Does Room Environment Influence the Experience of Esketamine Treatment?

Objective: Esketamine (Spravato®) nasal spray, an NMDA receptor antagonist, is FDA-approved for use with an oral antidepressant in adults with treatment-resistant depression. Each outpatient session requires a 2-hour observation period following self-administration. This study explored patient preferences for room environment during these sessions, considering esketamine's psychological effects and the extended observation required.

Methods: Our facility features four private treatment rooms—two traditional and two nontraditional. Patients who experienced both room types in at least two sessions were eligible for the survey. The traditional room included a reclining massage chair, desk, and window with adjustable shades. The nontraditional room was larger, with more windows, a couch, an outdoor balcony, and an intercoastal view. Patients could choose their room, adjust window shades, select room temperature, and opt for a blanket or soft music. A 5-question questionnaire gauged patient responses.

Results: Thirty-eight consecutive patients, with 423 encounters, were eligible and consented to the survey. All agreed the room environment impacted their experience and found both settings comfortable. Only 3 patients (8%) strongly preferred one room. Adverse events like nausea, hypertension, sedation, or dissociation were rare and did not vary between room types. The nontraditional room was preferred by those appreciating natural light and observing intercoastal activity, while the traditional room was chosen for its subdued environment conducive to rest or internal focus.

Conclusions: Customizable environmental conditions in both traditional and nontraditional rooms enhance patient comfort during esketamine treatment. However, room choice did not affect the occurrence of adverse events related to intranasal esketamine.