Intranasal esketamine: A novel drug for treatment-resistant depression

Am J Health Syst Pharm. 2020 Aug 20;77(17):1382-1388. doi: 10.1093/ajhp/zxaa191.


Purpose: To review the efficacy, safety, and place in therapy of intranasal esketamine, a treatment modality for treatment-resistant depression.

Summary: An electronic literature search of PubMed, MEDLINE, and the and Food and Drug Administration (FDA) websites covering the period April 2015 through June 2020 was performed using the following search terms: esketamine, intranasal esketamine, depression, and treatment-resistant depression. Other resources included review articles and the manufacturer's product labeling. All relevant English-language articles and reports on clinical trials conducted in humans were included. Esketamine (Spravato, Janssen Pharmaceuticals) is an intranasal antidepressant approved by FDA for management of treatment-resistant depression (TRD) in patients with inadequate response to traditional antidepressant therapy. Esketamine is self-administered under the supervision of a healthcare provider and is used as an adjunct to oral antidepressant therapy. Patients are supervised for 2 hours after self-administering the medication to monitor for sedation, dizziness, dissociation reactions, and increased blood pressure. Esketamine has a favorable risk-to-benefit profile, with demonstrated efficacy in reducing depressive symptoms more rapidly than monotherapy with traditional oral antidepressants. Reported adverse effects include sedation, dizziness, dissociation reactions, and blood pressure elevations, but these effects are primarily confined to the 2-hour postdose monitoring window.

Conclusion: Patients with moderate to severe depression who are not sufficiently responsive to traditional strategies for managing TRD may benefit from adjunctive esketamine therapy.

Keywords: administration; antidepressive agents; depressive disorder; esketamine; intranasal; treatment-resistant depression.

Publication types

  • Review

MeSH terms

  • Administration, Intranasal
  • Administration, Oral
  • Antidepressive Agents / administration & dosage*
  • Antidepressive Agents / adverse effects
  • Depressive Disorder, Treatment-Resistant / drug therapy*
  • Depressive Disorder, Treatment-Resistant / physiopathology
  • Drug Therapy, Combination
  • Humans
  • Ketamine / administration & dosage*
  • Ketamine / adverse effects
  • Severity of Illness Index


  • Antidepressive Agents
  • Esketamine
  • Ketamine