Esketamine (Spravato)

Esketamine, also known as S-ketamine or (S)-ketamine, is the S-enantiomer of the racemic mixture of ketamine. It is a dissociative hallucinogen and belongs to the class of arylcyclohexylamines. Esketamine acts primarily as an N-methyl-D-aspartate (NMDA) receptor antagonist, which contributes to its antidepressant effects. Compared to its counterpart, R-ketamine, esketamine has a higher affinity for the NMDA receptor.

Esketamine is used as a fast-acting antidepressant, especially in treatment-resistant depression (TRD). In 2019, the U.S. Food and Drug Administration (FDA) approved an intranasal formulation of esketamine under the brand name Spravato for adults with TRD in conjunction with an oral antidepressant. This marked a significant advancement in the pharmacological management of depression, especially for patients unresponsive to conventional therapies.

Unlike traditional antidepressants, which often take several weeks to show clinical benefit, esketamine can lead to improvements in depressive symptoms within hours to days. Its mechanism of action is believed to involve modulation of glutamatergic neurotransmission and downstream effects that enhance synaptic plasticity and neurogenesis.

 Administration of Spravato is only allowed in certified healthcare settings where patients can be closely monitored after dosing. Call Zoe Psychiatry and Sleep Medicine today or book an appointment online to start your wellness journey.