Intranasal Ketamine for Treatment-Resistant Depression

Multiple studies have shown that when used as a nasal spray, ketamine may help depressed patients who have not responded to conventional therapy. Ketamine is a medication that is most often used intravenously for anesthesia, and multiple studies have shown that a single intravenous infusion of ketamine produces a rapid antidepressant response.

Intranasal medications avoid the inconvenience and discomfort of IV therapy. And, intranasal drug delivery offers many advantages: it provides a route to the brain that bypasses problems related to gastrointestinal absorption as well as drug metabolism prior to absorption, and intranasal medications have a rapid onset of action. Oral ketamine is extensively broken down by the liver before it can be absorbed by the body, so oral therapy is not a good option. Therefore, the intranasal route has been investigated extensively.

In a randomized, double-blind, placebo-controlled, crossover trial of patients with major depression at the Icahn School of Medicine at Mount Sinai, New York, researchers found that a single intranasal dose of ketamine (50 mg) outperformed placebo; the response rate was 44% versus 6%, respectively. Anxiety ratings also decreased significantly more with ketamine. Patients showed significant improvement in depressive symptoms at 24 hours after ketamine compared to placebo. Intranasal ketamine was well tolerated with minimal psychotomimetic or dissociative effects and was not associated with clinically significant changes in hemodynamic parameters like blood pressure.

Intranasal ketamine represents a promising advance in treatment-resistant depression (TRD) therapeutics. Most studies report a duration of response up to 7 days and remission up to 3-5 days after a single dose. “Most adverse events … subsided spontaneously by 60 to 90 minutes post dose,” said Vanina Popova, MD. In addition, “there was no pushback” to the nasal delivery system. “The route of administration was well received, and it was certainly more convenient than intravenous administration.”

Ask our pharmacist for more information about compounded intranasal ketamine. We customize medications to meet each patient’s specific needs.

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