnosed with treatment resistant depression
Standard treatments have helped somewhat but you're still significantly impaired
Esketamine therapy isn't typically a first-line treatment. We generally recommend trying conventional approaches first, as they work well for many people with fewer logistical requirements. But when those approaches haven't been enough, esketamine offers a genuine alternative.
Esketamine therapy may also be considered for treatment resistant anxiety and certain other conditions, though the evidence is strongest for depression.
Is Esketamine Therapy Safe?
This is often the first question people ask, and it's an important one. Esketamine has a long safety record in medical settings. In fact, it's been used in hospitals worldwide since the 1970s. At the lower doses used for depression treatment, it has a well established safety profile.
That said, esketamine therapy should only be administered in a proper medical setting with appropriate monitoring. This isn't something to pursue through unregulated channels or without medical supervision.
During treatment, you may experience:
Dissociation: Some people experience a sense of disconnection from their surroundings or altered perception during treatment using an intranasal spray. This may be temporary and typically resolves within an hour or two after treatment ends. Some people find this experience neutral or even pleasant; others find it uncomfortable. We monitor you throughout and can adjust throughout.
Physical Effects: Temporary increases in blood pressure and heart rate, nausea, and dizziness can occur. These are managed through careful monitoring and, when needed, supportive medications.
Drowsiness: You'll likely feel drowsy after treatment and won't be able to drive yourself home. Plan to have someone pick you up and take it easy for the rest of the day.
Esketamine is not appropriate for everyone. Certain medical conditions including uncontrolled high blood pressure, certain heart conditions, active psychosis, or a history of esketamine misuse may make esketamine therapy inadvisable. A thorough assessment before treatment ensures it's safe for your specific situation.
What Does Esketamine Treatment Involve?
Initial Assessment
Before beginning esketamine therapy, you'll have a comprehensive psychiatric assessment to determine whether esketamine is appropriate for you. This includes reviewing your depression history, previous treatments, current medications, and medical conditions that might affect safety.
We want to ensure esketamine therapy is genuinely the right option for your situation – not just an alternative to try, but a well considered choice based on your specific circumstances.
The Treatment Session
We administer esketamine for depression using an intranasal spray. Here's what to expect:
Comfortable Setting: You'll be in a private, calm treatment room designed to help you feel at ease. Many people listen to music or use an eye mask during the treatment.
Monitoring: A clinician monitors your vital signs throughout the treatment, ensuring your safety and comfort.
Duration: The treatment itself typically takes a few minutes, with additional time for monitoring before and after. Plan for about 2-3 hours total for each session.
During the Treatment: You'll remain conscious but may experience altered perceptions, dreamlike states, or dissociation. Some people find this introspective; others simply rest. We're there to support you throughout.
After the Treatment: The acute effects typically wear off within 1-2 hours. You'll rest in our care until you're feeling stable, then someone will need to drive you home. Most people feel relatively normal by the next morning.
Treatment Course
Esketamine therapy isn't a single treatment, it typically involves a series of sessions. A common initial protocol involves:
Induction Phase: A series of treatments, typically two sessions per week for the first four weeks and then one session per week for the next four weeks. After we tailor frequency from week nine onwards.
Assessment: Evaluating your response and determining next steps
Maintenance: For those who respond well, occasional maintenance treatments (often monthly or as needed) to sustain improvement
The exact protocol is tailored to your response. Some people experience significant improvement after just a few sessions; others need the full course before noticing changes. Some maintain their improvement long-term with occasional boosters; others may need more frequent maintenance.
Integrating with Other Treatment
Esketamine therapy works best as part of comprehensive psychiatric care, not as a standalone treatment. We recommend:
Continuing Psychiatric Care: Ongoing medication management and psychiatric support optimises your outcomes and helps maintain improvement.
Psychotherapy: The neuroplasticity promoted by esketamine may create a window of opportunity for therapy to be more effective. Engaging in therapy during and after esketamine treatment can help consolidate gains and address underlying patterns.
Lifestyle Support: Sleep, nutrition, exercise, and stress management all affect depression and can support your recovery.
What Results Can You Expect?
Esketamine therapy has shown remarkable results for many people with treatment resistant depression, but it's important to have realistic expectations.
Response Rates: Research suggests that a large portion of people with treatment resistant depression experience meaningful improvement with esketamine therapy. This is particularly significant given that these are people who haven't responded to other treatments.
Speed of Response: Many people notice improvement within hours to days of their first or second treatment – a stark contrast to the weeks required for traditional antidepressants.
Duration of Effect: The effects of a single esketamine treatment are temporary, typically lasting days to weeks. This is why a series of treatments is used, and why maintenance sessions are often needed to sustain improvement.
Individual Variation: Response varies significantly from person to person. Some people experience dramatic improvement; others notice more modest benefits; some don't respond to esketamine. We can't predict with certainty who will respond, though completing the full induction course gives you the best chance.
Not a Cure: Esketamine therapy isn't a cure for depression. It's a powerful tool that can provide significant relief. It still requires ongoing care including maintenance treatments, medication management, and therapy in order to maintain improvement.
Common Questions About Esketamine Therapy
Will I become addicted?
When used as prescribed in a medical setting with appropriate intervals between treatments, esketamine therapy does not typically lead to addiction. We carefully monitor use and space treatments appropriately. That said, esketamine therapy isn't appropriate for people with a history of esketamine misuse.
Will I hallucinate?
Esketamine produces altered perception and dissociation rather than true hallucinations. You'll be aware of where you are and that you're receiving treatment. The experience is often described as dreamlike or floaty. It's temporary and resolves within a couple of hours.
Can I drive myself home?
You'll be impaired for several hours after treatment and must arrange for someone to drive you home. You should not drive, operate machinery, or make important decisions for the rest of the day.
Is ketamine therapy covered by Medicare?
Esketamine therapy for depression is not currently covered by Medicare in Australia, however, a pharmaceutical benefit scheme (PBS) subsidy may apply. Costs vary depending on the treatment protocol required. We provide clear information about costs during your initial assessment.
How is this different from TMS?
Both Esketamine therapy and TMS (Transcranial Magnetic Stimulation) are options for treatment-resistant depression, but they work very differently. TMS uses magnetic pulses to stimulate brain regions; esketamine is a medication affecting brain chemistry. Some people respond better to one than the other. For some patients, both may be considered as part of a comprehensive treatment plan. Your psychiatrist can help determine which option might be most appropriate for you.
A Note on Safety and Setting
Esketamine therapy should only be undertaken in an appropriate medical setting with proper screening, monitoring, and follow-up care. We provide esketamine therapy at Hirondelle Private Hospital, where you have access to comprehensive medical resources, properly trained staff, and the safety standards of an accredited facility.
Your safety matters, and proper medical care ensures the best possible outcomes.
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To better serve our patients and provide accessible, comprehensive care, Dr. Aly consults from Hirondelle Private Hospital and Brisbane Waters Private Hospital. These facilities are staffed with experienced professionals and equipped with the resources needed to deliver the highest standard of mental health services.
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CENTRAL COAST
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