What is intranasal ketamine?

Intranasal esketamine (a refined form of ketamine) is an innovative depression treatment that often works when other therapies are unsuccessful. It’s easy to administer as you simply spray the drug into your nasal passages so it can safely enter your bloodstream.
Anesthetists have been using ketamine as a general anesthetic for more than 50 years. Research shows that ketamine can also affect your brain and significantly improve mood.
Receiving ketamine typically requires an intravenous (IV) infusion, where the drug passes directly into your vein through a needle in your arm. Intranasal esketamine is a far more convenient way of receiving ketamine treatment. The Bright Horizons Psychiatry team uses Spravato® intranasal esketamine, which is only available from practices registered with the Risk Evaluation and Mitigation Strategy (REMS) program.

Why might I need intranasal esketamine?

You might benefit from intranasal esketamine if you suffer from treatment-resistant depression. Depression causes profound unhappiness, self-loathing, and hopelessness. You can’t change these negative emotions no matter what you do. Instead, they typically worsen until life becomes unbearable. Around 1 million people worldwide lose their lives to severe depression each year. For many people, psychotherapy and antidepressant medication provide an effective route to recovery. However, some patients make little or no progress. If you have this type of treatment-resistant depression or severe major depressive disorder, intranasal esketamine could be the answer.

How does intranasal esketamine work?

Ketamine affects cells in your brain called receptors. Receptor cells prevent your brain from producing a neurotransmitter (chemical messenger) called glutamate that your brain requires for proper function.
People with depression often have low glutamate levels. By blocking receptor cell activity, intranasal esketamine increases glutamate production and improves mood. Antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) also increase neurotransmitter levels, but they work on other ones like serotonin and dopamine, in addition to glutamate. This is why intranasal esketamine can work when antidepressants haven’t. The Bright Horizons Psychiatry team finds that patients typically experience the best results when they use intranasal esketamine in combination with an antidepressant.

What does having intranasal esketamine involve?

If you and your provider agree that intranasal esketamine offers significant benefits for you, they prepare a treatment schedule and you complete a patient enrollment form.
You must visit Bright Horizons Psychiatry each time you have intranasal esketamine treatment. As part of your REMS introduction, your provider discusses the risks of side effects like sedation and dissociation, and the potential for misuse before you start Spravato. You spray the medication into your nose, then relax in a comfortable room where the team monitors you for two hours. This ensures they can act quickly if you suffer any adverse effects. If you’re not getting results with other depression treatments, ask your doctor about intranasal esketamine. Call Bright Horizons Psychiatry today or book an appointment online.