Esketamine for treatment-resistant depression

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.

Study at a glance

Abstract

Generic name: Esketamine hydrochloride Brand name: Spravato Formulation: 28mg in 0.2ml nasal spray solution Market Authorisation holder: Janssen-Cilag International NV Indication: Treatment resistant major depressive disorder in adults who have failed to respond to at least two different antidepressants during the current moderate to severe episode. To be used in combination with a selective serotonin reuptake inhibitor (SSRI) or serotonin-noradrenaline reuptake inhibitor (SNRI). Dose: The starting dose is 56 mg for adults aged <65 years and 28 mg for adults aged ≥65 years 1 . Subsequent doses (56 mg or 84 mg for those <65 years; 28 mg, 56 mg or 84 mg for those ≥65 years) are given twice a week for 4 weeks, followed by once a week for 4 weeks, and then once a week or once every 2 weeks from week 9. Treatment is recommended for at least 6 months after symptoms improve. Cost: £163 for 28 mg (one device) Classification: Prescription only medicine (POM) subject to additional monitoring (▼). Controlled drug schedule 2.