Spravato for depression is an FDA-approved nasal spray treatment that offers fast-acting relief for adults struggling with treatment-resistant depression. It’s derived from ketamine and has similar rapid-acting antidepressant effects. In this article, we’ll explain what Spravato is, how it works in the brain, what makes it different from standard treatments and ketamine, and who it’s for.
What Is Spravato?
Spravato is the brand name for esketamine, a molecule derived from ketamine. Esketamine is an enantiomer of ketamine, meaning it is one of the two mirror-image molecules that make up ketamine in its generic form.
Spravato is specifically used to treat depression, unlike ketamine, which is used to treat many different mental health disorders. It comes as a nasal spray, which patients self-administer under the guidance of mental health professionals at an approved clinic. The FDA approved Spravato for treatment-resistant depression (TRD) in 2019, and it’s estimated that over 140,000 patients have since received the medicine.
Who Is Spravato For?
Spravato is approved for adults with a formal diagnosis of major depressive disorder (MDD) who meet one of the two conditions:
- Treatment-Resistant Depression (TRD) – Tried at least two standard antidepressants at the maximum recommended dose for at least six months with no significant response.
- Major Depressive Disorder with Suicidal Ideation (MDSI) – Judged to be at risk for suicide by a clinician.
Patients must also agree to continue using standard antidepressant therapies in addition to Spravato.
There are some instances where patients aren’t eligible to receive Spravato because of the drug’s risk profile. This includes certain types of cardiovascular diseases, and if the patient is receiving other types of ketamine therapy at the time of treatment.
How Does Spravato Work?
Spravato has the same mechanism of action as ketamine, which involves blocking proteins called NMDA receptors in the brain. These receptors normally respond to the chemical messenger glutamate, which drives nerve cell communication in the brain.
Spravato blocks NMDA receptors on inhibitory neurons, which leads to increased glutamate signaling and overall brain activity. This effect helps boost activity in underactive areas of the brain, such as the prefrontal cortex (PFC).
Spravato also increases synaptic plasticity, the ability to form and reorganize connections between nerve cells. This process can help strengthen neural pathways in the brain that may be underactive in depression. It can also facilitate people to more easily adopt healthy coping strategies and overcome negative cycles of thinking.
What Makes Spravato Different from Regular Antidepressants?
One of the most significant advantages of Spravato is how quickly it works. While traditional antidepressants like SSRIs (selective serotonin reuptake inhibitors) often take weeks to start working, many people feel relief from Spravato in hours or days.
Another significant difference is that Spravato can help people who haven’t responded to any other treatments. Many individuals with TRD have tried several medications without success. Spravato offers them a promising option.
Moreover, antidepressants can cause ongoing side effects, such as weight gain, sexual dysfunction, and sleep problems, that affect daily life. Spravato, however, has mild side effects that tend only to last a couple of hours following treatment administration.
Clinical Evidence for Spravato for Depression
Spravato’s effectiveness has been tested in several clinical studies. One of the largest studies is SUSTAIN-1, which included over 700 adults with TRD.
After four weeks of using Spravato, about 65% of the patients had a significant improvement in their symptoms. This means their depression symptoms were cut in half or more. These improvers continued to use Spravato, and by the end of 12 weeks, 52% were in remission, meaning they no longer met the criteria for clinical depression.
What Are the Side Effects?
Like any medication, Spravato can cause side effects. The most common ones include:
- Nausea
- Dizziness
- Dissociation (a feeling of being detached from your body or surroundings)
- Fatigue
- Increased blood pressure (usually temporary)
These effects usually happen soon after the treatment and fade within a couple of hours. That’s why patients are monitored in the clinic for at least two hours after each session.
How Is Spravato Different from Ketamine?
Spravato and ketamine are closely related and work in similar ways in the brain. However, they have some important differences.
Spravato is FDA-approved and given only as a nasal spray under medical supervision. Ketamine, on the other hand, is not approved by the FDA for depression, though it is used “off-label” for this purpose. Ketamine can be given in several ways, including IV infusions, intramuscular injections, oral tablets, or nasal spray.
Some studies suggest that ketamine may act even faster than Spravato and may require fewer sessions. Ketamine also tends to produce stronger psychedelic or mind-altering effects, which some people find helpful for emotional insight or personal growth.
Whereas Spravato is only given for TRD and MDSI, people can receive ketamine for a wide range of conditions, including:
If you’re interested in exploring any of these benefits of ketamine, then be sure to check out our services at Kadelyx in Phoenix, Arizona. Our bespoke clinic provides guided IV ketamine services tailored to suit the unique needs of each patient. Our compassionate and knowledgeable team is here to help you take the next step toward healing.
Key Takeaways
- Spravato is an FDA-approved nasal spray treatment for adults with treatment-resistant depression or suicidal thoughts.
It works by blocking NMDA receptors in the brain, which boosts activity and increases synaptic plasticity. - Spravato acts quickly, with many patients feeling better within hours or days.
- Clinical studies show that patients improve with Spravato after only a few weeks.
- It is different from ketamine, but both can offer hope when other treatments haven’t worked.
