Pasithea

Esketamine Treatment

What is Esketamine (Spravato)?

In 2020 Medical and Healthcare Products Regulatory Agency (MHRA) in the UK approved Esketamine (Spravato®) as a medication that can be used in the treatment of patients who suffer from moderate to severe treatment-resistant depression.

SPRAVATO® is the brand name of an esketamine nasal spray, which is now available at Pasithea Clinics. Esketamine is a Schedule III controlled substance (CIII) and is used, in conjunction with an oral antidepressant, to treat adults with treatment-resistant depression. The decision to prescribe esketamine is determined by a clinical psychiatrist, and patients wishing to access this treatment must be under the care of a Pasithea clinics physician, for the duration of treatment.

As a result of Esketamine (Spravato®) being MHRA-approved, insurance companies are beginning to cover this treatment.

How does Esketamine treatment work?

Esketamine, like Ketamine, has the potential to distort your perception during the first two hours after treatment, so it must be administered in a clinic setting. This is done on an outpatient basis.Treatment is self-administered and you will be taught by our specialist nurse how to self-administer the nasal spray to achieve the best results.

With the nasal spray, you give yourself three doses, spaced five minutes apart, under doctor supervision. You remain in the clinic under doctor observation until potential side effects have passed.

Esketamine must be used in conjunction with a conventional antidepressant. There are two different types of anti-depressant which Esketamine can be used with: SSRIs and SNRIs. Common examples of these type of drugs include Sertraline and Duloxetine. The intention is that Esketamine provides rapid relief from depression symptoms until the other medication takes effect. This is one of the reasons it is known as a fast-acting anti-depressant.

How does Esketamine treat depression?

Esketamine, and its related drug, Ketamine, are highly effective depression treatments for a number of reasons:

Esketamine’s antidepressant function works through a different mechanism than other drugs. Conventional antidepressants work by increasing levels of naturally occurring chemicals such as serotonin, norepinephrine and dopamine. These chemicals are messengers that relay communication between brain cells. The theory is that having greater quantities of these neurotransmitters allows for better communication between brain cells and positively affects mood.

Esketamine works in a similar fashion, but unlike other antidepressants its mechanism of action increases levels of glutamate, the most abundant chemical messenger in the brain. The result? A greater impact on more brain cells at one time.

Common antidepressants are slow-acting. It often takes several weeks to make a noticeable difference in how people with depression feel, says Kaplin. On the other hand, esketamine immediately impacts brain cells, offering relief from depressive symptoms within hours.

Up to 33% of people with depression don’t respond to multiple kinds of conventional antidepressants. This is the percentage of people who would be defined as ‘treatment-resistant’. Esketamine is proven to reduce depression symptoms in a majority of these people in clinical trials.

The only other approved drug therapy for treatment-resistant depression is a combination of Olanzapine (an antipsychotic drug) and Fluoxetine (a conventional antidepressant). However, this treatment has significant long-term effects that include substantial weight gain, metabolic changes, diabetes and high blood pressure.

Research suggests that untreated depression causes long-term brain damage and is a risk factor for dementia. Studies show that people with depression have up to 20% shrinkage of the hippocampus, a region of the brain critical for memory and learning. But Esketamine may counteract the harmful effects of depression.

Animal studies indicate that connections between brain cells diminish under chronic stress, but Esketamine reverses these stress-related changes. Esketamine is different from any other

antidepressant in that it not only prevents the neurotoxic effects of depression on the brain, but it also seems to have a growth-promoting effect

Who is eligible for Esketamine treatment?

To be eligible for esketamine treatment at Pasithea Clinics, patients must meet the following criteria:

· Be currently suffering from treatment-resistant depression

· Have tried at least two different types of antidepressants for at least six weeks each

· Be at least 18-years of age or above

However, the decision to prescribe esketamine is determined by a consultant psychiatrist and may depend on different factors.

What are the side effects?

Like all medicines, esketamine can cause side effects, although not everybody experiences them. Listed below are some common side effects of esketamine (SPRAVATO®). Please note the list of side effects below is not exhaustive.

· Disassociation, which means feeling disconnected from yourself, your thoughts, feelings and things around you

· Feeling dizzy

· Headaches

· Change in sense of taste

· Feeling sleepy

· Decreased feeling or sensitivity, including around the mouth area

· Spinning sensation

· Nausea

Serious side effects include: Increased risk of suicidal thoughts and behaviour, increased blood pressure, problems with thinking clearly and bladder problems. If patients have concerns about side effects before, during or after their experience with SPRAVATO®, these should be

discussed with the treating consultant psychiatrist or the health care professional leading your session.

Mode of Administration treatment length

Esketamine is taken by a nasal (nose) spray device

The treatment must be administered in our clinic under supervision of one of our trained clinicians.

Your consultant psychiatrist at Pasithea will decide how many nasal sprays you need per treatment session and how often you should have a session.

The recommended dose regimen is shown below:

Recommended dosing for Spravato in adults <65 years with treatment-resistant Major Depressive Disorder

Induction Phase

Weeks 1-4

Starting day 1 dose: 56 mg,
Subsequent doses: 56 mg or 84 mg twice a week

Maintenance Phase

Weeks 5-8

56 mg or 84 mg once weekly

From Week 9

56 mg or 84 mg every 2 weeks or once weekly

What is the cost of Esketamine treatment?

For more information about our pricing structure for Esketamine/Spravato treatment please contact us at info@pasitheaclinics.co.uk