• By Deborah Balzer

Mayo Clinic Minute: How esketamine can help severe depression

May 7, 2019

Millions of people struggle with clinical depression. The Food and Drug Administration recently approved a medication to help those suffering with this serious mental health issue. Unlike other antidepressants, Dr. Jennifer Vande Voort, a Mayo Clinic psychiatrist, says it can work very quickly to relieve hard-to-treat depression.

Watch: The Mayo Clinic Minute

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Esketamine, a version of the drug ketamine, has been approved for treatment-resistant depression.

"Ketamine is a mixture of two enantiomers of a drug, meaning that it has two molecules in it. Esketamine is one molecule of the drug ketamine," says Dr. Vande Voort.

These drugs are unlike other antidepressants.

"They provide a rapid-acting antidepressant response, and they also have anti-suicidal properties."

How does esketamine work?

"Esketamine is working on the glutamatergic system, and that's thought to create synapses in the brain. When we have depression, sometimes we don't have as many connections or synapses within the brain cells, so those synapses go away. Esketamine is thought to create these synapses, or connections, between our brain cells again."

Esketamine is prescribed as a nasal spray that must be administered in a clinical setting. And it's not for everyone.

"They have to fail two antidepressant trials at adequate dosages and durations to meet criteria to be considered for esketamine."

Dr. Vande Voort says for the right people, there is great promise with esketamine.

"If we can get something into somebody's system and have it work quickly then maybe we can avoid some of the suicide attempts."

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