Can Nasal Spray Esketamine Help Treatment-Resistant Depression?

What you need to know

• Intranasal esketamine is a newer treatment option for depression that hasn’t responded to at least two other antidepressants
• The study examines how this treatment works in real-world clinical settings across Canada
• Researchers will track both benefits and side effects to better understand its practical use

Understanding Treatment-Resistant Depression

Depression affects millions of people worldwide and is one of the leading causes of disability. While many people respond well to standard antidepressants, about one-third of patients have what’s called “treatment-resistant depression” - meaning they’ve tried multiple medications without adequate improvement. This can be incredibly frustrating and demoralizing for both patients and their healthcare providers.

What is Esketamine?

Esketamine is derived from ketamine, an anesthetic medication that has been used for decades. Scientists discovered that ketamine, in lower doses, can rapidly improve depression symptoms. Esketamine is a more targeted form of ketamine that’s delivered as a nasal spray. It works differently than traditional antidepressants by affecting a brain chemical system called glutamate, rather than serotonin or norepinephrine.

The Research Study

This study is being conducted across six major medical centers in Canada to understand how esketamine works in real-world clinical settings. Unlike tightly controlled clinical trials, this research examines the treatment as it’s actually used in regular medical practice. The researchers will track 60 patients with treatment-resistant depression who receive esketamine nasal spray twice weekly for four weeks.

What Will Be Measured

The researchers will look at several key factors:

• Changes in depression symptoms using a standardized rating scale
• Side effects and how well patients tolerate the treatment
• Whether patients develop any cravings or addiction-like responses
• How many patients complete the full treatment course
• Practical aspects of implementing this treatment in clinical settings

What This Means for You

If you or someone you know has depression that hasn’t responded well to standard treatments, intranasal esketamine may be worth discussing with your healthcare provider. However, there are some important considerations:

• The treatment requires regular clinic visits for supervised administration
• Insurance coverage varies and the medication can be expensive
• You’ll need monitoring for at least two hours after each dose
• Side effects like dissociation and increased blood pressure can occur
• It must be used alongside an oral antidepressant

Conclusions

• This research will help healthcare providers better understand how esketamine works in real-world settings
• The results could provide valuable information about who is most likely to benefit from this treatment
• The findings may also help improve access by demonstrating real-world effectiveness and safety