Overview
Esketamine, primarily known by its brand name Spravato, represents a significant advancement in the therapeutic landscape for mental health, particularly for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal ideation. As the S(+) enantiomer of ketamine, it offers a more targeted approach to NMDA receptor antagonism, leading to rapid antidepressant effects. While racemic ketamine has a longer history, esketamine's development focused on optimizing therapeutic outcomes and managing side effects. Its administration, typically through nasal spray under medical supervision, marks a shift towards in-clinic treatments that leverage its unique pharmacological profile. The journey from its anesthetic origins to its current role in psychiatry highlights ongoing innovation in psychopharmacology and the growing acceptance of novel therapeutic modalities.