Older adults are more prone to depression because of health problems, the death of a loved one, isolation, or major life transitions like retirement. National Institute of Mental Health (NIMH), shared that an estimated 14.2% of seniors aged 65 and older experience clinical depression at some point in their lives. Some of these patients can also have depression that is resistant to treatment, and traditional antidepressants may not be effective. That’s where interventional psychiatry steps in and offers some newer treatments like esketamine.
Unfortunately, depression in the elderly is typically underdiagnosed and undertreated. Fatigue, sleep disturbance, and loss of interest in activities are attributed to the normal aging process, and not necessarily recognized as symptoms of depression. Older adults may also be hesitant to seek treatment for their depression due to stigmas about mental illness or other attitudes.
Challenges of Treating Depression in Older Adults:
What Is Esketamine?
Esketamine is delivered via nasal spray for the treatment of treatment-resistant depression (TRD) in adults. In 2019, the U.S. Food and Drug Administration (FDA) approved esketamine for the treatment of TRD in addition to an oral antidepressant in patients who have not responded to other treatments–– it has since been approved for use as a monotherapy, so it doesn’t need to be prescribed alongside an antidepressant.
Esketamine is an enantiomer of ketamine, a well-known anesthetic that has been safely used in medical settings for decades. Over the past several years, it has been discovered to be effective in the realm of depression, more specifically in treatment-resistant depression. It works by impacting the NMDA receptors in the brain that influence the glutamate system. This effect enhances neuroplasticity, enabling the brain to create new connections and transform in ways that can help lessen symptoms of depression. One of the most important benefits of esketamine is that it works to provide rapid relief, typically within hours or days, compared to traditional antidepressants, which may take weeks to start working.
Why Esketamine Is Gaining Popularity for Depression
Esketamine is a promising option for those who don’t respond to conventional antidepressants. Unlike other antidepressants that act on serotonin and norepinephrine, esketamine acts on a different part of the brain called the glutamate system.
One of the biggest benefits of esketamine is how quickly it works. While typical antidepressants can take weeks to work, esketamine can relieve symptoms in a matter of hours or days—making it a great option for anyone who needs to get better quickly.
When taken under medical supervision, esketamine is strictly regulated by the FDA, and the risk of abuse is low.
Is Esketamine Safe for Older Adults?
Esketamine was shown to be a potentially effective and safe treatment in older adults when given under strict medical supervision. While older individuals generally have other health issues than younger individuals, research indicates that with cautious evaluation, monitoring, and administration by a healthcare professional, esketamine can be an effective option for depression treatment in this group. Research has indicated that esketamine can be effective and safe in older individuals, when properly evaluated, monitored, and administered by a healthcare professional.
Esketamine and Older Adults: Safe with Proper Care
Esketamine is generally safe, although older adults may have particular health considerations. With the right precautions, it can be an effective treatment.
Main Concerns for Older Adults:
Close Monitoring: Patients are closely monitored during and after treatment to watch for any potential effect on blood pressure, cognition, or mood.
Medical Supervision: Esketamine is always administered in a clinic, under professional supervision, to ensure safety—especially for people who may be at higher risk for side effects.
While older adults may have special risks, they are considerations that pertain to all who take esketamine. Mental health professionals assess each patient’s needs to ensure the safest and most effective treatment regimen.
Administering Esketamine: How Does It Work?
Esketamine is given as a nasal spray in a medically supervised setting like Roseville Center for Interventional Psychiatry. Treatment begins with twice weekly sessions for the initial month, then possibly be tapered based on the individual’s response. Each session requires close monitoring to ensure safety.
After esketamine is administered, patients are observed by medical personnel for up to two hours. This is because the medication has short-term effects like mild dissociation or a temporary increase in blood pressure. For older patients, this monitoring is especially required to ensure a safe and effective treatment. Fortunately, side effects for the most part resolve on their own during the session, and patients are generally able to return to their normal schedule after a good night’s rest.
Should Older Adults Consider Esketamine?
Esketamine is a potentially effective treatment for older adults with treatment-resistant depression. While it has potential risks and side effects, as with all medications, its rapid augmentation of depressive symptoms and new mechanism of action make it a valuable option for older adults who have not responded to traditional antidepressants. As always, those considering esketamine should consult with a health professional to discuss the benefits and risks and determine the most appropriate course of treatment for their individual circumstances.
At Roseville Center for Interventional Psychiatry, we conduct comprehensive evaluations to determine the ideal treatment plan for you. Our compassionate personnel are dedicated to walking you through the process and helping every step of the way.. If you or someone you love is struggling with depression, don’t wait to get help, call now at (916) 755-6000.
