Spravato for depression is an FDA-approved treatment that’s helping people with severe, treatment-resistant depression find relief. In this article, we’ll explore what Spravato is, how it works in the brain, how it compares to ketamine, and whether it might be the right option for you.
Understanding Spravato?
Spravato is the brand name for esketamine, one of two mirror-image molecules (enantiomers) that make up ketamine. Ketamine is a medication that was initially developed for anesthesia, but has since emerged as a promising mental health treatment.
Janssen Pharmaceuticals, part of Johnson & Johnson, developed Spravato as a nasal spray formula specifically to treat depression. The FDA approved Spravato for treatment-resistant depression (TRD) in 2019, offering hope for patients who haven’t found relief from standard antidepressants. Spravato was approved for major depressive disorder with suicidal ideation (MDSI) one year later, and more than 90,000 patients in the U.S. are reported to have used it since.
How Spravato Works in the Brain
Spravato works differently from conventional antidepressants. Whereas drugs like SSRIs and SNRIs target serotonin, a chemical messenger involved in mood, Spravato affects glutamate. This neurotransmitter plays a crucial role in learning, memory, and neural communication in the brain.
By blocking certain types of NMDA receptors, Spravato increases glutamate transmission and boosts neural activity in the prefrontal cortex (PFC). This brain area is crucial for regulating mood and emotion and is often underactive in depression.
Glutamate also plays a crucial role in learning, memory, and neuroplasticity — the brain’s ability to form and reorganize neural networks. Neuroplasticity helps in depression treatment through different mechanisms, including:
- Promoting the growth of nerve cells, potentially restoring damage to areas caused by chronic stress
- Helping “re-wire” neural networks associated with unhealthy thinking and behaviour patterns
- Increasing flexibility of thinking, allowing patients to “break free” of negative thought cycles
Spravato vs. Ketamine: What’s the Difference?
If you’re struggling with severe depression, both Spravato and ketamine could be promising options. Here are some key differences between the two medications.
Potency
Both Spravato and ketamine interact with NMDA receptors, influencing glutamate and promoting neuroplasticity. However, Spravato interacts more strongly with these proteins, and so lower doses are typically used in treatment. This reduces the risk of side effects.
Uses
Spravato is only available if you have a formal diagnosis of TRD or MDSI. Meanwhile, ketamine is being used off-label for several different mental health disorders, including anxiety, post-traumatic stress disorder (PTSD), and substance abuse disorders.
Adminstration
Because Spravato is FDA-approved, healthcare providers must follow a strict protocol when administering Spravato. The Spravato Risk Evaluation and Mitigation Strategy (REMS) outlines that Spravato can only be used in a registered clinic, and patients must be observed for at least two hours after treatment. Conversely, there is no regimented protocol for ketamine use, and prescriptions can be made for at-home use.
Whereas ketamine can be administered in various forms—including intravenous (IV) infusions, nasal sprays, and oral tablets—Spravato is only available as a nasal spray.
Higher-dose IV infusions of ketamine can cause a psychedelic state, which can be transformative when combined with therapeutic support. We provide this type of ketamine therapy at Kadelyx. In contrast, the psychoactive effects of Spravato are milder.
Costs
Spravato has a much higher upfront cost than ketamine. However, due to its approval, most insurance companies cover the medication costs. You’ll typically only need to cover deductibles, copays, and evaluation fees, which will vary depending on your treatment plan.
While ketamine therapy is rarely covered by insurance, some clinics are more affordable than others and provide financial support to those in need. At Kadelyx, we give a 15% discount on treatment to all Veterans, Healthcare Workers, and School Teachers.
Effectiveness
Spravato and ketamine have similar effectiveness in reducing depression symptoms. However, IV ketamine may provide relief more quickly.
What to Expect from Spravato Treatment?
At Kadelx, we’re a trusted provider of Spravato in Phoenix, Arizona. Here’s what you can expect from treatment at our clinic:
1. Initial evaluation: Our medical team will assess your patient history to determine whether Spravato is right for you
2. Supervised administration
You’ll self-administer the nasal spray under the supervision of our healthcare professionals, who will guide you through the process and ensure you feel comfortable and supported.
3. Monitoring period
You’ll be observed for two hours post-treatment to ensure that side effects subside sufficiently before you go home. You’ll need to have a lift organised as it’s illegal to drive after Spravato.
4. Follow-up care
You’ll meet with a healthcare provider to assess your response to the medicine and develop a personalized treatment plan based on your needs.
Treatment typically involves twice-weekly treatments for four weeks in the initial phase, followed by weekly doses for the next four weeks. After week nine, patients are typically given one dose every two weeks.
Is Spravato Safe?
While Spravato is considered safe when administered properly, like any medication, it can cause side effects.
Common Physical Side Effects Include:
- Dizziness
- Nausea
- Increase in blood pressure and heart
- Drowsiness or fatigue
Common Psychological Effects May Include:
- Dissociation – feeling separate from your body
- Confusion
- Changes in perception
Patients are monitored closely during and after each session to manage any adverse reactions.
Potential Long-Term Risks
Research so far suggests that Spravato has a low risk of dependence or withdrawal when used under medical supervision. However, as with any relatively new treatment, the long-term safety data is still evolving. Regular follow-ups are crucial to monitor ongoing effectiveness and potential risks.
Am I Eligable for Spravato?
Diagnostic Criteria
You may be eligible for Spravato if:
- You have a diagnosis of Major Depressive Disorder (MDD): This must be confirmed by a qualified mental health professional.
- Your depression is classified as treatment-resistant: This means you have not responded adequately to at least two different antidepressant medications of adequate dose and duration during your current depressive episode.
- You’re judged to be at risk of suicide: This needs to be confirmed by a clinician, and you shouldn’t have any psychotic features.
Exclusion Criteria
You may not be eligible for Spravato if any of the following apply:
- History of certain cardiovascular diseases
- Uncontrolled hypertension: Elevated blood pressure that is not well-managed poses a risk.
- Pregnancy or breastfeeding: Spravato may pose risks to the fetus or infant.
- Known hypersensitivity to esketamine, ketamine, or any of the formulation’s components
You must take an oral antidepressant along with Spravato and refrain from using any other ketamine therapies throughout the treatment course.
If you’re unsure whether you’re eligible for Spravato, you can book a free consultation with our team at Kadelyx, and our healthcare providers can assess your suitability based on your patient history.
Benefits of Spravato for Depression
1. Provides hope for treatment-resistant depression
For individuals who haven’t responded to multiple antidepressants, Spravato offers a viable alternative. In clinical trials involving TRD patients, more than 50% reached remission when Spravato was combined with an oral antidepressant.
2. Rapid Relief of Symptoms
Unlike SSRIs and SNRIs, which often take weeks to become effective, Spravato can deliver noticeable mood improvements within hours or days. This makes it especially valuable for patients in crisis.
3. Sustained Improvement in Symptoms
Spravato’s antidepressant effects can last for several days post-dose, and it does not need to be taken daily. This intermittent dosing schedule may reduce the risk of developing drug tolerance.
In one extensive study, patients with TRD saw sustained symptom relief after a month of twice-weekly treatments. Continued, less frequent dosing maintained these benefits for up to 42 weeks.
4. Reduction of Suicidal Thoughts
Spravato has been shown to quickly reduce suicidal ideation, making it an important option for emergency mental health situations. Clinical studies show that participants experience a significant drop in suicidal thoughts within 24 hours of treatment when used alongside standard care.
5. FDA-Backed Safety and Efficacy
FDA approval ensures that Spravato has undergone rigorous testing. It can only be administered according to guidelines designed to ensure patient safety and optimal therapeutic outcomes.
6. Insurance Coverage
Most major insurance companies, including Medicare and Medicaid, cover the costs of Spravato, making it an affordable option for patients.
Spravato Treatment in Phoenix, Arizona
Kadelyx is a leading provider of Spravato in the heart of the Phoenix area. Our experienced team of medical professionals is dedicated to ensuring your safety and comfort throughout the entire treatment process. Unlike other Spravato clinics, we offer integration support, helping you maximize the benefits of Spravato and promote overall well-being.
Get in touch to find out more about our services and how we can help.
