The prevalence of depression has become an urgent public health concern in the United States. The impact of depression is far-reaching and affects individuals of all ages and backgrounds. However, rates of depression are rapidly increasing, particularly among young people. Nearly 1 in 10 individuals are affected by major depressive disorder (MDD), and suicide is now the second leading cause of death for people aged 15 to 24 in the U.S1. The severity of our nation’s depression problem is escalating rapidly, highlighting the pressing need for fast-acting depression treatment options, and options for those with treatment-resistant depression.
Recent advancements in medical research have led to the development of new treatments and medicines, including a novel medication called Spravato. Spravato offers hope for individuals who have struggled to treat their depression or who need relief from their depression symptoms quickly. In this article, we will delve into what Spravato is and explore how it can help you or a loved one with depression.
What is Spravato?
Spravato, also known by its generic name esketamine, is a new, FDA-approved antidepressant medication designed to alleviate symptoms of treatment-resistant depression (TRD) in adults. It is a nasal spray formulation of esketamine, a specially formulated derivative of ketamine.
Unlike traditional antidepressants, Spravato works by targeting a mechanism in the brain called the NMDA receptor. Through modulating a chemical called glutamate, a neurotransmitter involved in neural communication, Spravato helps to restore synaptic connections and ultimately increases the release of other mood-regulating neurotransmitters such as serotonin and dopamine, which, in turn, relieves depressive symptoms.
A Brief Overview of Ketamine as an Antidepressant
Ever since the failed D.A.R.E. program, ketamine is perhaps most commonly known as a “horse tranquilizer”. However, ketamine was first developed in the 1960s as an anesthetic for surgical procedures involving soldiers in the Vietnam War. At low doses, ketamine was found to provide pain relief without slowing down the central nervous system, and it quickly gained popularity due to its safety and effectiveness in both human and animal medicine.
Since then, ketamine is used every day in hospitals nationwide for various medical purposes. It is commonly administered intravenously or through injections to induce and maintain anesthesia during surgical procedures. Ketamine’s fast-acting and dissociative effects make it particularly useful in emergency situations and for patients with limited anesthesia options. Ketamine is particularly useful in pediatric settings due to its safety profile and ability to provide sedation and pain relief for children. The versatile nature of ketamine has made it a valuable tool in hospital settings for decades.
Only in the last decade has ketamine had a resurgence in interest as a treatment for mental health conditions such as depression, anxiety, and PTSD. Initially driven by anecdotal reports of patients experiencing significant improvements in their symptoms, the psychiatric benefits of ketamine are backed up by a substantial and growing body of research supporting its effectiveness.
In 2019, the FDA approved a new formulation of ketamine developed specifically for treatment-resistant depression and depressive symptoms. This formulation only uses the “S” molecule found in ketamine, and is therefore called esketamine. Esketamine is the generic name for Spravato. Like traditional ketamine, Spravato has the ability to go to work rapidly. Symptoms tend to improve within just hours after the first infusion compared to the 6–12 week onset period of conventional medications.
How Does Spravato Work?
Unlike traditional antidepressants, Spravato works by targeting a different mechanism in the brain called the NMDA receptor. Glutamate is a neurotransmitter that plays a crucial role in brain function, including learning and memory, and the NMDA receptor is involved in the regulation of glutamate activity. By modulating glutamate, a neurotransmitter involved in neural communication, Spravato helps to restore synaptic connections and increase the release of other mood-regulating neurotransmitters such as serotonin and dopamine.
In addition, Spravato also increases the level of BDNF (Brain-derived neurotrophic factor), a protein that helps to support the growth and survival of neurons in the brain. This can lead to structural changes in the brain and contribute to the long-term effects of ketamine therapy.
What is Spravato Treatment Like?
The Spravato administration process is simple and hassle-free. First, the healthcare professional will ensure that the nasal spray device is assembled correctly and ready for use. They will also assess the patient’s readiness for the treatment session, ensuring they are in a suitable physical and mental state to receive the medication. The healthcare professional will guide the patient on how to self-administer the nasal spray. The patient will use the nasal spray in each nostril, and then wait for a period of time. After the administration, the patient is monitored by healthcare professionals to observe for any immediate side effects or adverse reactions.
Spravato vs. SSRIs
Spravato treatment and selective serotonin reuptake inhibitors (SSRIs) differ in their mechanisms of action and overall approach. Spravato (esketamine) works by targeting the NMDA receptor in the brain, modulating glutamate, and promoting the release of mood-regulating neurotransmitters. In contrast, SSRIs and other antidepressants primarily work by increasing the availability of serotonin by inhibiting its reuptake. These medications often require weeks or even months to reach their full therapeutic effects, while Spravato treatment can take effect in minutes.
This unique approach makes Spravato an exciting addition to the existing treatment options for depression.
What Does Spravato Treat?
Spravato (esketamine) is FDA approved to treat two conditions, Treatment-Resistant Depression (TRD) and Major Depressive Disorder (MDD) with Acute Suicidal Ideation or Behavior.
Treatment-Resistant Depression
Spravato is indicated for adults with treatment-resistant depression. Treatment-resistant depression refers to individuals who have not experienced a satisfactory improvement in depressive symptoms with at least two different antidepressant medications in the current depressive episode.
Major Depressive Disorder (MDD) with Acute Suicidal Ideation or Behavior
Spravato is also approved for use in adults with major depressive disorder who have acute suicidal thoughts or behavior. It can be used in conjunction with an oral antidepressant medication.
It is important to note that Spravato is administered under medical supervision, typically in a healthcare setting, due to safety considerations. It is not available for at-home use, and treatment sessions are closely monitored to ensure the well-being of the patient.
Efficacy and Benefits
While traditional oral antidepressant medicines and psychotherapy are first-line treatment options, Spravato nasal spray has exhibited promising results in clinical trials for the treatment of depression. These trials have shown that Spravato can provide rapid relief from depressive symptoms, often within hours or days. This swift onset of action is particularly advantageous for individuals experiencing severe depressive episodes or acute suicidal thoughts, providing them with much-needed relief and hope.
Although Spravato is a form of ketamine, neither ketamine nor esketamine are considered to be highly addictive substances, and the risk of physical and psychological dependence is considered to be low.
Spravato is not available for at-home use and must be administered under medical supervision in a treatment center. This controlled environment ensures proper dosage, monitoring, and the overall safety of the patient during each treatment session. Treatment centers that offer Spravato provide a supportive and structured environment where patients can receive comprehensive care that includes medication administration, therapy, and monitoring of their progress.
While Spravato has shown promise in helping individuals with treatment-resistant depression, it is essential to consult with healthcare professionals to determine the most suitable treatment approach for each individual’s specific needs. They can assess the potential benefits and risks of Spravato based on the individual’s unique circumstances and guide them through the treatment process.
One study revealed that around 70% of patients with treatment-resistant depression experienced improvement with esketamine and an oral antidepressant. At the same time, just over half of the comparison group who received a placebo showed similar benefits2.
In a phase III trial, 197 participants with moderate to severe treatment-resistant depression were randomly assigned to receive either esketamine or a placebo twice weekly in addition to their antidepressant. The group receiving esketamine alongside the antidepressant saw a more significant decrease in depression scores than the placebo group after 28 days. Impressively, the improvement was noticeable within 24 hours of the initial esketamine dose4.
Another study comparing patients who received esketamine or placebo demonstrated that 53% of those taking esketamine experienced significant symptom improvement. In contrast, only 42% of the placebo group reported similar benefits3.
Who shouldn’t take Spravato?
Esketamine is not appropriate for everyone. Children and teenagers are not candidates for Spravato. Typically, Spravato is used when adults have tried at least two other antidepressants and have not experienced relief from depression symptoms. There is a chance of abuse. Esketamine’s potential for addiction and misuse leads to its Schedule 3 classification5.
Before starting Spravato, tell your healthcare provider about all medications, including over-the-counter products and supplements, as there are significant drug interactions with certain medications. It is also critical to provide a complete physical and mental health history before starting Spravato, especially if individuals have any of the following conditions:
- Currently have or have ever had a history of psychosis.
- Allergy to ketamine, esketamine, or other ingredients in Spravato.
- History of vascular conditions in the brain or other body parts, such as aneurysmal vascular disease or arteriovenous malformation.
- Cardiovascular, cerebrovascular disease, or heart disease.
- History of drug abuse
- Hypertension or stroke
- Liver disease (moderate to severe
- History of brain injury, including changes in pressure in the brain or bleeding in the brain
- If you are pregnant or planning to become pregnant.
Side Effects of Spravato Treatment
Like any medication, Spravato (esketamine) nasal spray can have side effects. It is important to be aware of potential side effects and discuss them with your healthcare provider before starting Spravato treatment. Spravato treatment has Some common side effects that have been reported in clinical trials and real-world use of Spravato include:
Dissociation
Dissociation is a temporary feeling of detachment or distance from reality. It can also feel like you are disconnected from your thoughts or surroundings. Dissociation is one of the most commonly reported side effects of Spravato, and although it can be disorienting and uncomfortable, this side effect normally passes quickly.
Dizziness
Many people experience dizziness, lightheadedness, or vertigo after Spravato is administered. Because of this, a Spravato provider at a treatment center will likely suggest that you sit or lie down during and after the administration of the medication to minimize dizziness.
Nausea
Sometimes, Spravato can cause feelings of nausea, but this is usually just a result of the dizziness and dissociation. This side effect is usually mild and transient.
Increased Blood Pressure
Spravato may cause a temporary increase in blood pressure. Healthcare providers closely monitor blood pressure during treatment Spravato treatment sessions to ensure patient safety. During your treatment session, if you experience energy, increased blood pressure, increased heart rate, high blood pressure, or anxiety, just let your provider know, and they will take measures to mitigate those symptoms.
Hypoesthesia (reduced sense of touch)
Hypoesthesia is the medical term for loss of sensation and is a side effect of Spravato treatment. This is a temporary feeling, but if it persistent well beyond treatment, let your provider know immediately.
Less Common Side Effects
- Dysgeusia (reduced sense of taste)
- Dry mouth
- Constipation
- Diarrhea
- Anxiety
- Slurred or slow speech
- Tremors
- Euphoric mood
- Frequent urination
- Nasal or throat irritation or pain
- Sweating
There is potential for some individuals taking esketamine to experience more severe side effects. If you or someone you know experiences suicidal thoughts or behaviors about harming yourself, you should contact a health provider immediately. Individuals taking esketamine should not suddenly stop taking it, even if they feel better. Missing a dose or stopping esketamine can increase the risk of relapse and depression symptoms.
It is essential to discuss any side effects experienced with your healthcare provider. They can provide guidance on managing these effects or adjust the treatment plan if necessary. Not all individuals will experience these side effects, and some may experience different or additional side effects. Your healthcare provider will provide personalized information based on your specific situation and medical history.
Find Out if You Can Benefit From Spravato
Spravato treatment continues to rise in popularity because of the groundbreaking results that it offers individuals suffering from psychological and physical conditions. At Neuro Wellness Spa, we are committed to helping you regain your confidence, health, and life. We offer in-person and online psychiatry for medication management, and alternative treatments like TMS therapy, and integrative brief talk therapy program.
If you or somebody that you know could benefit from mental health treatment, or you want to learn more about Spravato don’t wait any longer to give us a call. Our team of psychiatrists and therapists is here to answer any questions you may have and give you more information on the best mental health treatment for you.
References
- Major Depression. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/major-depression
- Chen, J. (2022). How Ketamine Drug Helps with Depression. Yale Medicine. https://www.yalemedicine.org/news/ketamine-depression#:~:text=Interestingly%2C%20studies%20from%20Yale%20research%20labs%20showed%20that,prompts%20the%20brain%20to%20form%20new%20neural%20connections.
- Jalloh M. (2020). Esketamine (Spravato) for Treatment-Resistant Depression. American family physician, 101(6), 339–340.
- Popova, V., Daly, E. J., Trivedi, M., Cooper, K., Lane, R., Lim, P., Mazzucco, C., Hough, D., Thase, M. E., Shelton, R. C., Molero, P., Vieta, E., Bajbouj, M., Manji, H., Drevets, W. C., & Singh, J. B. (2019). Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study. The American journal of psychiatry, 176(6), 428–438. https://doi.org/10.1176/appi.ajp.2019.19020172
- LaBruna, H. (2022). Ketamine for treatment-resistant depression: What you need to know. Mayo Clinic. https://mcpress.mayoclinic.org/living-well/ketamine-for-treatment-resistant-depression-what-you-need-to-know/