Close-up side view of a lonely woman sitting at home with sad look

When it comes to treating treatment-resistant Depression (TRD), finding an effective and tolerable option can be challenging. Two medications used for TRD are Spravato (esketamine nasal spray) and Quetiapine (Seroquel XR), whose side-effect profiles and overall efficacy differ significantly. This blog post delves into the differences between Spravato and Quetiapine and provides insights into which might be the better option for those suffering from TRD.

What is Spravato?

Spravato (esketamine) is an FDA-approved nasal spray usually used in conjunction with an oral antidepressant for adults with TRD. Unlike traditional antidepressants that impact serotonin, norepinephrine, and dopamine, esketamine works on the glutamate system, offering a novel approach to Depression treatment. This mechanism can provide rapid relief, often within hours to days, compared to the weeks required for conventional antidepressants.

What is Quetiapine?

Quetiapine, marketed as Seroquel, is an atypical antipsychotic often used off-label to treat Depression, including TRD. It works by modulating neurotransmitters such as dopamine and serotonin, helping to balance mood and alleviate depressive symptoms. Quetiapine is typically used when other antidepressants have failed to produce the desired effect.

Comparing Efficacy: Spravato vs. Quetiapine

A recent study published in the New England Journal of Medicine compared the efficacy and safety of Spravato and Quetiapine in patients with TRD. The study found that:

  • Remission Rates: At eight weeks, 27.1% of patients in the Spravato group achieved remission, compared to just 17.6% in the Quetiapine group.
  • Sustained Response: Over 32 weeks, patients in the Spravato group maintained better remission rates (21.7%) compared to those in the Quetiapine group (14.1%).

These findings indicate that Spravato may offer superior efficacy in treating TRD, particularly for those who have not responded to other treatments​.​

Side Effects of Spravato

While Spravato can be highly effective, it is not without side effects. Common acute side effects include:

  • Dissociation: Patients may experience feelings of detachment or being disconnected from their surroundings.
  • Dizziness: Lightheadedness or vertigo can occur, particularly shortly after administration.
  • Sedation: Some patients may feel fatigued for up to 90-120 minutes after administration.
  • Nausea and Vomiting: Gastrointestinal discomfort is an uncommon side effect, occurring in less than 5% of patients.
  • Increased Blood Pressure: Blood pressure can rise temporarily following administration.

Despite these side effects, most patients find them manageable, especially given that they are temporary and the rapid benefits that Spravato can provide. Monitoring by healthcare professionals during and after administration also helps mitigate some of these risks.

Side Effects of Quetiapine

Quetiapine is also associated with  side effects, which can be more challenging for some patients:

  • Weight Gain: Significant weight gain is a common side effect.
  • Sedation: Quetiapine often causes drowsiness and may impair daily functioning, particularly when taken at higher doses.
  • Orthostatic Hypotension: A drop in blood pressure upon standing can lead to dizziness or fainting.
  • Metabolic Changes: Increased risk of diabetes and elevated cholesterol levels are concerns.
  • Extrapyramidal Symptoms: Involuntary muscle movements, though less common, can occur, especially with long-term use.

These side effects can be particularly troublesome for older adults or those with pre-existing health conditions, making Quetiapine a less attractive option for some patients.

Choosing the Right Treatment

When choosing between Spravato and Quetiapine for TRD, it’s essential to consider both efficacy and side effect profiles. Spravato offers rapid and significant relief for many patients, with side effects that are generally manageable under medical supervision. On the other hand, Quetiapine, while effective for some, carries a higher risk of long-term metabolic and weight-related side effects, which can be detrimental to overall health.

Seeking Help at Mid City TMS

At Mid City TMS, we specialize in providing cutting-edge treatments for Depression, including Spravato therapy. Our experienced team is dedicated to helping patients find the most effective and least burdensome treatment options. If you or a loved one is struggling with TRD, we invite you to explore the benefits of Spravato under the guidance of our skilled professionals.

At Mid City TMS, we are committed to offering the best possible care, ensuring that each patient receives a treatment plan tailored to their unique needs.  For more information on Spravato therapy and to schedule a consultation, contact Mid City TMS. Let us help you take the first step towards reclaiming your mental health and well-being.