Esketamine nasal spray
treatment request

Esketamine (brand name Spravato) is a form of ketamine given as a nasal spray. Most antidepressants work on serotonin or noradrenaline. Esketamine works on a different brain chemical, glutamate. It briefly blocks NMDA receptors, which leads to a burst of glutamate signalling through AMPA receptors. This switches on growth signals (such as BDNF) that help brain cells rebuild connections, especially in areas affected by long-standing depression. Some people notice improvement within days rather than weeks.

• Works through a different pathway from standard antidepressants.
• In clinical trials, roughly half of people who had not responded to two or more antidepressants responded.
• Can work faster than tablets, sometimes within the first week or two.
• Given in clinic under supervision, so side effects are monitored.

• Must be given in an approved treatment centre — you cannot take it home.
• Twice a week for the first 4 weeks, then weekly, then often every 1–2 weeks for months.
• You need to stay in clinic for monitoring (usually about 2 hours) and cannot drive until the next day after a proper night's sleep.
• Clinic session fees (nursing, monitoring, room) are not covered by Medicare or the PBS.
• It does not work for everyone; non-responders usually stop after 4 weeks.

• Esketamine has been subsidised on the PBS since 1 May 2025 for adults with treatment-resistant depression.
• Treatment-resistant means major depression that has not responded well enough to at least two different antidepressants, each taken at an adequate dose for an adequate time, in the current moderate-to-severe episode.
• It is started alongside a newly started oral antidepressant, prescribed by (or under the supervision of) a psychiatrist.
• You pay the standard PBS co-payment per dose (lower with a concession card).
• To claim a Medicare rebate for psychiatrist consultations you need a current referral from your GP — please upload it with this request.

• Common, usually within the first hour and settle the same day: feeling detached or dreamy (dissociation), dizziness, nausea, sleepiness, spinning sensation, numbness, headache, odd taste, anxiety.
• Blood pressure rises for a short time after each dose and is checked before and after.
• Less common: vomiting, feeling drunk, bladder symptoms, worsening mood or suicidal thoughts in the early weeks.
• Esketamine is a Schedule 8 (controlled) medicine because it can be misused.

• Aneurysm, a blood-vessel malformation in the brain, or a past bleed in the brain.
• A heart attack or other cardiovascular event in the last 6 weeks.
• Bipolar disorder, psychosis, or a current drug or alcohol problem (needs careful review).
• Pregnancy, planning pregnancy, or breastfeeding.
• Uncontrolled high blood pressure.

1. No food for 2 hours and no drinks for 30 minutes beforehand.
2. Blood pressure is checked.
3. You give yourself the nasal spray under nurse supervision (2–3 devices, 5 minutes apart).
4. You rest and are monitored until you are clinically ready to leave.
5. Someone takes you home — no driving, cycling or machinery until the next day.