Finding the Right Dosage for the Esketamine Nasal Spray for Depression (Spravato)

Depression takes over your life, making it challenging to go to work and spend time with loved ones. It’s tough when you want to get better, but nothing works.

Esketamine, also known as Spravato®, is a new medication for people with treatment-resistant depression (TRD) and major depressive disorder (MDD) with thoughts of suicide. It’s a revolutionary treatment that relieves symptoms quickly and has lasting effects.

Our compassionate psychiatrist, Dr. Hina Sidhu, at Reviv Functional Medicine & TMS Wellness Center in Fullerton, California, understands the struggles people with depression face when they can’t get relief from their symptoms. That’s why we offer treatments like esketamine.

In this month’s blog, we want to explain how esketamine works and the steps involved in finding the correct dosage to get results.

About esketamine

Esketamine is a nasal spray drug FDA-approved for people with TRD and MDD with thoughts of suicide. It’s a new medication made from ketamine, an intravenous (IV) anesthetic that’s been shown to help quickly relieve depression symptoms.

Esketamine is more potent than ketamine, relieving symptoms at a lower dose. It’s also less invasive because it comes as a liquid you spray in the nose instead of an IV in the arm.

However, esketamine may cause the same side effects as ketamine, like dizziness, dissociation (out-of-body experience), and drowsiness, and it is only administered under medical supervision. So, you have to come to the office for treatment and observation.

Esketamine dosage for depression

Esketamine dosage for depression varies and depends on depression type, symptoms, and response to treatment. Dosages range from 28-84 milligrams. Finding the correct dosage usually takes about four weeks. We call this the induction phase.

We start esketamine at a low dose of 28-56 milligrams. During the induction phase, you come to the office twice a week for four weeks so we can monitor your symptoms and adjust your dose. 

Our goal is to get you on a dose that provides the best relief and the fewest side effects. Typically, most people get the best results on 56-84 milligrams of esketamine. 

Once on your maintenance dose (usually by week five), you come in once a week for treatment. As your symptoms continue to improve, we transition you to two treatments a month on the maintenance dose, usually around week 9.

What to expect

Esketamine is an outpatient treatment given under medical supervision. We provide instructions on how to prepare for treatment and guidance on what to expect after.

We recommend stopping eating two hours before esketamine administration and stopping drinking 30 minutes before. At the office, we give you the nasal spray, and you administer it yourself. You may need four or more sprays to get the right dosage.

You remain at the office for two hours for observation and must have someone drive you home after. Esketamine makes you drowsy, so you want to take it easy the rest of the day.

What happens after esketamine treatment

The length of esketamine treatment varies. You should notice improvements in symptoms quickly and may only need esketamine for a short period. However, you can continue the medication for several weeks or months.

You must take your prescribed antidepressants and attend therapy sessions to get the most benefits from esketamine. The medication works by increasing neurotransmitters in the brain that trigger the new neural connections (brain communication pathways) to relieve depression symptoms.

Are you struggling with severe depression? Have you tried multiple antidepressants but can’t get relief from your symptoms? Let us help. We offer many innovative treatments for depression beyond medications, like esketamine and transcranial magnetic stimulation (TMS) therapy.

Don’t let your depression run your life. Call our office today or book an appointment online to learn more about our treatment options.