Esketamine nasal-spray treatment

What esketamine is

Esketamine is a nasal spray, supplied under the brand name Spravato®, used alongside an oral antidepressant for adults with treatment-resistant depression — depression that has not responded adequately to previous antidepressant treatments.

It is not a first-line treatment, and it is not suitable for everyone. Whether it is appropriate for you is a clinical decision made after a specialist assessment that considers your diagnosis, previous treatments, physical health, current medicines, risks and treatment goals.

Esketamine is given in a clinical setting under supervision. It is not dispensed for use at home.

Who it may be considered for

An assessment will usually look at:

• your diagnosis, and whether depression is the primary problem;
• which antidepressants you have taken, at what dose and for how long;
• other treatments you have had, including psychological therapy;
• your physical health, including any conditions listed below;
• your current medicines, including anything bought without a prescription;
• your use of alcohol or other substances; and
• your circumstances, supports and treatment goals.

A referral does not guarantee that an assessment can be offered, and an assessment does not guarantee that treatment will be recommended.

Health conditions your team will ask about

Some medical conditions affect whether esketamine can be used safely, or mean that extra checks are needed first. Your psychiatrist will ask about:

• blood pressure, particularly high blood pressure
• heart and circulatory conditions
• liver conditions
• kidney or bladder problems
• glaucoma or other eye conditions
• head injury, concussion or neurological conditions
• chronic pain
• previous ketamine or esketamine use
• hallucinations or dissociation
• use of alcohol or other drugs

Please bring recent investigation results if you have them, and a current list of your medicines and doses.

The treatment pathway

1. Referral — your referrer sends the clinic the information set out below, by email to reception. See information for referrers for the submission details and privacy considerations.
2. Eligibility review — the treating team reviews the referral and advises whether an assessment can be offered.
3. Specialist assessment — a psychiatrist discusses your diagnosis, previous treatments, physical and mental health, possible benefits, risks and the alternatives to esketamine.
4. Treatment planning — if treatment is appropriate and you decide to go ahead, the clinic explains the schedule, costs, consent, transport and how to prepare.
5. Administration and monitoring — each dose is self-administered under supervision in a monitored clinical setting. You remain at the clinic afterwards for an observation period, during which your blood pressure and how you are feeling are checked.
6. Review and continuation — response, side effects and the ongoing plan are reviewed. Continuing treatment is not automatic, and treatment may be stopped if it is not helping or is not tolerated.

What treatment days involve

• Treatment sessions can take a couple of hours, most of which is the observation period after the dose. Monitoring continues until the treating team considers you clinically stable; please allow extra time if needed.
• You will be given instructions about food, drink and medicines beforehand. Please follow them exactly.
• You must not drive after a dose. Arrange for someone to take you home, or follow the clinic’s transport advice. You must not drive, operate machinery or do anything requiring full alertness until the next day following a restful sleep, and only when you feel completely normal.
• Common effects during and after a dose can include feeling detached or dizzy, nausea, and a temporary rise in blood pressure. Tell the team if anything concerns you.
• Bringing a support person to your first session is often helpful.

Working with your other doctors

Esketamine treatment sits alongside the rest of your care rather than replacing it. You continue with your prescribed antidepressant, and your GP and any other treating clinicians remain involved. With your consent, the clinic writes to your referrer about the assessment, the plan and your progress.

Information a referral should include

Referrers should provide, on practice letterhead:

• current psychiatric concerns and relevant history;
• diagnosis, and previous antidepressant treatments with doses and duration;
• other treatments tried, including psychological therapy;
• relevant medical history, covering the conditions listed above;
• current medicines, including doses, and any allergies;
• recent investigation results;
• current risks and supports; and
• the patient’s contact details and the referrer’s contact details.

What this page does not promise

• It does not confirm that you will be accepted for assessment or treatment.
• It does not promise a particular response, or that any benefit will last.
• It does not set out fees. See the fees page, or ask reception, before you commit to treatment.

If you are in crisis or your depression is worsening quickly, do not wait for an appointment — see our urgent support page, contact your GP, or call 000 in an emergency.