Esketamine is a drug that is derived from the anesthetic ketamine that has a long history of being used to treat depression. Esketamine is a more potent form of ketamine and is fairly new to the market as it became FDA-approved in March 2019.
Esketamine treatments come in the form of a nasal spray, which has a brand name called Spravato. The nasal spray is to be used with an oral antidepressant to treat more severe cases of depression that are categorized as treatment-resistant depression (TRD).
Like antidepressants, esketamine raises the levels of certain chemicals like dopamine, norepinephrine, and serotonin that occur naturally in the brain as neurotransmitters. However, esketamine is different than antidepressants as it increases the brain's most prevalent chemical messenger: glutamate levels. This results in a greater reach and more substantial impact on brain cells with a single dose compared to antidepressants.
Because esketamine is considered a controlled substance, it must be administered by specially trained medical personnel in a certified clinical setting. Most patients receive it as an outpatient and go home in a couple of hours.