Esketamine and ketamine
There are insufficient data to recommend the routine use of esketamine or ketamine for treatment-resistant major depression; the use and prescription of these drugs should only be considered by a psychiatristCommittee for Evidence-Based Practice 2022.
Intravenous and subcutaneousLoo 2023 ketamine can significantly and rapidly decrease depressive symptoms in patients with treatment-resistant major depression; however, the optimal dosage and duration of therapy is unknown. At the time of writing, ketamine is not approved by the Australian Therapeutic Goods Administration (TGA) for this indication1, and its prescription is subject to local state and territory regulations.
Esketamine is a racemic isomer of ketamine that, when given intranasally, has demonstrated efficacy as an adjunct to oral antidepressant therapy for treatment-resistant major depressionBoudieu 2023Malhi 2021McIntyre 2021Wajs 2020Zheng 2020Seshadri 2024. Because of the risk of nonmedical use and transient adverse events (eg hypertension, sedation, confusion, dissociation), intranasal esketamine must be administered under the direct supervision of a healthcare professional. Post-dose monitoring is also required. Supervised administration of intranasal esketamine occurs only at registered specialist sites.