Background Though esketamine was approved by the Food and Drug Administration (FDA) for treatment-resistant depression in 2019, there is no published research on implementation challenges. Therefore, the aim of this study was to investigate online commentary about these challenges among mental healthcare providers. Methods Using the terms "esketamine" and "Spravato", the author searched social media groups dedicated to mental healthcare providers on December 15, 2022. Posts and associated comments about using or implementing esketamine into practices were included in the dataset and thematically coded. Prevalence of themes about implementation challenges, illustrative quotes, and sentiment analyses are reported. Results 186 relevant posts and comments from March 12, 2019 to November 27, 2022 were identified. The most discussed challenges were billing/reimbursement (65.1%), billing codes (48.9%), staffing (18.3%), pharmacy/drug procurement (16.7%), space (11.8%), time (10.2%), "Buy and bill" acquisition (9.1%), and the FDA Risk Evaluation and Mitigation Strategy (REMS) program (7%). Sentiment regarding reimbursement for esketamine was mostly negative [72.3% (34/47 posts)], as was sentiment towards esketamine's manufacturer (62.5% (5/8 posts). Most posts [86.7% (13/15 posts)] comparing esketamine to ketamine favored using ketamine. Conclusions These data suggest that under-reimbursement, billing challenges, and logistical barriers may be hamstringing implementation of esketamine into psychiatric practices.

Brian Barnett reports a relationship with CB Therapeutics that includes: board membership and equity or stocks. Brian Barnett reports a relationship with COMPASS Pathways Plc that includes: board membership. Brian Barnett reports a relationship with Mind Medicine Inc. that includes: funding grants. Brian Barnett reports a relationship with EBSCO Industries Inc that includes: consulting or advisory. Brian Barnett reports a relationship with Cerebral that includes: consulting or advisory. Brian Barnett reports a relationship with Janssen Pharmaceuticals that includes: consulting or advisory.

This study did not receive any funding

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