With the introduction of intranasal esketamine for depression, we see an example of drug companies repurposing older drugs, including anesthetics and psychedelics to treat stubborn symptoms like MDD. Esketamine is only approved to treat patients who did not experience relief after at least 2 courses of treatment with “traditional” antidepressants.
As reported in the 2013 BMJ, a large share of people taking antidepressants do not benefit from drug-based therapy.21 This may have opened a large market share for novel treatments that are unproven, but profitable in the short term for their manufacturers. We know there’s a better approach.
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Spravato(c) is a brand name for generic esketamine, a drug in a nasal spray format, that is to be taken with an additional SSRI or SNRI drug and is prescribed to treat MDD (extreme depression) in adults. It is not approved for children, and is not recommended for elderly patients. Additionally, esketamine has a high potential risk for abuse and addiction, and long-term effects are unknown, according to recent clinical research.22,23
Ketamine is the parent drug. Ketamine’s structure looks like 2 mirror-image molecules, one of which is esketamine, and is the one used in Spravato. Injectable Ketamine is a rapid-action profound anesthetic used before surgery. In pill form, Ketamine has also become popularized as a recreational street drug. Ketamine in nasal spray form is not approved or recommended by the FDA for safety reasons. It cites concern over brain lesions in animal studies, and that it cannot regulate or approve compounded versions of drugs.1-9,11
The side effects of both esketamine and Ketamine are very similar. However, the guidelines for prescribing these 2 drugs are very different — the anesthetic Ketamine is injected only once pre-surgery, while esketamine is designed to be used intranasally, in a monitored setting, once or twice a week over a period of many months to treat MDD.
What are the Side Effects of Intranasal Esketamine?
A common side effect of intranasal esketamine for depression is mental impairment that requires the person not drive, or operate machinery for at least 24 hours after a dose it taken. Strict guidelines are in place that mandate the drug be given in a controlled lab with specially licensed caregivers in proximity to monitor and assist the person during administration and for some hours post treatment before the patient can be safely transported back home.3-8
Common side effects of intranasal esketamine can include:
suicidal thoughts and behaviors
seizures
death of brain cells
liver impairment, urinary & bladder problems
increased heart rate
hallucinations, visual disturbances
diminished consciousness
difficulty thinking clearly or remembering, confusion, disorientation
long-term cognitive impairment
elevated blood pressure
respiratory depression
nausea, vomiting
sudden or severe headache
visual disturbances
anxiety, feeling panic-stricken
irritability
sedation
disassociation
dizziness, vertigo
Other side effects which are less common, include
allergic reactions
difficulty breathing
difficulty swallowing
hives or rashes
swelling of the face, lips, tongue, throat
drop in blood pressure
Intranasal Esketamine and Pregnancy
Intranasal esketamine is not safe during pregnancy or breast-feeding as it may harm the baby. Avoid it during pregnancy, and at least 6 weeks before planning a pregnancy, or if you are of childbearing age and sexually active.3
Long-Term Results of Antidepressants
The most prominent type of treatment to address depression and other mental health symptoms is built on the idea of drugs that can, for some, reduce symptoms over the short term. But longer term transformation back to a healthy state is not built into the blueprint of psychiatric drug treatment.
A human being is more than a bag of chemicals. Drug trials in the main are extremely short, and results are often inconclusive, even when they aren’t skewed by vested interests or written by authors employed by drug companies.20 Viewing mental health in this short-sighted way is a formula for failure, as the statistics clearly show. Limited efficacy of drug-based treatment, coupled with the likelihood of withdrawal phenomena when the drug is stopped are sound reasons to consider treatments that do aim for transformative results, without inflicting harm to the patient.12-16
A glaring example of how generally limited drug trials are, out of thousands of drug trials one can study, not a single one has a word to say about what the participants’ diets were like, or whether nutritional deficits were present, checked for chronic sleep problems, toxic exposures, or other issues prior to treatment. These and many other factors are ALL of prime importance in getting a true picture of an individual’s health.19
A Note on Suicidality in Treating Depression
As a note, suicidality is associated with those suffering extreme psychological pain. Rather than a “wish to die,” the condition is often viewed as a means of escape from this unrelenting torment. Clinical trials have observed that something as mild as a supportive approach to the person, asking where the unbearable emotional pain comes from is an effective, yet often forgotten intervention. Compassionate psychological counseling can have a powerful role in treatment.9
Big pharma’s Interest in Repurposing Psychedelics and Experimental Drugs for Mental Health
Based on past performance and legal challenges from victims of dangerous psychiatric drugs, the most obvious driver for pharmaceutical drug companies appears to be making a profit, and avoiding bankruptcy if they can.
Hundreds of drug companies, both small and overpoweringly huge, went bust in recent years because their products were dangerous, and their marketing strategies were found to be intentionally misleading. In the case of nasal spray fentanyl, doctors were enticed with kickbacks, parties, and free lap dances to encourage them to prescribe to people who had no medical need for the drug.
The corrupt opioid market has been beaten back (a bit) by lawsuits and a somewhat more educated broad public. A growing awareness on the part of both doctors and patients has begun to take a second look at the drug industry as a whole.
The novel use of psychedelics such as intranasal ketamine for depression appears to be a desperate attempt to keep big pharma’s foothold on the precipice of staying in business. Sadly, there seems to be little to no interest, in any genuine sense, in the health of their customers.17
Known Factors Contributing to Psychiatric Symptoms
A growing body of research demonstrates there are multiple factors that can contribute to depression and other psychiatric symptoms. It may take time to evaluate a person’s unique history and current condition but this is needed to assess the most important of these to address, and to successfully resolve the problems.18
nutrition and diet
microbiome health
exposures to contaminants in water, air, food, chemicals from environmental sources
genetic factors
significant life events, i.e., exposure to hardship, trauma, loss
Alternative Treatments Offered at ATMC for Mental Wellness
Alternative to Meds Center uses an extremely broad range of drug-free treatments for recovery of mental health symptoms that have persisted despite standard (or experimental) drug treatment. Where a person has found intranasal esketamine treatment unsatisfactory, or multiple medications, and desires to safely withdraw from these, the center offers specialized treatment programs to address the process in an orderly, comfortable way.
Please take some time to review the services offered at the center, so you can see the extensive range of treatment components that are used in designing a comprehensive individual treatment program.
For More Information
If you would like more information on our programs, including insurance coverage, costs, length of stay with us, or any other questions please contact us directly. A well-informed professional will speak with you and answer your questions. We are here to help. Find true recovery without the need for experimental drugs like intranasal esketamine for depression that didn’t help you transform and enjoy renewed natural mental health without drugs.
19. Jakobsen JC, Gluud C, Kirsch I. Should antidepressants be used for major depressive disorder? BMJ Evid Based Med. 2020 Aug;25(4):130. doi: 10.1136/bmjebm-2019-111238. Epub 2019 Sep 25. PMID: 31554608; PMCID: PMC7418603. [cited 2024 June 18]
22. Baudot J, Soeiro T, Tambon M, Navarro N, Veyrac G, Mezaache S, Micallef J. Safety concerns on the abuse potential of esketamine: Multidimensional analysis of a new anti-depressive drug on the market. Fundam Clin Pharmacol. 2022 Jun;36(3):572-581. doi: 10.1111/fcp.12745. Epub 2021 Dec 23. PMID: 34907579. [cited 2024 June 19]
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.
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