FDA Approves Esketamine Nasal Spray For Hard-To-Treat Depression There is no " Panacea for the pain" of long-standing depression which is severe, often with suicidal thoughts and attempts. However, the newly approved nasal spray, brand name Spravato, ( J&J) is the most revolutionary medication treatment in my lifetime, and there are great hopes that it will help many people with drug- resistant and psychotherapy resistant depression. So, how does this work? Ketamine and J&J's version of the closely related Esketamine work differently than any other anti-depressant ever approved for use. The drug targets a chemical called glutamate that is thought to restore brain connections that help relieve depression. Only certain psychiatrists with special certification in the administration and monitoring will be allowed to prescribe the nasal spray, and the drug can only be used in the presence and supervision of the physician in the office or in-patient setting, whichever is appropriate for the individual client. We have needed something which " breaks the chain" of depressive thoughts, and electroconvulsive therapy has been all there was which acts to do so. Some people are not candidates for ECT due to age, the anesthesia which must be given, and the side effects of memory loss, which may be severe in some people, even with the newer lower settings. Also, many people refuse to participate because of the old horror stories, and I understand why. IF this drug, Esketamine, or a similar form of Ketamine is used correctly and IF the psychiatrists who are trained to both oversee the patient administration of the nasal spray ( or IV infusion for Ketamine) and stay with them as it works, I believe this could be a " magic bullet" for many people to end the downward spiraling of deadly suicidal thoughts, plans and attempts. It's also being given to those who have had multiple hospitalizations for treatment of major depression which doesn't respond to the current anti-depreesants available. Some doctors have been prescribing Ketamine off label for severe, resistant depression for a few years. The problems, when they occurred, were related to monitoring and the fact that dosages administered were not standardized for safety. By safety, I mean that Ketamine can have transient, short-lasting disorientation and sometimes, a short " out of body" feeling. We see this same thing with most other drugs which are routinely used as preoperative sedative medications, but in higher doses. It is NOT believed that the very low dose nasal spray will induce any of the disorientation or depersonalization effects when patients are screened for suitability of treatment. How Spravato will be given: Each therapeutic dose of nasal spry are usually given every 2 weeks in a psychiatrist's office who has the certification obtained through training to monitor and support clients during the drug's psychoactive period. It is a very short- acting drug, but because there is a potential for abuse and short unpleasant side effects in some people, I don't see how it could be self- administered. Ketamine is mostly used IV as part of the sedation meds. given in the pre-op holding area by the anesthesiologist prior to surgery under general anesthesia, and is generally well- tolerated. It can produce some mild hallucinogenic effects, but usually not at the recommended therapeutic dose. Large syringes of Ketamine were developed and used originally as horse sedatives in vet practice. In the 1990's, the drug was diverted/ misused for a time as " Special K" at rave parties, but isn't thought to be widely used illegally at present. The only downsides I've recognized in professional literature about the clinical trials are the cost of the nasal spray, around $500 per nasal spray bottle, and the strict supervision needed to prevent a slightly groggy or disorientated client from leaving the office setting too early post- treatment. From what I've read, this is a very fast acting medication in that relief from depression is quick. It doesn't take months like the current SSRIs and SNRIs take ( if they work at all). The difference in the clinical trials are so promising and the results in those receiving the drug and not a placebo are extremely positive. The amount needed in 2 week or so intervals will vary from person to person, but at present, severe chronic depression is being relieved in a matter of weeks in the study clients. Whether or not it will return is not known, but it's widely thought that once the circuit breaker of depression and suicidal thoughts is broken, it stays broken and brain chemical functioning is normal. Likely, mental health visits to monitor mood levels will be a part of the long-term treatment plan. Probably most of us have lost someone we loved to suicidal depression. I lost my best friend, a psychiatrist I was friends with and worked with, when we were both 31 years old. I believe he'd definitely have tried Spravato, had it been available to him with a psychiatrist certified in the use and monitoring. I'd have strongly encouraged him to try it for the recommended time in the absence of an adverse reaction. In the clinical setting, I've seen the pain of deep depression and also the devastation of suicide- more times than I want to remember. There's simply no way to put a price on the value of restoring a normal mood in the many cases of people who are suicidal. Great hope is riding on this new drug therapy for those with chronic, severe depression. If anyone reading here or someone you know has deep depression with suicidal thoughts or attempts, I hope with all my heart that either this first formulation of Esketamine, the Spravato low- dose nasal spray, or subsequent forms will help you and a qualified treatment team save your life by eradicating the depression, and restoring a normal life.