Ketamine nasal spray is used to treat patients with treatment-resistant depression (TRD) and major depressive disorder (MDD) who have chronic suicidal ideation and:

• A defined depression diagnosis
• Have not found relief from at least 3 initial treatment therapies
• Are seeking an alternative to electroconvulsive therapy (ECT)
• Have well-controlled blood pressure
• Can commit to biweekly visits with a support person for transportation
• Have an established provider managing their care
• Additional screening criteria

While no formalized definition of treatment-resistant depression currently exists, TRD is commonly defined as failure of depressive symptoms to respond to both psychological and psychopharmacological interventions such as therapy or antidepressants. TRD represents the highest direct and indirect medical costs among those with MDD. Individuals with TRD are twice as likely to be hospitalized among those with MDD and have an almost 14% lifetime risk of suicidal behavior compared to 10% for those with MDD.

Those who would not benefit from ketamine as a form of outpatient therapy and would instead be recommended for alternative nonketamine therapies include:

• Patients who have depression due to bipolar disorder, schizophrenia or other psychotic disorders
• Patients with active substance abuse (alcohol or drugs)
• Patients with ketamine allergies or insensitivities
• Patients with uncontrolled hypertension due to ketamine’s blood pressure raising effects
• Patients with a known history of an aneurysmal vascular disease, arteriovenous malformations or intracranial hemorrhages

The full spectrum of ketamine’s antidepressant and antisuicidal effects have not been fully explained. However, we do know that this novel approach to therapy works with the brain’s NMDA receptors, which play a role in several neurological functions like memory, learning, movement and more. This is an alternative to SSRIs (Prozac, Paxil, Zoloft), which work with serotonin receptors.

We also know that ketamine affects other receptors and pathways in the brain, which creates a combination of positive effects that help combat depression.