Esketamine Nasal Spray Spravato for Treatment Resistant Depression

Esketamine Nasal Spray Spravato for Treatment Resistant Depression

In addition to TMS, the team at Mid City TMS is excited to be able to now offering for over a year now Spravato for treatment resistant depression.  To be considered treatment-resistant and eligible for insurance coverage for Spravato, a person has to have tried at least two other antidepressant medicines without benefit.  We have been very impressed with how effective and safe it has been in the patients we have treated with it so far.

Spravato is the brand name of a nasal spray that uses the drug esketamine. Some researchers and physicians say that esketamine is a revolutionary drug, as this is the first drug to take immediate effect when it comes to treatment resistant depression. When we take a closer look at the research behind this drug, the evidence gathered from the studies is promising and exciting.

What Is Esketamine Nasal Spray Spravato for Treatment Resistant Depression?

The active drug ingredient in Spravato is esketamine, which is a form of ketamine. Ketamine has been used widely as an anaesthetic, and approved by the FDA, since the 1970s.

Although the name ketamine might conjure up images of the party drug “Special K” and its adverse side effects, ketamine is actually the safest and cheapest anaesthetic on the market. Ketamine does not slow down a patient’s breathing or lower their blood pressure, and the drug does not need to be refrigerated, all of which cuts down on machinery and anesthesiology costs.  These factors make ketamine a crucial drug in areas where equipment and anaesthesiologists are limited, such as during natural disaster relief areas.

In the last few years, intravenous delivery of ketamine has grown increasingly popular in treating depression in clinics around the country. However, this version and method of treatment is not FDA approved for treatment-resistant depression and generally not covered by health insurance.

In early 2019, the FDA approved esketamine nasal spray Spravato for treatment resistant depression if taken in conjunction with an oral antidepressant. Spravato must be taken by patients using a Risk Evaluation and Mitigation Strategy (REMS), meaning that patients can only take the drug in a doctor’s office under their physician’s supervision by a REMS certified practitioner. The typical course of treatment involves twice weekly sessions for the first month and then tapering to once a week sessions for the next month and then every one to two weeks if maintenance treatment is decided to be a good option. In accordance with the REMS, after you take Spravato you’ll need to stay at the office for at least two hours so that we can observe you for sedation, dissociation, and blood pressure changes, and decide when it’s safe for you to go. Make arrangements for transportation; after taking Spravato, you should not drive or operate heavy machinery until the next day, following a restful sleep.

Why Is Spravato for Treatment Resistant Depression Receiving So Much Attention?

The esketamine nasal spray has many researchers excited because it is the first drug to produce immediate, noticable effects in patients with treatment resistant depression.

After just 24 hours of the initial dosing, the patients in this pivotal 2018 study who received esketamine in addition to antidepressants had an average improvement of 3.3 in their Montgomery-Asberg Depression Rating Scale (MADRS) compared to the group receiving the placebo and antidepressants. Furthermore, this level improvement lasted for an average of up to nine weeks even as frequency of administration of esketamine tapered off. In general, the esketamine doses evaluated in this study (28, 56, and 84 mg) appeared to be safe, with no new or unexpected safety concerns observed. Transient increases in blood pressure, particularly increases in systolic blood pressure, occurred and resolved within 2 hours. Perceptual change symptoms can occur shortly after initiation of esketamine and resolution occurs by 2 hours after administration.

How Does Spravato Work?

Spravato for treatment resistant depression works in several ways, including by blocking certain glutamate receptors. Glutamate is a kind of neurotransmitter. Neurotransmitters are chemicals used to send internal messages to different parts inside of our bodies. These messages are transferred through our brain by connectors called synapses.

Glutamate is present inside more than half of all synapses in our brain. Unlike antidepressants which usually target only one brain connection at a time, ketamine can target many neural pathways at the same time. Ketamine therefore has the ability to increase our brain’s internal communication skills, a brain function that often does not work optimally when people are depressed.

What Are The Concerns of the Studies on Spravato for Treatment Resistant Depression?

Although the results of the studies showed that Spravato is an effective medicine for treatment resistant depression, some researchers have lingering concerns.

One concern is that a number of patients who had been given esketamine in studies experienced their depressive symptoms worsen after the trial ended.  For example, in one study, 40% of patients who had been taking esketamine had relapses within 3-4 months after the treatment course was ended.

Ultimately, more research needs to be undertaken and larger studies need to be conducted before we can reach conclusive results, especially about long term effectiveness and safety.

Should I Use Spravato for Treatment Resistant Depression?

The studies so far have shown that Spravato coupled with conventional antidepressants works more efficiently than antidepressants alone.   As you will know already if you or a loved one has treatment resistant depression, finding an effective treatment plan can be very difficult. And even when you do manage to find an effective treatment plan, it can often take weeks or months to reap the benefits. This may not sound like a long time to some people, but to people living with depression—especially those with suicidal thoughts—that time frame can be far too long.

If you and your physician agree that you have exhausted traditional depression treatments, then it is worthwhile to consider trying Spravato for treatment resistant depression. Taking Spravato helps the majority of patients with treatment resistant depression feel better within a day rather than weeks or months. This instant relief is especially important if you or a loved one are experiencing suicidal ideation.

What is the Best Effective Method for My Treatment Resistant Depression?

There has been a long-standing need for additional effective treatments for treatment-resistant depression, a serious and life-threatening condition.  Thankfully, TMS produces positive results in about 70% of patients with treatment resistant depression. However, it does not work for everyone.  Spravato is usually an instantaneous and effective treatment.  It can be a good next step in treatment for the few patients who do not benefit from TMS.

Contact us today to learn more about how TMS or Spravato can help you.

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