Esketamine Therapy for Mental Illness: What to Expect

Once used primarily as an anesthesia, ketamine has made a name for itself in the mental health field for its surprising ability to treat mood disorders like depression, bipolar disorder, and post-traumatic stress disorder (PTSD).

Esketamine, a closely related compound to ketamine and marketed under the name Spravato®, has gained FDA approval specifically for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal thoughts.

At Holistic Behavioral & TMS Therapy, our team focuses on providing cutting-edge, effective treatments to improve mental wellness. Esketamine therapy offers a novel approach for patients who haven’t found relief with traditional methods.

Here’s a closer look at how esketamine works, what makes it different from ketamine, and what you can expect from treatment.

Ketamine vs. esketamine

Ketamine and esketamine are like siblings — they’re related but have unique traits. Although they share similar chemical structures, their specific makeup, FDA approval status, dosage, administration method, and the amount of research backing their safety and effectiveness differ.

Ketamine is traditionally an anesthetic and, while used off-label for some mental health conditions, it is not FDA-approved for depression.

Esketamine, a derivative version of ketamine sold under the brand name Spravto®, is FDA-approved for adults dealing with TRD or MDD who have suicidal thoughts and is used alongside an oral antidepressant.

The nasal spray form of esketamine

Unlike ketamine treatments that may involve IV administration, esketamine comes in a nasal spray. It’s not a prescription you use at home; we administer it here in our office and keep you under our care for a couple of hours to monitor your reaction.

As the medication enters your system, esketamine targets your brain’s glutamate system, a different pathway from traditional antidepressants. By affecting this neurotransmitter, it can lead to significant mood improvements, sometimes within hours.

What does esketamine therapy feel like?

Starting any new treatment can be intimidating, but understanding what to expect can ease some of that anxiety. 

Before your esketamine treatment

Before starting your esketamine therapy, we ensure you’re a good candidate. We review your medical and mental health history and discuss your previous treatments. If you qualify, we thoroughly explain the steps ahead, answer all your questions, and let you know what to expect.

On the day of your esketamine treatment, you should avoid eating or drinking a few hours before the session.

During the treatment session

We’ll guide you to a comfortable treatment room, where you’ll self-administer the esketamine nasal spray under our supervision. You’ll spray the medication into each nostril and then sit back and relax.

Monitoring

After you take the nasal spray, we observe you for about two hours to monitor your reaction to the medication and manage any possible side effects. It’s common to feel a bit dizzy or sleepy or experience mild dissociation (feeling disconnected from reality), but these effects typically lessen over time.

You might experience nausea, dizziness, headache, or increased blood pressure after taking esketamine. These are normal, temporary reactions. 

After the treatment

You might still feel drowsy or slightly off-balance at the end of your session, so you’ll need someone to drive you home. However, even if you feel fine, you shouldn’t drive yourself. 

It’s also important to rest and avoid strenuous activities for the rest of the day.

Follow-up care

We schedule regular follow-up appointments to monitor your progress, adjust the treatment, and combine the esketamine therapy with oral antidepressants.

If you suffer from depression, bipolar disorder, or PTSD, and other treatments haven’t helped, esketamine nasal spray could be a game-changer. Call Holistic Behavioral & TMS Therapy in Chicago or Aurora, Illinois, or Las Vegas, Nevada, or schedule an appointment online today for a consultation with our esketamine specialists.