Our Services
Esketamine
Esketamine · Nasal-spray treatment
If antidepressants haven't worked, there may be another way forward.
Esketamine is a nasal-spray treatment for adults with depression that hasn't responded to other medications. It's given as a course of treatments at our clinic, under the supervision of a psychiatrist and our clinical team. We offer it at both our Carlingford and Norwest clinics.
GP or referrer? Click here for our esketamine referral guide
Esketamine at a glance
The essentials, before you read further
What it treats
Treatment-resistant depression in adults who haven't responded to other antidepressants.
How it's given
A nasal spray you take yourself, under supervision.
Each visit
About two to three hours at the clinic, including monitoring afterwards.
Your day
Plan to rest afterwards and arrange transport home - you cannot drive afterwards/
Cost
Medicine is PBS-subsidies. A room and facility fee applies, which is fully covered for eligible third party patients.
The schedule
12 sessions, twice weekly to begin, then once per week afterwards
The basics
What is esketamine?
Esketamine is a nasal-spray medicine used to treat depression that hasn't improved with other treatments. It's a prescription medicine, so it's only given under the care of a psychiatrist.
It works on a different system in the brain — the NMDA receptors — rather than the serotonin and noradrenaline pathways that most antidepressants target. This different action is thought to help restore connections between brain cells in the areas affected by depression.
You take the spray yourself at our clinic, then stay with our team for a period of monitoring afterwards. Because it works differently to tablets, it can help some people who haven't found relief from other medications.
Who it's for
Is esketamine right for you?
Esketamine is for adults with depression that hasn't improved after trying other antidepressants — often called treatment-resistant depression. It offers a treatment that works differently to tablets.
You're an adult diagnosed with major depression.
You've tried at least two different antidepressants without enough improvement.
You can attend the clinic for treatment and monitoring, with transport home arranged.
You'd like to discuss an option that works differently to daily tablets.
What "treatment-resistant" means
Depression is often called "treatment-resistant" when it hasn't improved enough after trying two or more antidepressants at an adequate dose and for an adequate time. If that matches your experience, esketamine may be worth discussing.
A psychiatrist reviews your history and confirms whether esketamine is suitable for you — this assessment is done in person and takes around 45 minutes. A GP or treating-doctor referral is needed to begin.
The evidence
Does esketamine work?
Esketamine is TGA-approved and PBS-listed for treatment-resistant depression, supported by international clinical trials and real-world studies.
Because it works on the brain's glutamate system rather than the pathways most antidepressants target, it can help some people who have not responded to other medications.It does not work for everyone, and response varies.
Your psychiatrist reviews your progress formally throughout the initial 8 week course.
What to expect
What a treatment day is like
Your first appointment is a psychiatric assessment. On each treatment day after that, here's what happens.
No food for 2 hours before your dose, and nothing to drink in the 30 minutes before.
You take the nasal spray yourself at our clinic, guided by our healthcare professional.
You rest comfortably while we monitor you, usually for about two hours. Some people need a little longer, and you stay until our team is satisfied you are ready to go home.
We check how you’re feeling and ensure your blood pressure is within the appropriate range before you leave
You can't drive that day, so arrange for someone to take you home.
Safety
Safety & side effects
Because esketamine is given under supervision at our clinics, our team is available throughout the session. Side effects can include
A temporary sense of detachment or dissociation from yourself or your surroundings
Dizziness, drowsiness or feeling unsteady
Nausea, headache, or a temporary rise in blood pressure
This is why we monitor you for around two hours and ask you not to drive that day. When taken as prescribed under supervision, there is currently no evidence of dependence.
Esketamine isn't suitable for everyone — for example, with certain heart or blood-pressure conditions. Your psychiatrist checks this before you start.
Cost & Medicare
The medicine is PBS-subsidised for eligible patients. A separate facility, monitoring and administration fee applies each treatment day, approximately $350 to $450 per session, which Medicare does not cover.
For patients funded through WorkCover, DVA, ADF or another third party, treatment is fully covered with no out-of-pocket cost, subject to funder approval.
We take you through Informed Financial Consent before starting, so you know your costs in advance.
Information for GPs & referrers
Everything you need to refer a patient for esketamine including eligibility criteria, what to include on the referral and how to share it with us.
Frequently asked questions
How quickly will I feel better?
Some patients notice symptom relief within hours or days of starting treatment. Some take longer, and some do not respond. Everyone responds differently, and your psychiatrist will monitor your progress carefully, with a formal evaluation after the four-week induction phase.
Why can I not take it at home?
Because of the risk of sedation, dissociation and raised blood pressure, esketamine must be used under supervision with observation afterwards. It cannot be dispensed for you to take away, and is only given at approved treatment centres like Mind Connections where clinicians have completed the necessary training.
How is it different from my previous antidepressants?
Esketamine works on the brain's NMDA receptors, a completely different mechanism from conventional antidepressants. This is why it can help people who have not responded to multiple previous medications, and why improvement can occur much faster. It is also taken differently, as a nasal spray at the clinic rather than a tablet at home.
What does dissociation feel like?
Things may seem unreal, slowed down or foggy, or you may feel detached from your body. It starts soon after the dose, usually settles the same day, and often becomes less intense with repeated doses.
Am I eligible?
Esketamine is approved for adults with treatment resistant depression, who have not responded adequately to at least two different antidepressants at adequate dose and duration. Suitability is confirmed through a psychiatric assessment, with a referral from your GP or treating doctor.
How quickly will I feel better?
Some patients notice symptom relief within hours or days of starting treatment. Everyone responds differently, and your psychiatrist will monitor your progress carefully, with a formal evaluation after the four-week induction phase.
What does a treatment session feel like?
After self-administering the spray, many people feel dreamy, floaty or mildly disconnected for a period, sometimes with dizziness or drowsiness. These effects are expected, monitored, and settle the same day. You rest comfortably at the clinic for around two hours before going home.
Can I drive after treatment?
No. You must not drive or operate machinery on the day of treatment. Arrange transport to and from the clinic, and resume driving the following day after a restful night's sleep.
Will I become dependent on it?
Clinical trials showed no signs of addiction such as cravings, tolerance or withdrawal. Your clinician still monitors for dependence throughout your treatment. Tell them about any history of problems with alcohol, medicines or illicit drugs.
Is it covered by the PBS or Medicare?
Yes, esketamine is PBS-listed for eligible patients under psychiatric supervision. Out-of-pocket costs apply for in-clinic monitoring, typically $300 to $500 per session, and you will receive clear informed financial consent before starting. WorkCover, DVA and some insurers may cover costs with pre-approval.
Can I keep taking my other medications?
In most cases yes; esketamine is in fact used alongside an oral antidepressant. Tell your psychiatrist about all medicines, supplements and natural therapies you take so any interactions can be managed.
psychiatrists
Psychiatrists who offer esketamine
Dr Padmini Howpage
Consultant Psychiatrist & Psychogeriatrician
Dr Raiz Ismail
Consultant Psychiatrist
Getting Started
Your first appointment, made simple
Visit our 'What to expect' page to learn more about the booking process.
Obtain a referral
For psychiatry, ask your GP for a referral. For psychology, ask your GP for a Mental Health Care Plan and referral. This is what enables your Medicare rebates.
Book online or call us
Choose your clinician, location and time online, 24/7, or call our friendly reception team and we'll find a time that suits.
Attend your appointment
In person or by telehealth. Your first session is about understanding you, your history and what you'd like help with.
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