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Esketamine - Rosedale MD Clinic for Addiction

Esketamine, a derivative of the anesthetic ketamine, has gained attention as a treatment for major depressive disorder (MDD), especially in cases resistant to traditional antidepressants. Here’s an overview of esketamine, its uses, and its effects:

What is Esketamine?

Esketamine is the S-enantiomer of ketamine. While ketamine has been used as an anesthetic for decades, esketamine has been developed specifically for its antidepressant properties.

Mechanism of Action

Esketamine works differently from traditional antidepressants, which often target serotonin, norepinephrine, and dopamine. Instead, esketamine acts on the glutamate system, primarily as an NMDA receptor antagonist. This action is believed to help restore synaptic connections in brain areas involved in mood regulation.


  • Treatment-Resistant Depression (TRD): Esketamine is primarily used for adults with major depressive disorder who have not responded to at least two other antidepressant treatments.

  • Acute Suicidal Ideation: It has also been approved for rapid reduction of depressive symptoms in patients with acute suicidal ideation or behavior.


Esketamine is administered as a nasal spray under the supervision of a healthcare provider. The treatment involves:

  • Induction Phase: Twice-weekly doses for the first four weeks.

  • Maintenance Phase: Once-weekly doses from weeks five to nine, then bi-weekly or weekly thereafter.

Efficacy and Safety

  • Rapid Onset: One of the significant benefits of esketamine is its rapid onset of action, often within hours to days, compared to weeks for traditional antidepressants.

  • Side Effects: Common side effects include dizziness, dissociation, increased blood pressure, sedation, and nausea. Due to these potential effects, patients are monitored for at least two hours after administration.

Risks and Considerations

  • Abuse Potential: Like ketamine, esketamine has the potential for abuse and dependence, so it is used under strict medical supervision.

  • Cost and Accessibility: The treatment can be expensive and may not be covered by all insurance plans.

Clinical Studies and Approvals

Esketamine was approved by the FDA in March 2019 for treatment-resistant depression and later for acute suicidal ideation in adults. Clinical studies have demonstrated its efficacy, leading to significant improvements in depressive symptoms in many patients. For information about Esketamine treatment in Rosedale MD, please contact us today 443-559-8354


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