Why is Esketamine (Spravato) not recommended when some had psychotic symptoms?

Esketamine is a medication that is primarily used as a treatment for severe depression, particularly treatment-resistant depression. It is administered as a nasal spray and is a derivative of ketamine. While it can be effective for depression in some cases, it is generally not recommended for individuals who have a history of psychotic symptoms or conditions like schizophrenia for several reasons:

Esketamine has the potential to cause dissociative and hallucinogenic effects, especially at higher doses. These effects can resemble symptoms of psychosis, such as delusions and hallucinations. For individuals with a history of psychosis, taking a medication that can induce similar symptoms may exacerbate their condition or increase the risk of a psychotic episode.

Before considering esketamine or any medication for the treatment of depression or related conditions, it is essential for individuals with a history of psychosis to discuss their medical history and current symptoms thoroughly with a qualified mental health professional.