Addressing TRD: Finding the Right Esketamine Nasal Spray Dosage for You

If you’re one of the many struggling with treatment-resistant depression (TRD), esketamine nasal spray, known as Spravato®, might be the solution you’ve been seeking. 

Spravto is FDA-approved and targets your depression differently than traditional oral antidepressants. 

In the Atlanta, Georgia, area, Dr. Karen Giles and Dr. Cecilia Kwong at Breakthru Psychiatric Solutions have become leading authorities on TRD and its treatments, including Spravato. Here’s how they guide you to the right dosage and what to expect throughout the process.

Treatment-resistant depression

Depression has multiple causes and multiple potential treatments, so finding the right therapy can be a long, frustrating process. 

Persistent depression that seems impervious to traditional treatments affects more than 40% of people with depression. This is where esketamine comes into play, offering a new hope for relief.

What is esketamine?

Esketamine is a refined form of the anesthetic ketamine. Unlike traditional antidepressants that target serotonin, norepinephrine and dopamine, esketamine works by increasing glutamate — the brain’s most abundant chemical messenger — allowing it to impact multiple brain cells simultaneously. 

The result for many is rapid relief from depressive symptoms. Typical antidepressants can take weeks to show results, but esketamine can act within hours. 

To receive esketamine treatment, you need a prescription from a psychiatrist who specializes in TRD, like Dr. Giles and Dr. Kwong. 

Finding the right esketamine dosage

Determining the correct dosage of esketamine nasal spray is a personalized process. We carefully monitor and adjust your treatment to increase its success and decrease side effects.

1. Initial consultation 

We begin treatment with an assessment of your medical history, current medications, and depression symptoms, which helps us understand your unique needs and establish a baseline for your treatment.

2. Starting the treatment

You receive esketamine doses under medical supervision in our office’s controlled environment. The typical protocol involves two treatments per week for the first four weeks. 

Your first dose will be 56 mg. During subsequent sessions, we observe how you respond to the medication and may increase the dosage to 84 mg.

3. Monitoring progress 

After the initial phase (weeks 1-4), we usually decrease your treatment frequency to once a week for the next four weeks. Finally, we adjust treatment frequency based on response durability. We monitor your progress closely, looking for changes in your symptoms. Additionally, before every treatment, you will fill out rating scales for depression and anxiety. It’s important to tell us how you're feeling, so we can make informed dosage adjustments.

What to expect during esketamine treatment

During each session, you administer the nasal spray while you’re seated in a comfortable position. We monitor you for at least two hours post-treatment to ensure your safety and well-being. 

Short-term benefits

Many patients notice a marked improvement in their mood after just a few sessions; however, everyone’s experience is unique.

Long-term benefits

Some patients may achieve remission after just 12 treatments, but we may recommend ongoing maintenance sessions for lasting results.

Esketamine side effects

Like all medications, esketamine can cause side effects. While uncommon, these effects may serve a purpose in helping us pinpoint the correct dose for you.

The most common side effects are dissociation, nausea, dizziness, sedation, and increased blood pressure. These are usually temporary and diminish as your body adjusts to the medication. Staying hydrated, and resting afterward can minimize these effects.

Should you experience side effects or have concerns about your treatment, please call us immediately. 

Comparing esketamine to other TRD treatments

Esketamine is just one option for treating TRD. We offer various treatments depending on your unique circumstances. Here’s how esketamine compares.

IV ketamine therapy

Intravenous (IV) ketamine therapy is another treatment option for TRD. Both esketamine and IV ketamine deliver similar results, but they involve different administration and monitoring protocols. In addition, IV ketamine is not eligible for insurance coverage and Spravato is.

Transcranial magnetic stimulation (TMS)

TMS is a noninvasive treatment that uses magnetic fields to stimulate brain areas involved in mood regulation. It’s another option for TRD and does not require you to take an oral antidepressant in order to be effective.

Your role in finding the right esketamine dosage

Most of the responsibility for landing on the proper dosage of esketamine lies with Dr. Giles and Dr. Kwong, but you also play a role. For best results, you must:

• Come in for regular check-ups 
• Tell us how the medication makes you feel (keep a journal)
• Set achievable goals and realistic expectations for your treatment 

Finding the right treatment for TRD is a personal and sometimes challenging journey. If you’re considering Spravato, call Breakthru Psychiatric Solutions in Sandy Springs or Alpharetta, Georgia, or request an appointment online.