PENN ESKETAMINE TREATMENT PROGRAM
The Esketamine Treatment Program at The University of Pennsylvania offers a non-invasive, outpatient-based form of therapy for Major Depression. Intranasal Esketamine is approved by the U.S. Food and Drug Administration (FDA) for the management of adult patients with treatment-resistant depression (patients who have not responded to adequate antidepressant trials).
Our department has been involved in clinical trials exploring the antidepressant effectiveness and clinical safety of Ketamine-like treatments including Intranasal Esketamine since 2012.
Esketamine is administered via a nasal spray device. Intranasal Esketamine has proven effective as an adjunctive treatment (in addition to medications) for depression, and it is approved by the U.S. Food and Drug Administration (FDA).
Intranasal Esketamine has a positive safety and tolerability profile. Bitter taste, nasal irritation, dissociation, nausea, and vertigo are the most commonly reported side effects. Somnolence and increase in blood pressure can also be present. Side effects from intranasal Esketamine are expected to be transient and usually resolve within 1.5 hours and do attenuate with repeated doses. At Penn all patients are observed for a minimum of 2 hours post Esketamine administration. Patients are observed for comfort and side effects and are monitored with objective measurements as well.
Initial Assessment
Patients are initially evaluated by a psychiatrist with expertise in mood disorders and interventional psychiatry. The initial assessment includes a diagnostic and treatment evaluation focusing on determining the appropriateness of Esketamine as the next step in your treatment, as well as its risks, benefits, and other available treatments for your condition. Patients are carefully screened for the presence of conditions or underlying risk factors (aneurismal vascular disease, arteriovenous malformation, history of intracranial hemorrhage, psychosis, substance use disorders, medications with potential interactions, and pregnancy / breastfeeding) that might make the use of Intranasal Esketamine clinically unsafe. If Esketamine is deemed to be safe and appropriate for your case, you will be scheduled to commence a course of Intranasal Esketamine treatment. Scheduling is contingent upon insurance approval / coverage.
Treatment with Intranasal Esketamine
Esketamine treatments are administered on an outpatient basis and last a minimum of 2 hours depending on the phase of treatment and recovery time. You will be instructed not to drive after treatment due to the potential for delayed sedation.
Esketamine is administered two times per week for up to four weeks initially. Patients are reassessed for clinical progress and need for dose optimization by an experienced psychiatrist. Additionally, patients are assessed for side effects and other changing conditions before each session.
If you do benefit from Esketamine, we will discuss with you how this improvement can be best sustained, including the possibility of intermittent maintenance Esketamine doses with a frequency that can range from 1 per week to 1 per month. The frequency of sessions can then be gradually tapered to discontinue treatment or to transition into maintenance treatment with optimized oral antidepressants if clinically feasible.
If no clinical benefit is achieved after an adequate trial of Esketamine, we will discuss other treatment options and suggest appropriate referrals or courses of action.
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