Esketamine Nasal Spray: Rapid Relief for TRD and Suicide Prevention-Mechanisms and Pharmacodynamics.
Neuropsychiatric disease and treatment January 1, 2024 Hui Song, Yang Luo, Lingzhi Fang
Esketamine nasal spray provides rapid relief for treatment-resistant depression (TRD) and helps prevent suicidal behavior. It works primarily by blocking NMDA receptors in the brain, with additional effects on AMPA receptors, opioid receptors, monoaminergic receptors, and inflammatory pathways, though the full synergistic mechanisms are not yet understood. Multiple randomized controlled trials show that esketamine reduces depressive symptoms within hours and maintains these benefits over several weeks, with a favorable safety profile and minimal side effects in long-term use. Its approval offers a new therapeutic option for patients with severe depression, impacting healthcare practices and policies.