Gardening the Mind (Esketamine Treatment)

  

Today’s post was written by Stephanie Debnath, PMHNP.  She is a psychiatric nurse practitioner who works with esketamine (Spravato) and TMS (transcranial magnetic stimulation) at SoCal TMS.  Full disclosure: Stephanie has treated me with both TMS and esketamine. There is a link at the end of this post to the SoCal TMS website and their social media for more information on esketamine.  To read Stephanie’s post on this blog about TMS scroll back to October 20, 2023, Renewed and Recharged. Check back on Thursday for my perspective on esketamine treatment.

 

Gardening the Mind 

 

 

As many of us try to balance out our busy lives, stress, worries, and interests, we gravitate towards a vice. For some it’s reading, others it’s exercise, and for a lot of people it is something less healthy—regardless, we all have a thing. I garden. I like to plant something in the ground and care for it. Pruning the damaged leaves makes me feel like I’m caring for wounds, watering it reminds me of how good I feel after a big drink of water on a hot day, and watching buds form tells me it’s growing. I make many mistakes in the garden. Neglect, sun scald, drought, poor choice of area in the garden. Some are not wins, but others are decent. I like to get my hands in the dirt and see the worms, because seeing worms equals healthy soil, usually. I always have my eye on the prize of a fruit or vegetable to come. That’s my goal. It will mean that my plant is thriving. Often, I work hard. Take the courses. Follow the steps. Sometimes, I pour blood, sweat, and tears into growing something. It can still fall short. I do a lot in the garden, but I do forget to fertilize.

 

Treating patients with Treatment Resistant Depression, means treating patients who have put a lot of effort into their mental health. It means people have tried many, many medications. Some for years, some just once, but there is usually a long list. They have done countless therapy sessions, sometimes with many therapists, sometimes just one. They have had alternative or interventional treatments, sometimes multiple, sometimes just one. What these patients have in common is that they have worked hard and made mistakes; Not tending to their wounds, not nourishing their bodies, and stunting their growth. They work hard, they take the courses, they follow all the steps—year, after year, after year. They often pour blood, sweat, and a lot of tears into trying to regain power in this area, trying to take hold of their mental health. So, what if for some people those things are almost enough? They are helpful but keep them falling short of their goal. The plant grows, but there is no crop. Their Treatment Resistance makes it harder for them to flourish with just the basic. For some…perhaps they need to fertilize.

 

Esketamine is a newer treatment, FDA approved in 2019 for Treatment Resistant Depression and 2020 for Major Depressive Disorder. It is essentially a derivative of the molecule Ketamine, something used largely across the medical field for amnesic (short-term memory loss), analgesic (pain-relieving), and hypnotic (sleep-producing) purposes. It is a nasal spray/medication that is self-administered by the patient, in office, with the psychiatric provider on site. The sessions last about 2.5 hours for proper monitoring, and vitals are taken along the way by a nurse or technician. During the peak of the medication in the first hour, there is some light dissociation which allows the patient to go “within”. It gives patients the opportunity to switch to observation mode and evaluate things that are challenging to do in everyday life. The drug wears off about an hour in and the second hour is spent recovering. These sessions have been described by patients as “inward therapy”, but it is different for everyone. 

 

The way I see esketamine therapy is like this: it is the fertilizer to our roots when it comes to the brain (and neurons). It boosts the elements and chemicals that cause excitation, strength, bonding, and growth, and it sends signals to the base of the “plant” (brain) that encourages it to produce the nutrients it needs. Patients often say, “I’ve tried so many things, so many meds, so many therapies. I feel like my brain needs a jumpstart.” Well, they are probably correct. A lot of people are putting in the effort, the blood, the sweat, and tears but they fall short. Like when I forget to fertilize, I am only getting a minimal growth, with almost no fruit. 

 

While not all treatments and therapies are right for people, I can say that esketamine is an option that will help many. It still pains me to hear patients say, “I wish this would have been around 20 years ago.” I do, too. I wish the advancements of today were present decades ago, and everything was further along. I wish if we wanted to take up gardening, we just knew everything there is to know, and did it all correctly each season. We can still wish, but we must try along the way, too. This emerging treatment has helped many, many patients in different ways than traditional medications for depression. It has stimulated the brain differently than electromagnetic waves, and it has restored hope for those who feel they go season after season with no crop. As a clinician in psychiatry, my intention is never to push one treatment over the other, but to inform and encourage a new way of pruning, tending, and nurturing a garden. After all, the right amount of fertilizer can bring a bountiful harvest.  

 

 

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