In New York City, the fast pace and constant pressure can exacerbate Depression—especially for those who’ve tried multiple antidepressants with limited success. That’s why we’ve built out a Spravato medication guide that includes the most up to date research about the incredible potential of esketamine treatment.
One groundbreaking study, SUSTAIN‑3, offers hope: long-term data and our own experience at Mid City TMS demonstrates that Spravato nasal spray plus an antidepressant is both safe and effective, even over several years, for individuals with treatment-resistant Depression (TRD).
At Mid City TMS, we stay at the forefront of Depression treatment—whether you’re considering neuromodulation via TMS or exploring advanced pharmacologic interventions like Spravato. Here’s what NYC patients need to know about this evolving landscape.
The Turning Point for Treatment-Resistant Depression in NYC: Your Spravato Medication Guide
For patients who have tried multiple antidepressants without adequate relief, Spravato represents a fundamentally different approach to treating Depression. Unlike traditional medications that can take weeks to show benefits, Spravato works through a distinct mechanism—targeting NMDA receptors to rapidly influence brain chemistry and promote neural connectivity.
This Spravato medication guide will highlight some important research to help you understand what to expect from Spravato treatment. From your initial consultation through long-term maintenance, Mid City TMS is here to empower you to make informed decisions about your care.
Why SUSTAIN‑3 Matters: A Deep Dive into the Study
Understanding the long-term effectiveness and safety of any Depression treatment is essential for patients weighing their treatment options. 2023’s SUSTAIN‑3 study provides crucial data that helps answer the question many patients with treatment-resistant Depression ask: “Will this work for me not just now, but over the long term?”
Study Design & Scale
SUSTAIN‑3 is a phase 3, open-label, long-term extension study assessing flexibly dosed Spravato nasal spray alongside an oral antidepressant for up to 6.5 years in adults with TRD. This extended timeframe is particularly valuable because it goes far beyond typical clinical trial durations, offering insight into how the treatment performs in real-world, ongoing use.
Participants entered either through an initial 4-week induction or directly into a variable-duration optimization/maintenance phase allowing researchers to track outcomes across different patient trajectories.
SUSTAIN-3’s Findings: Stability & Relief Over Time
The study demonstrated both rapid initial improvement and sustained long-term benefits. During the induction phase, average scores on the MADRS scale—a standardized measure of Depression severity—dropped by −12.8 points (SD 9.73), signaling rapid improvement in symptoms.
More importantly, this benefit endured over time; during the maintenance phase, the average MADRS change was a modest +1.1 points (SD 9.93) — showing stability rather than relapse, which is an area of major concern with Depression treatments.
The remission data tells an even more compelling story; remission rates (MADRS ≤ 12) were 35.6% at the end of induction—and improved to 46.1% during maintenance. Final datasets show remission approaching 48–50% sustained over years suggesting that continued treatment may actually enhance outcomes rather than merely maintaining them.
Spravato’s Long-Term Effects and Safety
Long-term safety is a primary concern for any treatment protocol, and SUSTAIN‑3 provides reassuring data on this front. No new safety signals were identified over the lengthy follow-up—despite up to 4.5 years of intermittent Spravato treatment. This finding is particularly important because it indicates that the side effect profile remains predictable and manageable over extended use.
Adverse events (AEs) were generally transient and occurred specifically on dosing days with common examples including headache, dissociation, and dizziness that typically resolved within hours. A small percentage of participants had serious AEs (~14.9%), including some deaths—typically unrelated to treatment (e.g., COVID-19, myocardial infarction, one completed suicide).
Additionally, cognitive function remained stable over time, with no evidence of decline in working-age adults—an important consideration for patients concerned about their ability to maintain work and daily responsibilities.
New Findings: Durable Response Even After Relapse
Depression is often a recurrent condition, and understanding how treatments perform during subsequent courses is clinically valuable. Another subgroup analysis looked at patients who initially relapsed and underwent a second induction phase of Spravato. Response rates were robust (~72%), with remission in ~62%, and no new safety concerns during retreatment. This data implies that patients who experience a return of symptoms can benefit from restarting treatment with similar effectiveness to their initial course.
The Implications of Spravato Treatment in NYC:
These research findings translate into a number of tangible benefits for patients seeking Depression treatment through the use of Spravato in New York City—and beyond. Consider our Spravato medication guide highlights for how this treatment can work to your advantage.
1. More than a Quick Fix: Spravato Offers Long-Term Relief
Relapse is common in TRD—nearly 70% of patients relapse within 6 months after any initial treatment. Spravato however, as shown by the SUSTAIN‑3 trial, offered patients sustained improvement lasting years, offering hope for durable relief rather than temporary respite. This sustained benefit can be especially impactful for New Yorkers juggling demanding academic programs or high-stress careers, where stability in mental health directly affects the ability to maintain performance and quality of life.
2. Built-In Safety: A Comforting Advantage
Knowing that serious AEs are uncommon and transient side effects happen only on dosing days helps patients feel safer choosing Spravato over the uncertainty of repeated medication switching. For patients who have already experienced numerous medication trials without success, this predictability can reduce treatment-related anxiety and instill new hope.
3. Immense Flexibility: Perfect for the NYC Lifestyle
Spravato protocols are individualized based on patient response and symptom stability. Some patients dose weekly; others every two or four weeks, based on symptom severity and how well they maintain improvement. That flexibility can be especially helpful for patients who have busy schedules with work commitments, long commutes, family responsibilities, or academic demands that make rigid treatment schedules more challenging to maintain.
4. Continuity: Real-World Relief
Patients with treatment-resistant Depression often benefit not only from initial remission but from the ability to regain relief if relapse occurs. The study supports restarting Spravato effectively if needed, providing patients with a treatment option they can return to rather than having to search for entirely new approaches each time symptoms reemerge.
Comparing Treatment Options for NYC Patients: Spravato, TMS, and Antidepressants
At Mid City TMS, we offer a spectrum of cutting-edge treatments to match individual needs. Below you’ll find a comprehensive guide for patients deciding between Spravato, TMS, and antidepressants:
| Treatment | Onset | Durability | Side Effects | Ideal For |
| Spravato + Antidepressant | Weeks to months | Sustained (up to 6.5 years) | Transient on dosing days; rare SAEs | TRD with need for durable, flexible relief |
| TMS (rTMS / Theta-Burst) | Weeks | Sustained benefits | Mild scalp discomfort, safe, non-systemic | Patients seeking non-pharma care |
| Standard Antidepressants | Weeks to months | Variable durability | Systemic side effects can be common | First-line MDD or adjunctive cases |
For some patients, starting with TMS therapy in NYC is ideal; for others, especially when medications have repeatedly failed, Spravato may be the better path. All of our treatments at Mid City TMS are evidence based, FDA approved, and compatible with one another.
Integrating Spravato Awareness into Mid City TMS Care
Highlighting esketamine’s long-term safety profile and clinical efficacy through our Spravato medication guide, Mid City TMS is here to help patients make more informed decisions about their care.While our core expertise is neuromodulation, we believe in being thorough in our approach to combatting treatment-resistant Depression. Our team ensures seamless transitions between treatment modalities—whether you’re pursuing Spravato treatment or TMS—while keeping your individual goals and clinical needs front and center.
At Mid City TMS, we make it a priority to stay updated on evolving research in treatment-resistant Depression; this allows us to better tailor personalized treatment plans that address your specific symptoms and circumstances. This proactive, comprehensive approach allows us to recommend the most appropriate intervention for each patient.
By maintaining expertise across multiple evidence-based modalities, we can adapt your treatment plan as your needs evolve, providing continuity of care with a team that understands your full treatment history. Contact us to schedule your consultation, explore your options and begin your path to recovery.
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