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FAQs

What is ketamine nasal spray?

Ketamine nasal spray, sometimes referred to as intranasal esketamine, is used as a nasal spray to treat patients with treatment-resistant depression (TRD) and major depressive disorder (MDD). The main type of ketamine used is SPRAVATO® (esketamine) CIII nasal spray, which is administered in combination with an oral antidepressant.

Why is ketamine nasal spray effective?

The full spectrum of ketamine’s antidepressant and antisuicidal effects have not been fully explained. However, we do know that this novel approach to therapy works with the brain’s NMDA receptors, which play a role in several neurological functions like memory, learning, movement and more. This is an alternative to SSRIs (Prozac, Paxil, Zoloft), which work with serotonin receptors.

We also know that ketamine affects other receptors and pathways in the brain, which creates a combination of positive effects that help combat depression.

Who is ketamine nasal spray for?

Ketamine nasal spray is used to treat patients with treatment-resistant depression (TRD) and major depressive disorder (MDD) who have chronic suicidal ideation and:

  • A defineddepression diagnosis
  • Have not found relief from at least 3 initial treatment therapies
  • Are seeking an alternative to electroconvulsive therapy (ECT)
  • Have well-controlled blood pressure
  • Can commit to biweekly visits with a support person for transportation
  • Have an established provider managing their care
  • Additional screening criteria

While no formalized definition of treatment-resistant depression currently exists, TRD is commonly defined as failure of depressive symptoms to respond to both psychological and psychopharmacological interventions such as therapy or antidepressants. TRD represents the highest direct and indirect medical costs among those with MDD. Individuals with TRD are twice as likely to be hospitalized among those with MDD and have an almost 14% lifetime risk of suicidal behavior compared to 10% for those with MDD.

Those who would not benefit from ketamine as a form of outpatient therapy and would instead be recommended for alternative nonketamine therapies include:

  • Patients with a known history of an aneurysmal vascular disease, arteriovenous malformations or intracranial hemorrhages.
  • Patients who have depression due to bipolar disorder, schizophrenia or other psychotic disorders.
  • Patients with active substance abuse (alcohol or drugs).
  • Patients with ketamine allergies or insensitivities.
  • Patients with uncontrolled hypertension due to ketamine’s blood pressure raising effects.
How do I safely use ketamine nasal spray?

Doctors will begin by assessing the patient, including vital signs, mood and response to previous treatment (if any). Patients will have their blood pressure checked to ensure a proper level since patients with high blood pressure are not eligible for ketamine therapy.

Patients will likely be asked to blow their nose and will then be reclined at a 45-degree angle. The patient is given the nasal spray and self-administers the drug by inhaling the spray in each nostril. After 5 minutes, a second dose will be administered, and then after another 5 minutes an optional third dose will be administered.

After the last dose is inhaled, the patient will be monitored and then periodically assessed for depression, suicidality, hallucinations, dissociation and physical symptoms. The doctor will also keep tabs on the patient’s blood pressure. After the 2-hour mark, the patient will be able to go home with the assistance of a driver if the doctor deems it safe.

For the first 8 weeks of treatment, there are 12 total sessions – twice weekly for the first 4 weeks, and then once weekly for the next 4 weeks. After the initial 8 weeks patients can receive treatment as often as once per week or as infrequently as once per month.

What is neural plasticity and how does it relate to Ketamine?

Neuroplasticity means that our brains can adapt. We can learn new things, strengthen areas of the brain that have been weakened and recover from injury.

Ketamine treatments are effective because of neuroplasticity. The goal of ketamine treatment is to change the negative consequences of neuroplasty that are a result of chemical imbalances, drug use or trauma. 

Clinical studies show that ketamine can enhance structural neuroplasticity and strengthen synaptic connections. Ketamine therapy has the potential to rewire the brain in a positive way by changing the brain’s circuit functions and prompting the restoration or growth of new synapses. 

Researchers have discovered that ketamine’s effect on the brain is a two step process: within hours circuit function is improved, then within a day new synapses begin to form. This is why ketamine has a near immediate effect on improving behavior as well as long-term benefits. The restoration of circuit function jump starts the process and the formation of new synapses keeps it going. 

Ketamine can block glutamate activity on certain neural receptors. This increases something called brain-derived neurotrophic factor (BDNF). BDNF is a protein that enhances neuroplasticity. And as you now know, improved neuroplasticity means it’s easier for the brain to adapt and change. 

The period during and just after ketamine treatment is when neuroplasticity is at its highest. This is a time when rewiring is possible. The patient and medication administrators should be very mindful about what is being experienced so that the brain is reprogrammed in the way that’s intended. When utilized correctly, ketamine can break the cycle of negative thought patterns, update your perception of reality and help you see reality more clearly. 

The connection between neuroplasticity and ketamine therapy has been one of the most exciting medical findings in the last 50 years. It’s helped neuroscientists better understand what influences mental health disorders and how to treat them, and we’re still learning more every day. 

Pros and Cons of Ketamine Therapy

PROS:

•  Rapid onset of action: Unlike traditional antidepressants, which can take weeks or even months to take effect, ketamine can provide relief from symptoms of depression and anxiety within hours of administration.

•  Effectiveness in treatment-resistant cases: Many people with depression and anxiety do not respond to traditional antidepressants, but research has shown that ketamine can be effective in these cases.

•  Low risk of addiction: Unlike some other medications used to treat mental health conditions, ketamine has a low risk of addiction and dependence.

•  Potential to help with other conditions: In addition to depression and anxiety, ketamine is being studied for its potential to help with conditions such as PTSD, OCD, and chronic pain.

CONS:

•  Lack of long-term safety data: While ketamine has been used safely as an anesthetic for decades, there is limited data on the long-term safety of using it to treat mental health conditions.

•  Risk of side effects: Common side effects of ketamine include confusion, hallucinations, and changes in blood pressure.

•  Risk of abuse: Ketamine is a schedule III controlled substance, and it has a potential for abuse and dependence, although this risk is considered low when used under medical supervision.

•  Limited availability and high cost: Ketamine is not yet FDA-approved for treating mental health conditions, and it is not widely available. The cost of treatment can also be high and may not be covered by insurance.

Is Ketamine Natural?

You may have heard of the recent excitement around ketamine. First synthesized in 1962 by Calvin L Stevens, ketamine is a schedule III non-narcotic first approved for use in 1970 as a dissociative anesthetic used in surgery for both human and veterinary medicine.

However, ketamine has seen a resurgence in popularity after discovering its potential as a therapy for pain and treatment resistant depression in 2000. Popular for its safety profile when compared to CNS depressants like opiates, this discovery has been described as “the single most important advance in the treatment of depression in more than 50 years”. Fast Forward 20 years and we’re now seeing ketamine clinics springing up across the globe offering safe and convenient walk-in/out-patient treatments for people with previously untreatable depression and pain.

Even more remarkable, a recent report shocked the psychedelic world: Long considered a human invention, ketamine has been isolated in a fungus known as Pochonia chlamydosporia.

Pochonia chlamydosporia is a microscopic fungus being investigated as a biopesticide for nematodes, or roundworms. It is believed that this fungus produces ketamine as a defense mechanism against helminths, a class of small parasitic worms that feed on fungi like Pochonia. This represents an example of biochemical warfare at the microscopic level.

The discovery of naturally occurring ketamine in organisms like P. chlamydosporia expands the potential for ketamine research. In recognition of this exciting development, Noonautics is initiating research to verify and further understand this groundbreaking discovery.1