Choosing Between Ketamine and Esketamine in TRD

This episode, titled ‘Choosing Between Ketamine and Esketamine in TRD,’ features the expert psychiatrist discussing the following critical questions:

Is there a profile of patients with treatment-resistant depression for whom esketamine is the preferred choice?

How do safety and efficacy factor into choosing between ketamine and esketamine for treatment-resistant depression?

Led by the moderator, the expert psychiatrist examined how he matches patients to each agent. He generally steers patients toward the insurance-covered option because it is more sustainable, while honoring a preference for ketamine’s flexible dosing and longer evidence base. He describes the 2 agents as essentially equivalent in safety, apart from infusion-site discomfort with ketamine and a bitter taste with esketamine, although an infusion can be stopped mid-session and an intranasal dose cannot. On efficacy, he cites response rates of roughly 70% to 80% with repeated intravenous ketamine compared with about 60% with esketamine, balanced against esketamine’s insurance coverage and more regulated, REMS-based care model.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, ‘Safety Monitoring and Treatment Continuation With Esketamine in TRD,’ Dr. Yudkoff will continue his discussion on treatment-resistant depression and highlight day-to-day safety protocols and what drives patients to stay on or stop treatment.