The Next Big Thing in Treating Depression
Are you curious about Spravato and how it can help treat depression? Learn about Spravato, current research on esketamine, and what treatment looks like.
Living with depression can feel like a never-ending battle, especially when you are stuck in a cycle of trying treatments and therapies–but not finding relief. Chronic depression is a continuous, long-term form of depression that is characterized by persistent sadness and a loss of interest in daily activities, it can make people feel:
Anxious and annoyed
Tired or lack of energy
Discontented and apathetic
Guilty with a sense of worry
Hopeless and helpless
Restless and angry
Isolated and impatient
In many cases, antidepressants can treat these symptoms–but are slow acting. It can take months, or even years, to find the correct medication and dosage to treat depression. Depression is a chemical imbalance in the brain; without proper treatment, it can be life-threatening. Spravato is the only FDA-approved esketamine nasal treatment on the market to be used in combination with an oral antidepressant to treat major depressive disorder and treatment-resistant depression.
Who can take Spravato?
If you found yourself nodding ‘yes’ while reading that list, then you might be a part of nearly one-third of the population who does not respond to antidepressant medication.
A person is considered to have treatment-resistant depression if they have been diagnosed with a major depressive disorder and have not responded to adequate treatment using two or more antidepressants for an appropriate time with no relief of symptoms. This diagnosis is only given through a trained medical provider and will be necessary if you are pursuing treatment with Spravato.
What is Spravato?
Spravato is the first nasal spray of esketamine on the market to be used by adults who are experiencing treatment-resistant depression. It was approved by the FDA to be taken in combination with an anti-depressant for the following diagnoses:
Adults with treatment-resistant depression (TRD)
Adults with major depressive disorder (MDD) that have suicidal thoughts or actions
Spravato shows promising results for those facing acute crises and is used as an outpatient treatment. Ketamine is made up of two enantiomers (s)ketamine and (r) ketamine. Spravato is esketamine which is derived from a molecule of ketamine called (s)ketamine. It is considered to be four-fold more potent than the other enantiomer (r)ketamine for the NMDA receptor. This allows for lower doses of esketamine nasal treatment to be given with reduced dissociative properties than would be experienced during an IV ketamine treatment.
The exact mechanism of how Spravato works is still unknown. It is believed that ketamine and esketamine work through a series of complex biological processes. Ketamine is an NMDA antagonist which encourages the activity of glutamate production in brain regions that are important for mood, emotions, and stress. Neuroplasticity is increased when glutamate signaling is increased. It is thought that the impairment of neuroplasticity in the brain is linked to depression. When neuroplasticity function is supported and increased, patients feel a sense of relief, allowing for the creation of new synapses in the brain. The result of this process is the alleviation of depressive symptoms and an increase in coping mechanisms when dealing with stress.
The Research on Esketamine
Ketamine has been used for nearly six decades as an FDA-approved emergency room anesthetic. It has been studied for over 20 years regarding mental health and is used off-label as a treatment for depression, anxiety, PTSD, and neurological pain.
Esketamine administered intranasally under the brand name Spravato was approved in 2019 by the FDA, and Janssen Pharmaceutical trials are ongoing. Research is continuing on both ketamine and esketamine treatments and their effects on mood disorders, psychological disorders, and pain management. There is a lot to learn about how exactly ketamine and esketamine work within the brain, along with the short-term and long-term effects of treatment with those who have MDD or TRD.
A 2019 randomized clinical trial showed that esketamine nasal treatment in combination with an antidepressant decreased the risk of relapse at 16 weeks among patients who achieved stable remission by 70% compared to those who took a placebo nasal treatment and antidepressant.
In November 2022, Janssen Pharmaceuticals who owns the brand name Spravato released the findings from their phase 3B clinical trial of esketamine nasal spray in combination with a continuing selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI). The results showed that the esketamine nasal spray enabled a significantly greater percentage of patients to achieve remission at Week 8 and remain relapse-free in the longer term up to Week 32. The positive results will help open access to these life-saving treatments to people who have struggled to find relief in the past.
Spravato Treatment
A low dose of Spravato is self-administered through an intranasal spray. After five minutes, another small dose is self-administered. Following the final dose, patients will stay in the office for two hours while being monitored. Patients are encouraged to wear eye shades, listen to relaxing music, and focus inward during this time.
Esketamine peaks in the body around 20-40 minutes, but some patients report feeling the antidepressant effects within 24 hours to a couple of days following treatment. The relief is faster than any antidepressant on the market, which can take anywhere from four to six weeks for effectiveness. The immediate effects of symptom relief make Spravato useful in an acute major depressive episode where the patient might be considering self-harm or have suicidal ideation.
The initial administration, called the induction phase, will take place two times a week for four weeks. If the patient shows signs of therapeutic benefit during this induction phase, they will move into a maintenance phase of treatment. During the maintenance phase, the dosage, and frequency will be decided based on each patient's needs to maintain clinical improvement. It is not recommended to stop treatment abruptly. If you miss a treatment, you will need to work with your healthcare provider to decide how to proceed with dosing and treatment duration.
Take Spravato in a Medical Setting
Spravato is only available as a treatment at certified Spravato treatment centers under the supervision of a healthcare provider. Spravato, like ketamine, is considered a class III drug. If you have a history of addiction, you should speak with your medical care provider. There is a myth that you can become addicted to ketamine, but it is unlikely in a medical setting with proper care that you would develop an addiction. Your medical care provider should check you for signs of abuse and dependence before and during your Spravato treatment.
Spravato Side Effects and Risks
The side effects of Spravato are typically mild and well tolerated. Some common side effects include sedation, disassociation (feeling disconnected from mind and body), dizziness, nausea, diarrhea, vomiting, vertigo (spinning sensation), anxious thoughts, lethargy, and increased blood pressure.
Monitor Blood Pressure
In rare cases, Spravato can cause a temporary increase in blood pressure that can last up to four hours. Your medical provider will monitor your blood pressure during your treatment, which lasts 2 hours. Tell your medical care provider right away if you experience chest pain, shortness of breath, sudden severe headache, change in vision, or seizures after taking your Spravato treatment.
Avoid Driving for One Day After Taking Spravato
Patients taking Spravato are not permitted to drive following treatment and must arrange transportation home. Given the sedation and dissociative properties of Spravato, the FDA has a boxed warning and recommends that patients do not drive or operate heavy machinery for 24 hours. Patients should also avoid other central nervous system depressants or sedatives like alcohol, opiates, or illicit substances.
Avoid eating and drinking before and after your Spravato treatment,
Spravato may result in nausea and vomiting shortly after self-administration. To minimize these side effects, it is recommended that you:
Avoid eating for at least 2 hours before taking Spravato
Avoid drinking for up to 30 minutes after taking Spravato
Insurance
Spravato treatment is approved by the FDA in combination with an oral antidepressant and might be covered by insurance. Intravenous ketamine treatments are not covered by insurance, but we can bill insurance for parts of your visit if you choose to go the intravenous route. If you would like to find out if your insurance will cover treatment, you can contact us, and we work with your insurance providers to get you pre-approved and cover as much of the cost as possible.
Explore Your Treatment Options With MindWell
At MindWell our mission is to provide safe, effective affordable care to all those who need it. We understand that the process of trying treatment after treatment can be overwhelming, confusing, and costly–but it doesn’t have to be! We offer Spravato and ketamine treatments that show positive results for people who haven’t found relief with other therapies.
MindWell serves the greater Greenville, South Carolina area and beyond, our experienced and trustworthy medical staff can help guide you during this process. Contact us today and set up a consultation to see if ketamine treatments are right for you. There is no charge for this informational call. Contact us by phone, email, or the contact button to get started.
Disclaimer: This material is intended for general information purposes only and does not constitute medical advice. Responses to inquiries, whether by email, telephone, or other means, do not constitute medical advice.
