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SPRAVATO® Treatments: A Breakthrough for Treatment-Resistant Depression

If you’ve been treated for depression but still experience symptoms, you might have treatment-resistant depression (TRD). For most people, antidepressants and psychotherapy can ease depressive symptoms. However, standard treatments may not be enough for those with TRD. They might offer little relief or improve symptoms temporarily, only for them to return. 

In such cases, breakthrough treatments like SPRAVATO® can help. SPRAVATO® (esketamine) is a prescription nasal spray medicine that’s FDA-approved to treat treatment-resistant depression or major depressive disorder (MDD) with suicidal thoughts or behaviors. For either diagnosis, your doctor will prescribe SPRAVATO® along with one other oral antidepressant medication.

Treatment-Resistant Depression

TRD means your depression doesn’t improve even after trying antidepressant medication. An antidepressant trial must be of adequate duration (6-8 weeks) and dosage before your doctor can diagnose TRD.  TRD also can be diagnosed if the side effects from medications are intolerable, therefore preventing the individual from continuing the pharmacological treatment.

Treatment-resistant depression affects about 30% of people diagnosed with depression. When you have this diagnosis, you’re more likely to have: 

  • Anxiety
  • Depressive episodes that last longer
  • Suicidal thoughts and behavior
  • Reduced ability to experience pleasure

It’s still unclear what causes TRD. But factors like brain chemistry, environment and genetics can come into play. Experts also believe that chronic stress may lead to TRD because it changes how your hypothalamic pituitary adrenal (HPA) axis functions. HPA helps the body stress to adapt.

What is SPRAVATO®?

SPRAVATO® (esketamine) is the first nasal spray approved by the FDA to treat TRD. It’s made from ketamine, an anesthetic that has also been used to treat depression for years. But it’s only recently that SPRAVATO® earned its FDA approval. Esketamine is more potent, which means you can use it at a lower dose and theoretically experience fewer side effects.

Common Side Effects

SPRAVATO® can cause various side effects, which often peak within 40 minutes of treatment and wear off within two hours. When you take SPRAVATO® (esketamine), you may: 

  • Feel disconnected from your reality or body
  • Hallucinate 
  • Experience high blood pressure
  • Feel drunk, nauseated, or light-headed
  • Have headaches

These symptoms tend to lessen after the first two treatments. Your doctor will monitor you for at least two hours after administration to ensure your safety and manage any immediate side effects.

How SPRAVATO® (Esketamine) Works

SPRAVATO® nasal spray works differently from traditional antidepressants. SSRIs, SNRIs, and other conventional antidepressants increase the level of naturally occurring chemicals like dopamine, norepinephrine, and serotonin. These chemicals are neurotransmitters that transmit messages between brain cells. The concept is that having an influx of these messengers allows for better communication in the brain and positively affects mood.

SPRAVATO® works in the same way but unlike conventional antidepressants, it increases glutamate levels in the brain. Glutamate is the most abundant neurotransmitter in the brain, and when the level rises, it leads to a greater impact. That explains why SPRAVATO® is fast-acting and can offer relief from depressive symptoms within hours. Common antidepressants are slow-acting and usually take several weeks to realize a difference. 

SPRAVATO® Treatment Process

SPRAVATO® is a Schedule III drug, meaning it has a moderate potential for abuse but also accepted medical uses. As such, you must receive SPRAVATO® under medical supervision at a certified treatment center. 

Your doctor will prescribe the nasal spray, which you self administer under their supervision. Your provider will guide you through the process and ensure you’re using it correctly. The initial phase of treatment typically involves two sessions per week for the first four weeks, followed by weekly or bi-weekly sessions, depending on your progress and response to the treatment.

After administering SPRAVATO®, you will need to stay at the treatment center for at least two hours. During this time, healthcare professionals will monitor you for any immediate side effects and ensure your safety. Have someone accompany you to and from the treatment center, as you will not be able to drive or operate heavy machinery until the day after your session.

Drug Interactions

SPRAVATO® can interact with CNS depressants and stimulants like opioids, benzodiazepines, amphetamines, salts, methylphenidate, etc. These interactions can increase the risk of side effects from SPRAVATO® and the depressants and also increase the risk of high blood pressure. You should, therefore, tell your doctor about any prescription drugs (or just drugs in general) that you’re taking.

Other contraindications of SPRAVATO® include:

  • If you have a brain bleed
  • If you have some blood vessel issues like aneurysms
  • If you had an allergic reaction

Your doctor may also run some tests to determine your candidature for the therapy. They’ll check for high blood pressure, mental health diagnoses that are contraindicated, liver disease, cognitive impairment, pregnancy, etc., and provide medical advice on the best cause of action.

You will also want to talk to your doctor about whether to drink alcohol or use cannabis and what to do when you start taking a new drug during your SPRAVATO® treatment. Any additional information can go a long way in preventing drug interactions and complications.

Benefits of SPRAVATO® Treatment

Depression is one of the most common mental health diagnoses in the United States, affecting millions of people each year. And while most people who get help go on to lead healthy, happy lives, some with TRD may struggle to find effective therapy.

SPRAVATO® offers several key benefits for individuals struggling with TRD:

Decreases Suicidal Thoughts

If you’re struggling with severe depression, you might also experience suicidal thoughts. SPRAVATO® has been shown to help decrease these thoughts more effectively than other treatments. In fact, it’s the only drug besides lithium, that’s proven to reduce suicidal thoughts.

Conventional drugs, on the other hand, may actually do the opposite. They can elevate suicidal thoughts at the start of treatment, particularly in children and young adults.

SPRAVATO® is Effective for TRD

About one-third of those with depression don’t respond to conventional drugs. SPRAVATO® decreases depressive symptoms in most of these people in clinical trials. Apart from SPRAVATO®, the only other pharmacotherapy that works for TRD is a blend of fluoxetine and olanzapine. 

But this combo comes with significant long-term effects like diabetes, metabolic changes, substantial weight gain and high blood pressure. Transcranial magnetic stimulation (TMS) and ketamine infusions are also very effective treatments for TRD.

Promotes New Neural Connections

Another unique benefit of SPRAVATO® is its ability to help your brain form new connections. Esketamine promotes synaptogenesis, the process of creating new synapses between neurons. This can enhance your brain’s ability to adapt and recover, potentially leading to longer-lasting improvements in your mental health.

SPRAVATO® at Relief Mental Health

If you’re dealing with persistent depression, don’t struggle alone. Relief Mental Health provides SPRAVATO® treatments to help you manage the symptoms and regain control over your life. We also have a team of therapists ready to help and support you throughout the process. Contact us today for more information.

Jamie Pacilio, PA-C

Jamie Pacilio, PA-C is a psychiatric physician assistant at Relief Mental Health in Red Bank, New Jersey. She specializes in SPRAVATO®️ treatment for severe depression and provides medication management for a variety of psychiatric diagnoses. With a focus on personalized care and innovative treatments, Jamie is dedicated to improving the mental health and well-being of her patients.

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