Esketamine, also known by its brand name, Spravato, is a relatively new antidepressant with a novel mechanism of action – it conveniently comes as a nasal spray. It is FDA-approved for treatment-resistant depression and depression with suicidality. It does not take the place of inpatient psychiatric hospitalization for people who are suicidal to the point of being a potential danger to themselves.

Treatment-resistant depression is quite common. People with treatment-resistant depression have not responded adequately to first-line antidepressant treatments. They may have also tried augmenting agents that help antidepressants to work better.

Despite adequate trials of antidepressants and sometimes augmenting agents, people with treatment-resistant depression continue to struggle with symptoms of depression, including depressed mood, lack of interest or pleasure in activities that normally bring them joy, sleep and appetite disturbance, fatigue or lack of energy, difficulty concentrating or thinking clearly, a feeling of being abnormally slowed down or sped up, a sense of worthlessness or irrational guilt, and thoughts of death or suicide.

Esketamine has found a niche in the management of treatment-resistant depression, as well as depression with suicidality. Its effects tend to be rapid, sometimes within the first day of treatment. For others, it takes longer to see a response – up to four weeks or more. It has been shown to be safe and efficacious.

Esketamine must be administered in a healthcare facility. All people receiving esketamine will have their blood pressure, pulse and oxygen saturation checked before treatment. These parameters will subsequently be checked periodically after treatment. All people are monitored by our treatment staff for at least two hours following the administration of the nasal spray in our comfortable esketamine suite.

Side effects from esketamine typically resolve within the two-hour monitoring window after receiving the nasal spray. Esketamine is known to cause sedation and dissociation, including feeling as if one is outside of themselves (depersonalization) or that one’s surroundings are not real (derealization).

Perceptual changes can occur. People may see shapes and colors that are not there. Increased blood pressure may occur. In rare cases, esketamine can cause respiratory depression, or decreased drive to breathe. Esketamine also has the potential for misuse and abuse.

Like all antidepressants, esketamine may increase the risk of suicidal thoughts and behaviors in young people. It is important to note that people receiving esketamine cannot drive or operate heavy machinery until the following day. They are welcome to have a friend or family member stay with them during treatment.

Esketamine is generally administered twice weekly for the first four weeks of treatment. This is considered the induction phase of treatment. After induction, people will enter the maintenance phase, which generally requires once weekly esketamine treatment for the first month, and then treatment weekly or every other week thereafter.

While some people are able to stop esketamine treatment and maintain stability of their depression with oral agents and psychotherapy, others will require indefinite treatment with esketamine to maintain relief of their depressive symptoms.

If you or a loved one is suffering from treatment-resistant depression or depression with suicidality and interested in esketamine treatment, please give the Cruz Clinic a call at (734) 462-3210 or visit us on the web at www.cruzclinic.com. You will speak with our intake department, who will set you up with an appointment with one of our esketamine prescribers to review your history, the risks and benefits of esketamine treatment, and what to expect during treatment. Once you meet with your prescriber, treatment can begin. There is no need to suffer from treatment-resistant depression or depression with suicidality any longer.



Dr. Wedes is a board-certified Psychiatrist who specializes in General Adult Psychiatry. Conditions he commonly sees include depression, bipolar disorder, anxiety, ADHD, and schizophrenia, among others. He strives to create a safe environment free from judgment. Dr. Wedes graduated from the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and completed residency at University of Pittsburgh Medical Center. He has over 10 years of experience.