Overcoming the myths of esketamine administration: different and not difficult

Summary

Intranasal esketamine, approved in 2019 and 2020 for treatment-resistant depression, helps more than half of non-responders after 2–4 failed antidepressant attempts. Guidelines recommend starting it as an add-on therapy in a medical setting for dose selection, monitoring, and managing adverse events. Long-term treatment is safe, with very rare severe side effects. This review critically evaluates published articles on preparation, management, and observation of the treatment, noting that psychiatrists face new but manageable procedures compared to standard prescribing.

Study at a glance

Abstract

Intranasal esketamine for treatment-resistant depression has been introduced and approved by the FDA and EMA in 2019 and 2020, respectively. Since then, the administration practices were found different among countries. Major depression has a high impact on many humans lives worldwide and more than a third of treated people are not responding after several treatment attempts. Additional administration with esketamine closed this gap for more than the half of these non-responders. Guidelines for the treatment of major depression recommend starting with add-on esketamine after 2–4 serious attempts of treatment with standard antidepressants (SSRI/SNRI) irrespective of augmentation with others, e.g., second generation antipsychotics or lithium. Thus, intranasal esketamine became an important role in the evidence-based treatment of major depression. The authors review and critically evaluated published articles focusing on preparation, management and observation of intranasal esketamine treatment. There exists a clear recommendation for administrating intranasal esketamine in a medical environment, not limited to a clinical setting for selecting the dose, monitoring the improvements and managing adverse events. The administration of intranasal esketamine is considered as safe during the application itself and long-lasting or severe adverse events during long-term treatment are very rare. Since this is a new approach for treatment application psychiatrists face new different but not difficult treatment procedures compared to prescribing only a medication.