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Adult Psychiatry
Depression - Esketamine

Esketamine is a new type of antidepressant medication. Unlike traditional antidepressants, it targets the brain's glutaminergic system, stimulating the secretion of glutamate in brain neurons. This, in turn, increases the number and strength of connections between brain neurons in a short period of time. As the connections between brain neurons become more active than before, a person's mood and energy levels also improve.


Esketamine as an Option for Treatment-Resistant Depression

Depression is a complex disorder with various causes. Most treatments for depression are based on the monoamine hypothesis, which posits that the brain lacks serotonin and other neurotransmitters. By taking antidepressants to supplement these substances, depressive symptoms can be alleviated.


However, for some patients, depression remains difficult to treat. Some may try various antidepressants without finding relief, and residual depressive symptoms can significantly impact their lives and work performance, increasing the risk of relapse.

When facing treatment-resistant depression, psychiatrists often explore alternative approaches. They may choose different types of antidepressants, consider transcranial magnetic stimulation (TMS), or, in more severe cases, admit the patient for electroconvulsive therapy.

Esketamine is a novel antidepressant that differs from conventional medications. It targets the brain's glutaminergic system, stimulating glutamate secretion in neurons, which in turn rapidly enhances the number and strength of connections between brain neurons. As these connections become more active, an individual's mood and energy levels improve.

It is worth mentioning that Esketamine is chemically similar to ketamine, a substance often abused recreationally. Esketamine is the S-enantiomer of ketamine, and it has a higher affinity for the glutaminergic system, resulting in greater stimulation.

Some people may worry that Esketamine could lead to abuse issues similar to ketamine. However, Esketamine is not considered addictive, and according to clinical trial data, no patients exhibited abuse behavior or withdrawal symptoms after discontinuing treatment. During treatment, no one requested increased dosages or more frequent administration. Many ketamine abusers develop symptoms of cystitis, but no clinical trial participants experienced interstitial cystitis.

In conclusion, Esketamine offers a promising alternative for individuals suffering from treatment-resistant depression. While it shares similarities with ketamine, it does not carry the same risks of abuse or side effects, making it a viable option for patients who have not found relief with traditional antidepressants.

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Weighing the Pros and Cons of Esketamine: A Comprehensive Guide Before Deciding on Treatment


Esketamine, a novel glutamate-based medication, has emerged as a promising treatment option for patients with treatment-resistant depression. However, before choosing to undergo Esketamine therapy, it is crucial to understand the advantages and disadvantages of this treatment method.

Approved in the United States, Esketamine is used for treating treatment-resistant depression and alleviating acute suicidal thoughts in patients with depression. Generally, patients can experience the therapeutic effects of Esketamine within 24 hours, and over half of them achieve symptom remission within 28 days. Patients who undergo the entire Esketamine treatment course have a significantly reduced long-term relapse risk—by 70%—compared to those taking conventional antidepressants. Furthermore, more than half of the patients maintain remission one year after completing the treatment course.

However, there are some drawbacks to consider. According to current guidelines, users of Esketamine must also take conventional antidepressants, such as SSRIs or SNRIs. This does not mean that Esketamine's effectiveness is influenced by traditional antidepressants; rather, in past studies, patients prescribed Esketamine were also taking antidepressants simultaneously. Consequently, there is insufficient data to prove that Esketamine alone can effectively treat treatment-resistant depression.

Following Esketamine administration, some patients may experience side effects such as dizziness, nausea, headache, fatigue, vomiting, urinary symptoms, and reduced taste and sensation. However, these side effects typically last for a short duration. According to research, only 3.8% of patients discontinue treatment within 48 weeks due to these side effects.

It is essential to note that not all patients with depression are suitable for Esketamine treatment. If patients have had an allergic reaction to any component of the medication or have a history of aneurysm, brain hemorrhage, or heart attack within six weeks, doctors should not prescribe Esketamine. Additionally, we do not recommend using Esketamine during pregnancy.

Compared to conventional antidepressants, Esketamine treatment is more expensive. Patients also need to spend more time in the clinic to receive treatment. During the initial stages of treatment, patients require two sessions per week, with each session lasting two hours. This may pose a challenge for working individuals.

In conclusion, Esketamine presents a potentially effective alternative for those with treatment-resistant depression, but it's essential to weigh the pros and cons before committing to this treatment option.

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The Intriguing Process of Administering Esketamine: A Nasal Spray Treatment Followed by Psychotherapy

Esketamine is a unique antidepressant that distinguishes itself from other drugs in its class. Administered through a nasal spray device, healthcare professionals demonstrate the proper use of the nasal spray to patients before treatment begins.

Before using the nasal spray, patients should first wipe their noses and then lie down comfortably with their heads tilted back. With the device's tip inserted into one nostril, patients cover the other nostril with a finger and press the plunger of the nasal spray device upwards while simultaneously inhaling. After removing the device, patients should inhale gently to help retain the medication within the nasal cavity.

The procedure is repeated for the other nostril. After completing the process, healthcare professionals check the nasal spray device to ensure the medication has been fully administered. Patients must then rest for five minutes before using another device if required. The number of devices and dosage adjustments depend on the doctor's assessment of the patient's emotional state.

Following Esketamine administration, patients need to stay in the clinic for 1.5 to 2 hours. A relaxing and quiet environment is provided for them to rest, while healthcare professionals monitor their blood pressure regularly. If high blood pressure is detected, appropriate treatment is administered immediately.

As mentioned earlier, Esketamine is a glutamate-based medication that stimulates neurons to release glutamate, thereby rapidly increasing the number and strength of connections between brain neurons in a short period.

However, the formation of these neural connections requires proper guidance, much like pruning a bonsai tree during its growth to transform it into a piece of art. Approximately one hour after taking Esketamine, some doctors may provide patients with psychotherapy and counseling to fully harness the therapeutic effects of the medication.

In conclusion, the administration of Esketamine involves a unique process that combines nasal spray treatment with psychotherapy to effectively address treatment-resistant depression.

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