Spravato®
(Esketamine)
Spravato® is an FDA-Approved esketamine nasal spray treatment that works differently than traditional antidepressants, providing rapid relief for treatment-resistant depression and acute suicidal ideation in a safe, monitored setting.
Esketamine is a derivative of ketamine, which has been used for decades as an anesthetic. Esketamine acts on the N-methyl-D-aspartate (NMDA) receptor in the brain, which plays a role in mood regulation. Unlike traditional antidepressants, which target neurotransmitters such as serotonin and norepinephrine, esketamine works through a different mechanism, leading to rapid onset of antidepressant effects.
How it Works
The exact mechanism of action of Spravato® in treating depression is not fully understood, but it is believed to involve modulation of glutamate signaling in the brain.
Glutamate is the most abundant neurotransmitter in the brain and is involved in various brain functions, including learning, memory, and mood regulation. By targeting the NMDA receptor, Spravato® may help restore balance to glutamate signaling, leading to improvements in mood and cognition.
Spravato® is administered as a nasal spray under the supervision of a healthcare provider in a certified treatment center. The dosage and frequency of treatment vary depending on individual response and tolerability. Typically, you may receive Spravato® twice weekly for the first four weeks, followed by maintenance doses as needed. Each treatment session lasts approximately two hours, including monitoring for side effects.
Week 1–4
Two treatments per week
Week 5–8
One treatment per week
Week 9+
Maintenance doses as needed
Efficacy
Clinical trials have demonstrated the efficacy of Spravato® in reducing symptoms of depression in patients with treatment-resistant depression (TRD).
In a pivotal study, patients receiving Spravato® in conjunction with an oral antidepressant experienced significantly greater improvement in depressive symptoms compared to those receiving a placebo nasal spray with an oral antidepressant. Importantly, some patients experienced rapid relief within hours of receiving Spravato®, which is notable given the delayed onset of action of traditional antidepressants.
Safety & Side Effects
While Spravato® has shown promise as a treatment for TRD, it is not without risks. The most common side effects reported during clinical trials include dissociation, dizziness, nausea, sedation, and increased blood pressure.
As a result, patients must be monitored closely during and after treatment sessions to ensure their safety. Additionally, due to the risk of dissociation and sedation, you are advised not to drive or operate heavy machinery for the remainder of the day after receiving Spravato®.
Spravato® is contraindicated in the following conditions:
- Aneurysmal vascular disease
- Intracerebral hemorrhage
- Hypertension
- Cognitive impairment (attention, judgment, thinking, reaction speed, motor skills)
- Hypersensitivity to esketamine, ketamine, or any excipients
Considerations for Use
Spravato® is indicated for use in adults with TRD who have not responded adequately to other treatments. It is not intended as a first-line therapy for depression and should be reserved for patients who have exhausted other options.
Before initiating treatment with Spravato®, healthcare providers should conduct a thorough assessment to determine the appropriateness of the treatment and discuss potential risks and benefits with their patients.
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