 Treatment as Part of a Depression Relapse Prevention Plan){kind=link}
Although millions of people are empowered to coexist with their Depression through comprehensive and personalized treatment plans, the long-term management of this condition can often be complicated by the potential risk of relapse. Instances of relapse or breakthrough Depression are especially common when dealing with treatment-resistant Depression (TRD), in which a patient’s symptoms persist or worsen despite ongoing treatment.
In light of this challenge, experts are turning toward esketamine, sold under the brand name Spravato, as an important component in any standard Depression relapse prevention plan—an intervention with the potential to help patients everywhere circumvent the dangers of TRD relapse.
Studying Esketamine and TRD
Instead of impacting serotonin like traditional SSRIs do–esketamine, or Spravato, acts upon the body’s glutamate system which plays a crucial role in mood regulation. Esketamine was approved by the U.S. Food and Drug Administration (FDA) in 2019 as a treatment for Depression, making it a novel adjunctive treatment option when administered in conjunction with traditional antidepressants. Given its relatively recent approval, Spravato’s long-term efficacy and effects are actively being studied by clinicians across the globe.
Efficacy of Esketamine (Spravato) in Relapse Prevention
Administered as a nasal spray under medical supervision, the onset of esketamine’s benefits can occur in as little as a few hours, providing rapid relief from TRD as opposed to traditional antidepressants, the benefits of which take weeks—even months—to manifest. But beyond its acute benefits, how effective is esketamine on TRD over longer periods of time?
In 2019, coinciding with esketamine’s official approval, researchers published their findings in the Journal of the American Medical Association of the first controlled maintenance study of esketamine. This three-year, phase 3, multicenter, double-blind, and randomized withdrawal study investigated esketamine’s long-term efficacy on 455 patients. Of these patients, 297 adults achieved stable remission or response after 16 weeks or treatment and were subsequently entered into a randomized maintenance phase that occurred between 2015 and 2018. Patients who achieved stable remission and those who achieved stable response (without remission) were randomized 1:1 to continue esketamine nasal spray or discontinue esketamine treatment and switch to placebo nasal spray, with oral antidepressant treatment continued in each group.
Based on hazard ratio (HR) estimates, the combination of esketamine and antidepressants decreased the risk of relapse among the stable remission subgroup by 51%. Among those who had achieved a stable response, esketamine and antidepressants decreased the risk of relapse by 70% as compared to the placebo group.
In summation, the study concluded that using the continued use of esketamine offers more potent effects than oral antidepressants alone; when used in conjunction with antidepressants, esketamine produces “significant, clinically meaningful” results among patients at risk of a TRD relapse, “supporting a positive benefit-risk ratio of long-term treatment.”
Integrating Esketamine in a Comprehensive Depression Relapse Prevention Plan
While research shows that esketamine holds definitive promise as a standalone treatment, its true potential is realized when integrated into a multifaceted Depression management strategy; for individuals struggling with a history of acute Depression, preventing relapse requires ongoing and attentive care. Alongside cognitive behavioral therapy (CBT) and prescribed antidepressants, esketamine can also be used in conjunction with transcranial magnetic stimulation (or TMS), to further reduce the risk of relapse.
Preventing TRD Relapse with Mid City TMS
Formulating a diligent Depression relapse prevention plan plays a crucial role in overcoming the ongoing challenges of TRD. Mid City TMS is proud to be a licensed esketamine Spravato treatment center, as well as a longstanding provider of reliable TMS services to thousands of New York residents. Contact us today to learn more about how these two alternatives can dramatically decrease your risk of facing a depressive relapse.