Treatment resistant depression is a compelling clinical problem associated with significant suffering, disability, and risk. 1 in 3 individuals achieve significant depressive symptom reduction on a first antidepressant, only about 2 in 3 individuals achieve significant depressive symptom reduction after serial trials of antidepressants, and as many as 4 of 10 individuals experience a recurrence of depression after initial improvement. Many individuals require more intensive treatment involving multiple medications, different forms of psychotherapies, and neurotherapeutics (e.g., electroconvulsive therapy [ECT] or transcranial magnetic stimulation [TMS]).
At Brigham and Women’s Faulkner Hospital, the Department of Psychiatry offers an alternative treatment option—intranasal esketamine therapy—to individuals who have not experienced adequate relief with standard treatments (defined as 2-4 trials of antidepressants in the current episode of depression, or inadequate response to neurotherapeutics). Unlike ketamine (from which esketamine is derived), esketamine is approved by the FDA for treatment of treatment resistant major depressive disorder.
At Brigham and Women’s Faulkner Hospital, to determine eligibility for esketamine treatment, patients undergo a consultation and medical clearance. Suitable patients will receive esketamine treatment in our Outpatient Infusion Center (OPIC),a closely monitored setting that provides enhanced safety and a positive patient experience.
Details of the ketamine infusion program and eligibility requirements are as follows:
Target population – healthy adults (at least18 years old) with treatment resistant depression (failure of 2-4 adequate trials of antidepressant medications or ECT/TMS).
Eligibility interview – 1-hour long.
Medical health – medical clearance will be provided by the ketamine-providing psychiatrist unless there are special concerns, in which case medical clearance will be provided by your primary care physician.This includes basic lab work, EKG, and a physical examination.
Treatments – Treatments are provided twice weekly for 4 weeks, weekly for 4 weeks, then weekly/every other week, thereafter. Treatments last a minimum of 2 hours.
Cost – Esketamine is covered by insurance after prior authorization from the insurance company is obtained. Continued treatment requires additional, scheduled, prior authorizations.
Discharge supervision – patients will need a responsible adult to transport and supervise the patient upon discharge (this cannot be a livery service such as Uber, Lyft, or a taxi)
Location – infusions will be performed at Brigham and Women’s Faulkner Hospital in the OPIC on the third floor.
Time allocation –After initiation of treatment a patient is monitored for a minimum of 2 hours.
Referral process – referrals must be made through the patient’s treating psychiatrist or psychiatric nurse practitioner.
Patients, if you think you would benefit from esketamine therapy, please contact your providing psychiatrist or psychiatric nurse practitioner.