SPRAVATOTM (esketamine) from the Janssen Pharmaceutical Companies of Johnson & Johnson has been approved by the FDA for the treatment of adults living with treatment-resistant depression as of March 4, 2019. Esketamine is the S(+) enantiomer of ketamine. Ketamine is the racemic mixture of ketamine, 50% S(+) and 50% R(-).
Klarity Clinic welcomes esketamine as a novel treatment modality which may provide numerous patients the relief they are desperately seeking. It will also likely be covered under certain insurance plans. We encourage patients to thoroughly research and consult with their mental health providers on whether they are a good candidate for esketamine.
Initial studies have shown that esketamine has a positive effect on 36-58% of treatment resistant depression patients. However, the positive changes do not seem to be as robust as intravenous ketamine therapy.
After analyzing preliminary information on esketamine, Klarity Clinic has identified a few potential drawbacks:
- It will likely be approved for in-office administration only.
- Is currently recommended to be given alongside a new oral antidepressant.
- A recommended 90-120 minute monitoring and observation time following administration.
- Questionable difficulty in obtaining insurance authorization.
- Likely high cost of the product. Those with high deductible insurance plans may reach their limit.
- Good but likely less robust effect on symptoms.
Despite these potential issues, Klarity Clinic still recommends patients seriously consider esketamine as another treatment alternative.
However, it is important to note that just because a patient fails or finds esketamine treatment minimally effective; it does not mean that they will fail intravenous ketamine therapy as our patients experience an over 90% success rate with greater reduction in symptoms. So if you have not had the success you desire with SPRAVATOTM, we encourage you to consider treatment at Klarity Clinic.
Klarity Clinic is analyzing whether esketamine will be incorporated into our practice whether as a stand-alone treatment or in conjunction with our infusion protocols.
Updates will be published in the future as more information on esketamine is released.