Motivations and Barriers for Psychiatric Practice Adoption of Esketamine Nasal Spray for Treatment-Resistant Depression in the United States

OBJECTIVES: Esketamine is a novel, rapid-acting treatment for treatment-resistant depression (TRD). While esketamine was approved by the FDA in 2020, there are several barriers to adoption for psychiatric practices that may limit patient accessibility to treatment. This study assessed motivations and barriers for the adoption of esketamine treatment in psychiatric practices in the US using a survey.

METHODS: The survey was developed based on issues identified in the published literature and from in-depth interviews with practicing psychiatrists. The survey included questions regarding 1) the psychiatrist’s experience administering ketamine/esketamine; 2) the motivations for adopting esketamine treatment; 3) the barriers to adopting esketamine treatment; 4) attitudes towards reimbursement models utilized for esketamine; and 5) the healthcare provider’s position and the practice where they work. The survey population consisted of psychiatrist members of organizations across the US. The survey was analyzed using a descriptive approach and thematic analysis.

RESULTS: Five psychiatrists were interviewed, and descriptive information was obtained regarding motivations/barriers to adoption of esketamine. A total of 31 psychiatrists participated in the survey. Among respondents, 6 (19%) reported administering esketamine and 8 (26%) reported they administer ketamine. Of the 6 providers that administer esketamine, 5 (17%) also administer ketamine. Psychiatrists generally agreed esketamine is effective for TRD (somewhat agree=45%; strongly agree=42%). However, most providers disagreed that esketamine is accessible (somewhat disagree=32%; strongly disagree=32%) or affordable (somewhat disagree=22%; strongly disagree=30%) for patients. Respondents reported investment in infrastructure (moderate barrier=32%; extreme barrier=48%) and clinical staff (moderate barrier=35%; extreme barrier=39%) as barriers to providing this medication.

CONCLUSIONS: The findings of this study suggest that psychiatrists generally believe that esketamine is an effective treatment for TRD, but that there exist significant barriers to access and use of esketamine. Future research should evaluate the health burden associated with real or perceived barriers to treatment.