Spravato is the brand name for esketamine. The FDA approved esketamine in 2019 for treatment of depression that isn’t responding to other methods or drugs. Our providers now use Spravato with patients when appropriate.
Why was esketamine was developed?
It’s estimated that 5 million Americans have a depressive disorder that hasn’t resolved with current treatments. Esketamine is targeted to help those patients with treatment-resistant depression.
For the FDA approval, Spravato was evaluated in three short-term clinical trials and one longer-term maintenance trial. The drug does involve some risks, but the FDA felt its benefits outweigh those risks, citing the need for new effective alternatives for treatment-resistant depression. This is especially true since one of the main byproducts of treatment-resistant depression is suicide.
How does esketamine compare with other antidepressants?
Current antidepressants target the monoamine neurotransmitter systems — predominantly serotonin, norepinephrine, and dopamine levels in the brain.
Esketamine affects the function of the brain’s glutamate neurotransmitter system. This contrasts with many oral antidepressants that affect the serotonin neurotransmitters.
Esketamine isn’t a new drug, but this new FDA approval is specifically to treat depression. Spravato is a nasal spray that is quite fast acting. This is different than other antidepressants that often take four to six weeks to become fully effective. Even at that point, they are not effective for some patients. Spravato delivers quick results. Patients may experience changes to the brain that reduce symptoms of depression in just hours, not weeks.
How does Spravato work?
Clinically, Spravato is called an NMDA receptor antagonist, an ionotropic glutamate receptor. It is to be used as a nasal spray in combination with an oral antidepressant. The exact mechanisms of how esketamine affects the brain to help with depression are not known.
Spravato isn’t thought to be a first line of treatment. Instead, it is intended for individuals with treatment-resistant depression. This usually means they have had adequate time using two other antidepressant medications, but didn’t experience relief from them.
How do our providers administer Spravato?
The conditions of the FDA’s approval of Spravoto are that it needs to be administered under medical supervision in a doctor’s office or clinic. Patients using Spravato will come to our providers’ Elgin office. There they will receive treatment one or two times per week. After administering Spravato, patients need to remain in our offices for a couple of hours to ensure they are not experiencing any adverse reactions.
What are the side effects with Spravato?
These are the most common side effects noted in the clinical trials of Spravato:
- Decreased feeling
- Increased blood pressure
- Feelings of inebriation