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Esketamine Nasal Spray Is A Newly Approved Solution for Treatment-Resistant Depression

Esketamine Nasal Spray Is A Newly Approved Solution for Treatment-Resistant Depression

Anxiety and depression disorders are the most common mental illnesses in the US. They are affecting over 40 million adults with the age of 18 and older every year.  Despite the fact that anxiety disorders are highly treatable, less than half of those suffering receive treatment. Specialists suggest that depression and anxiety could develop from a complex set of risk factors. Genetics, brain chemistry, personality, and unfortunate life events can all trigger depression to occur. The prevalence of depressive episodes was higher among adult females compared to males. There are several differences in the manner in which the depressed moods manifest based on age and sex. Depression in men usually manifests in tiredness, irritability, and anger. On the other hand, specialists have noticed that women’s depressed moods evolve in sadness, worthlessness, and guilt.

Treatment-Resistant Depression

The most popular theory that aims to explain the development of depression in individuals is based on the fact that it may be caused by low brain levels such as neurotransmitters. Serotonin and norepinephrine are the neurotransmitters which are associated by the brain with the feelings of happiness and wellbeing. Yet, recent studies show that the neurotransmitters may not be the only cause of it. This suggested specialists that antidepressants which aim to increase serotonin and norepinephrine levels may not be a treatment that works for every individual suffering from depression. As traditional antidepressants only affect neurotransmitters, it may be the reason why some patients do not respond positively to them.

Treatment-resistant depression is a challenge to the field of clinical psychiatry.  Almost half of the individuals who suffer from major depressive disorder experience treatment resistance.  It is often linked with suicidal ideation and suicide attempts. The current antidepressant treatments play an invaluable role as they fail to relieve the symptoms of depression. Those individuals struggling with major depressive disorder which is treatment resistant do not respond to treatments. This condition makes them battle with persistent feelings of sadness, sleep disturbances, low energy, and, eventually, deep thoughts of death and suicide.

Specialists cannot provide exact data to explain why some individuals experience treatment-resistant disorder and others do not. However, they have observed that women and senior citizens are struggling with TRD at higher rates. The reasons behind the vulnerability to antidepressant treatments can stand behind biological and psychological factors, as well as the overall health which can also play a major role in it.

Rapidly-Acting Treatments

The National Institute of Mental Health has funded a research project which promotes the development of quicker and innovative therapies for treatment-resistant depression. Specialists have noticed that current existing antidepressant medications usually take up to a few weeks to reduce the symptoms of depression and suicidality in patients. Moreover, some patients suffer from major depressive disorder which does not fully responds to the existing treatments. Trouble is that severe depression can become life-threatening if not treated. Usually, the patients who suffer from it start developing suicidal thoughts which resulted in several suicidal attempts.  Recent studies show worrying results that estimate that over 50 percent of individuals in the US who die by suicide suffer from major depression. Although the best way to prevent suicide is the early detection and treatment of depression, some patients diagnosed with depression do not respond positively to the current existing treatments.

The urgent need for faster and more efficient antidepressant treatment has made researchers consider ketamine as a viable solution for individuals who suffer from treatment-resistant major depressive disorder. The drug has been proved to have a significant positive effect in reducing the symptoms of depression within hours.

What Is Esketamine?

Ketamine is a drug which has hallucinogenic effects and is used illegally. It is a short-acting drug which induces euphoria, sustained pain relief, and sedation mixed with powerful hallucinogenic effects. Yet, although ketamine and esketamine are perceived to be practically the same thing, they work differently especially due to the way they are administered. Both ketamine and esketamine aim to bump up levels of feel-good brain chemicals called serotonin. Yet, esketamine targets glutamate which is a neurotransmitter that sends messages across the brain.  Various clinical trials have proven that esketamine is up to ten times more effective than any current antidepressant treatment currently existing.

The side-effects of Spravato nasal spray

Before approval, the intranasal esketamine was tested several times and has proved to be generally well tolerated. Yet, due to the risk of various adverse outcomes and the potential abuse or misuse of the drug, the newly approved esketamine nasal spray is only available through a restricted distribution.  There are a few common side-effects experienced by the patients who were part of the controlled clinical trials and treated with Spravato. The most common side-effects were including disassociation, dizziness, vomiting, nausea, lethargy, and increased blood pressure. All patients were constantly monitored during the clinical trials and the treatment with the esketamine nasal spray were either interrupted or reduced depending on the side-effects experienced by the patients. Yet, the long-term safety study conducted by the specialists has shown that Spravato nasal spray was generally well tolerated by the patients.

Although electroconvulsive therapy (ECT) was proven to be a faster acting antidepressant method, it comes with several risks of cognitive side-effects. That is why researchers have made significant efforts to discover a better solution to help individuals struggling with treatment-resistant depression. After a long-standing need for additional and more efficient treatments for treatment-resistant depression, The U.S Food and Drug Administration has approved Spravato, the esketamine nasal spray. FDA has conducted several controlled clinical trials to determine the efficacy and safety of this drug. Due to safety concerns, the drug will only be available through a restricted distribution system as it must be administrated in a certified medical environment where the patient can be monitored. Yet, it is a promising solution for patients who were struggling with major depressive disorder episodes.

The newly approved esketamine intranasal spray has rapid effects on reducing the symptoms of major depressive disorder. Usually, within 24 to 48 hours, the symptoms of depression are reduced in patients. These rapid effects of Spravato are a promising solution for helping patients at high risk of committing suicide or self-harm.

If you or a loved one is suffering from any form of addition or depression then take the first step and seek help, call us on 0203 955 7700 where one of our experts can point you in the right direction.

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Dipesh Pattni / 21st March 2019/ Posted in: Latest News

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Detoxification (detox) is the medical intervention required for someone who is physically dependent to drugs or alcohol. If required, medical detoxification would be the first step taken in residential rehab. Detox is used to prevent uncomfortable and dangerous (even fatal) withdrawals symptoms resulting in suddenly becoming abstinent from alcohol/certain drugs.

The goal of a medical detox is to aid in the physical healing required following long term addiction and rid the body of all together of substance whilst providing a cushion for unpleasant symptoms of withdrawals. Detox is not considered the whole treatment for drug/alcohol addiction and it is always recommended that a comprehensive rehabilitation program is used along side to help maintain long term abstinence.

Medication is often required for alcohol detox. If you are dependent on alcohol and experiencing withdrawal symptoms it is vitally important to seek medical advice prior to stopping. There is a long list of medications used when treating alcohol addiction and the exact medication given to an individual will depend on their needs/medical history. Some of these include;

  • Chlordiazepoxide (Librium)
  • Lorazepam (Ativan)
  • Diazapam (vailium)


Librium and Valium are the most commonly used detox medication in the UK. All medication used to help with alcohol detox have been proven to help reduce the effects of withdrawal symptoms.

There are also a number of drugs recombined by the NHS to help treat alcohol misuse. Some of these include:

  • Naltrexone
  • Disulfiram (Antabuse)
  • Nalmefene
  • Acamprosate (campral)

Medication is always required for heroin detox. For someone suffering from heroin addiction, the thought of detoxification (detox) can be exceptionally daunting. Withdrawal symptoms from opiates, such as heroin, can be severe and include pain, vomiting, nausea and shaking.

There are different ways that heroin detox can be carried out, most usually either ‘maintenance therapy’ or ‘full medical detox’.

Attempting to switch from heroin to a heroin substitute, usually on a controlled prescription, is known as Maintenance therapy. Subsites used are most often methadone or buprenorphine.

A full medical detox from heroin will always be carried out in a residential rehab setting and will allow the individual to switch form heroin to a substitute and slowly withdraw completing treatment free of all substances. Someone using a heroin substitute can choose to have a full medical detox at any time, however detoxing substances such a methadone can often add to the length of detox required. Drugs most commonly used to fully detox from heroin are, Subutex, Suboxone and Methadone. Much like alcohol, the exact drugs used will be dependent on the individuals needs/medical history.

Once detoxed from heroin the risk of overdose is much higher following relapse due to tolerance following withdrawal.

The length of treatment in a residential rehab depends on a number of elements. Some substances require longer periods of detox than others.

Private paying patients will also often choose a length of stay that suites their therapeutic and financial needs. As a rule, a full treatment program in a rehab is considered to be 28 days (often referred to as a month), however, treatment is offered in several different ways and lengths starting at 7 days.

Treating alcohol addiction will always require a minimum of 7-10 days, this would be considered the detoxification (detox) faze. The length required for treating drug addiction can vary drastically depending on the substance being used. Detox for Heroin addiction is generally around 14 days minimum, with more time required if substances such a methadone are being used. Treating prescription drug addiction can often take the longest. The time required for treating gambling addiction, eating disorders and sex addiction will be based on the individuals needs.

Rehab programs can be as long as an individual requires but primary treatment is normally caped at 12 weeks, with the offering for further secondary and tertiary treatment thereafter.

*based on average rehab stays, everyone will vary dependant on needs and medical requirement/history.

There is no need for your employer to know that you are seeking help for trauma and addiction unless you choose to involve them with the process. All employers should have a policy that explains what you do if you cannot come to work due to illness – illness to include treating alcohol addiction/treating drug addiction.

If your work absence extends over 7 days your employer is likely to require an official statement of fitness to work which would be obtained from your GP. This would need to supply evidence of your illness as well as any adjustments required for returning to work, fazed return or reduced hours, but does not need to specify in detail the reason why you have been absent.

If you are absent from work for 7 days of less, for example entering rehab for a detoxification (detox) on a Saturday for 7-10 days taking a full week away from work, you can self-certify your illness by letting your employer work you will not be attending work for that period of time. Exactly how an individual would do this would be dependent on a specific companies’ policies on taking sick leave.

Any time longer than 7 days it is likely an employer will require a note from the individuals GP certifying their sickness and a fit note on return. Most companies have a clearly outlined policy on sickness and receiving sick pay so the exact requirement can vary. A rehab will always be willing to advise on time off work.

How much does rehab cost is a very frequently asked question. The cost of treatment can range from £1,000 per week upwards depending on the place, with luxury rehab being the most expensive.

There are free options available on the NHS but the waitlist of those looking for free treatment is longer than that for privately paying patients. Some private health insurance policies will cover treatment in some rehabs around the country.

Choosing the right rehab centre will often be based on priced but it is important to follow guidance on the most suitable treatment centre for an individual’s needs which our expert team of advisers are on hand to offer.

There are certainly pro’s for both treatment near by and traveling for treatment with one of the most asked question being should I get rehab near me? There are rehabs all over the UK and around the world that all offer expert programs, let’s look at how to choose a rehab.

Local treatment

Being close to home gives certainly has benefits. Visitors are normally permitted in rehab following the first 7 days stay, therefore if an individual is in treatment for a length of time longer than that being local will make it easier for loved ones to visit.

Most rehab centres will also provide a full aftercare plan for someone following treatment, this will include ongoing aftercare in the specific treatment centre. Living close by can make it easy to take full advantage of ongoing aftercare. There can also often be the option for ongoing care with an individual therapist, again being close by will allow that treatment to be carried out face to face.

Some individuals wish to be local but are willing to look broader, for instance the greater city of residence (London, Manchester, Liverpool, etc)

Treatment Away

Getting treatment away from home can be very appealing to some. Being out of the local area makes it a lot harder to just walk out of treatment as resources locally are unknown. Some also take comfort in knowing that they are not near home and focus more on treatment.

As the price for treatment can vary so much from one residential treatment centre to another, private paying patients often would rather travel to keep the cost down. Those using private health insurance may also have to travel to find a treatment centre covered in their policy.

When opting for treatment away from home this can be anywhere in the UK and also abroad. Aftercare can still be carried out and very successful using tools such as The Online Rehab.

There is no right or wrong when choosing where to go to residential rehab, but our expert advisors are always on hand to help provide information on all possible options.

Whilst millions of people in the UK have taken recreational drugs (amphetamine, cannabis, cocaine, crack, crystal meth, GHB, heron, ketamine, methadone, and prescription drugs) and drank alcohol not all become ‘addicted’. Most recent reports show that 279,793 individuals were in contact with drug and alcohol misuse services in the last year with over half of that being from opiate addiction and a quarter for alcohol.

There are several risk factors invoiced in addiction and those using drugs and alcohol socially, simply take the risk. These risks are as follows;

Tolerance – basically, if a substance is used repeatedly an individual’s tolerance to it will build. This will result in more of the same substance being required to get the same effect. In the long run this can easily lead to addiction and physical dependencies.

Environmental risks – these can include influences such a peer pressure and stress as well as physical or mental abuse of an individual (particularly as a child). Overall, those who live with frequent pressures and stress are more likely to reach for a substance to cope and are therefore at higher risk of becoming addicted.

Drug type – it is very well known that certain drugs are simply more addictive than others. Using substances such as heroin increases the risk of becoming addicted for need to ‘chase’ a high as well as physical dependency.

Drug administration – how a drug is administered can affect its addictive qualities. A drug injected rather than smoked or snorted will release a quicker and more intense high thus making it psychologically (and in many cases physically) more addictive.

Biological factors – it is now widely reported that being an addict is not only psychological but also biological. This includes your genetic makeup, mental health, sex and age. It is also reported to be 8 times more likely for the child of an addict to become an addict themselves.

Its believed that addiction is approximately half genetics and therefore some are 50% more likely to become addicted than others.

How do you help a loved one trapped in addiction?

The first step is to help and encourage the individual to become willing to accept help. They do not need to be shouting this off the rooftops, but they do need to be willing to go into treatment. There are ways to help someone become willing to get treatment for alcohol or treatment for drugs.

Set boundaries – set boundaries and stick to them. Once you have laid them out follow through with whatever consequences you have set however hard it is.

Stop finances – if you are financially supporting someone stopping these finances can be the quickest way for the addict needing to ask for help. With no money to acquire a substance an addict’s options become very limited.

Intervention – getting together with other family members/friends/colleagues and staging an intervention is often very successful in the fist stage of acceptance and gaining an admission to residential rehab.

You can’t make them quit, this can lead to dangerous withdrawal. Boundaries are very important in helping someone become willing to get help. Unfortunately you cannot do someone’s recovery for them and without self-motivation it is very hard to make it work.

The next step is to call our highly trained advisers 0203 955 7700.

There is a huge range of rehab options available and where to start can be completely over whelming so let us help.