Treatment-Resistant Depression Care in Recife
Intranasal esketamine (Spravato®)
About the treatment
Treatment-resistant depression is a clinical condition in which the patient does not respond adequately after using at least two different antidepressants, at proper doses and duration. In these cases, advanced therapeutic strategies may be needed, always under specialist medical supervision.
Intranasal esketamine (Spravato®) is an option approved by Anvisa and the FDA for specific cases of treatment-resistant depression and major depression with acute suicidal ideation, after careful medical evaluation and in combination with conventional psychiatric treatment.
Indicação: Esketamine is not a first-line treatment. Indication depends on defined clinical criteria and shared decision-making between physician and patient.
What is esketamine (Spravato®)?
Derived from ketamine
Esketamine is a ketamine derivative administered intranasally that acts on NMDA receptors in the central nervous system. Its mechanism differs from traditional antidepressants such as SSRIs and SNRIs.
Mechanism and evidence
Clinical studies show that, in carefully selected patients, esketamine may have a faster onset of action, always within an individualized treatment plan and under medical supervision.
Potential benefits (in selected patients)
Faster onset of action
Possible faster onset compared to traditional antidepressants.
Option for resistant depression
Therapeutic option for treatment-resistant depression.
Reduction of severe symptoms
May help reduce severe depressive symptoms when correctly indicated.
Individualized plan
Responses vary by clinical profile and require ongoing supervision.
Assisted administration protocol
Esketamine is self-administered via nasal spray, always in a clinical setting under direct medical supervision. After each application, the patient remains under observation for at least 2 hours with appropriate monitoring.
Induction phase (weeks 1 to 4)
2 applications per week on non-consecutive days.
Initial maintenance phase (weeks 5 to 8)
1 application per week.
Extended maintenance (from week 9)
Biweekly or monthly applications, depending on clinical response and ongoing reassessment.
Monitoring and safety
- • Blood pressure monitoring
- • Mental state and sedation assessment
- • Clinical observation for at least 2 hours after application
- • No driving or operating machinery on the day of application
Contraindications and precautions
Contraindicações absolutas: hypersensitivity to esketamine, active cerebrovascular disease (stroke, aneurysm), uncontrolled hypertension
Usar com cautela: history of psychosis, bipolar disorder, substance abuse, liver disease
Avaliação necessária: Before starting treatment, a full medical evaluation is required, including lab tests and detailed psychiatric assessment.
Frequently Asked Questions
Is esketamine safe?
When used according to medical protocols in a supervised setting and with proper criteria, esketamine has a known safety profile. Its use outside the clinical environment is not allowed.
What are the most common side effects?
Dizziness, nausea, dissociation, sedation, and transient blood pressure elevation may occur. These effects are usually temporary and resolve within a few hours.
Does esketamine cause dependence?
Esketamine is a controlled medication with potential for abuse. For this reason, its use is restricted to supervised medical settings and never at home.
Important notice
Spravato® is a registered trademark of Janssen-Cilag. This content is purely informative and educational and has no commercial relationship with the manufacturer. Esketamine indication depends on individual medical evaluation and is not an automatic treatment recommendation.
Specialist medical evaluation
Esketamine use requires careful medical evaluation, clear indication, and ongoing follow-up. If you want to know whether this treatment could be indicated for your case, the first step is a specialist medical evaluation.
Contact
(81) 3090-6003Contact
(81) 3072-9816Clinically Reviewed by:
Dra. Roberta Maria Aguiar Milet
Anesthesiology
CRM-PE 19152 | RQE 2608
This content is informative and does not replace individual medical evaluation.
See full credentials
Physician specializing in Anesthesiology. Her practice extends beyond the operating room, with dedicated work in treating resistant depression through ketamine infusion.
Note: This content is for educational and informational purposes only. The information is based on scientific evidence and the clinical practice of the Intrador team, but it does not replace individualized medical evaluation. Conduct, indications, and treatments must be defined after medical consultation.
Clinical reviewer: Dr. Helio Widson Alves Pinheiro · Pain Medicine | Acupuncture · CRM/PE 21167 | RQE 2217, 2808
Published on: January 17, 2026
Reviewed on: January 29, 2026
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