Esketamine for treatment-resistant depression
Drug and Therapeutics Bulletin December 1, 2020 3 citations
Esketamine hydrochloride (Spravato) is a nasal spray for treatment-resistant major depressive disorder in adults who have not responded to at least two antidepressants. It is used alongside an SSRI or SNRI. Dosing varies by age: starting at 56 mg for those under 65 and 28 mg for those 65 and older, with subsequent doses given twice weekly for four weeks, then weekly for four weeks, then weekly or every two weeks. Treatment is recommended for at least six months after improvement. A 28 mg device costs £163. It is a prescription-only controlled medicine under additional monitoring.