Esketamine (Spravato)

Esketamine is the S-isomer of Ketamine (brand name Spravato) and has been shown in medical trials to act as an antidepressant medication. It is self-adminstered via intra-nasal spray under supervision where it is absorbed into the blood and the circulates to the brain where it acts via NMDA glutaminergic pathways which is a different mechanism of action compared to standard tablet antidepressants. 

The process commences with an assessment by one of our psychiatrists to determine if Esketamine is a suitable treatment. If suitable for esketamine a treatment session involves self-administation of the medication under close medical supervision in one of our two accredited locations, whilst the medication is active in a patient's system and until it wears off. It is recommended that this be undertaken twice a week for a month as the inducation phase of treatment and only if a patient responds in this month would treatment be continued into the maintenance phase, where treatments are spaced out to weekly and then fortnightly.

Esketamine has an evidence base to support that it can be of benefit to patients who have not responded to previous trials of antidepressant medications however just like medication and psychological treatments for Depression not all patients respond. An important part of informed consent also involves consideration of other options including combination medications and neurostimulation treatments like TMS which Axon Psychiatry can also offer as a non-medication treatment option.

Esketamine like all medical treatments has side effects and patients are educated on these during the initial consultation by our psychiatrists, as well as on potential benefits so they can make an informed choice whether Esketamine is appropriate for them. 

There are some medical reasons why Esketamine may not be suitable and a comprehensive medical history is undertaken at the initial assessment with our psychiatrists to determine this.

If patients are referred with a valid medicare referral to our doctors by their treating doctor (GP or Psychiatrist) or nurse practitioner the initial consultation attracts a Medicare rebate to partially reimburse some of the costs of the initial assessment, however there will be an out of pocket 'Gap' fee payable as well. 

In Australia Esketamine has recently been approved under the Pharmaceutical Benefits (PBS) Scheme for patients with treatment resistant depression who meet eligibility criteria. This has assisted in bringing the cost of this medication down however there is no medicare subsidy for the required monitoring that is an essential component for the treatment to occur.  A facility fee that is privately funded is payable for each treatment with Esketamine.