Esketamine (Spravato) Treatment: Nasal Spray Therapy For Depression

People suffering from treatment-resistant major depressive disorder (MDD) might experience relief from their symptoms with a relatively new therapy called Spravato (esketamine). This medication is delivered as a nasal spray and can provide relief from symptoms within hours. It has been approved by the U.S. Food and Drug Administration (FDA) for use in treating treatment-resistant depression.

This medication provides an innovative approach to treating people with major depression who haven’t experienced relief from other anti-depressant medications. Esketamine is administered in a clinical setting at Willapa Behavioral Health & Wellness where you are monitored for safety and effectiveness at all times.

What is Spravato (Esketamine)?

Esketamine is derived from the ketamine molecule and is an S-enantiomer of ketamine, making it more potent when it interacts with the N-methyl-D-aspartate (NMDA) receptor in the brain. It is believed that it works as an NMDA receptor antagonist to spur the development of new neural synapses or areas for nerves to connect.

Spravato is delivered in a nasal spray and must be administered in a certified doctor’s office or clinical setting. Because of its potential to cause sedation and dissociation, patients must be monitored in-office for two hours after taking esketamine and must arrange for transportation to and from their appointments.

How Does Spravato Work?

Esketamine binds to NMDA receptors in the brain, which increases the production and release of a chemical messenger to enhance communication between nerve cells. Similarly, traditional antidepressants also bind to receptor sites to increase the production of certain chemical messengers, including dopamine, norepinephrine, and serotonin.

Unlike traditional anti-depressants, however, Spravato increases the production and release of glutamate, which is the most abundant chemical messenger produced in the body. Because of this, researchers believe that esketamine’s action improves communication between more cells and provides faster relief from depression symptoms than traditional anti-depressants which can be slow-acting.

Who Can Benefit from Spravato Treatment?

The FDA approved esketamine for use with people who have treatment-resistant depression. This is defined as having tried two or more other anti-depressants for a minimum of six weeks without noticeable improvement in symptoms or remission.

Esketamine should not be used to treat depression in children or pregnant or breastfeeding women because safety and efficacy studies haven’t been completed with these populations. Those who have a history of drug or alcohol addiction, allergies to ketamine, or certain cardiovascular diseases should speak with their providers before starting esketamine nasal spray treatment.

A typical candidate for Spravato treatment might be an adult who has experienced symptoms of major depressive disorder for several months, has not responded to other anti-depressants, has no history of substance abuse disorder, and is not currently breastfeeding or planning to become pregnant within the next couple of months.

The Treatment Process

Your provider will talk to you about your symptoms, other anti-depressants you have tried, and your history of depression. They will review your medical history and ask about any medications you are currently taking (prescribed and over-the-counter) to check for potential drug interactions. If your provider believes you are a good candidate for Spravato treatment, they will talk to you about this medication, what to expect, and the potential side effects so that you can make an informed decision.

Both you and your provider will sign an enrollment form to participate in treatment. Each appointment will be scheduled in the office. Once you arrive, the provider will help you get settled into our Spravato room where you will sit or lay in a comfortable chair. You will be handed your Spravato nasal injector and asked to administer a dose of spray three times spaced five minutes apart. Once you have administered three sprays, you will remain in the room for two hours to be monitored for side effects. At this time, you can listen to music, color, sleep, talk, or whatever brings you peace and comfort.

Since esketamine can interfere with your ability to operate machinery or a car, you must arrange transportation to and from your appointments. Initially, your provider might schedule two appointments per week for four or more weeks, then evaluate how well it is working. If you have experienced improvement, your provider might decrease the frequency of your doses to once per week and then to twice per month, and finally, once per month over several months, with eventual discontinuation of use as symptoms of depression should be alleviated.

Safety and Side Effects

Several common side effects are associated with Spravato, including:

  • Dizziness
  • Sedation
  • Dissociation
  • Numbness
  • Spinning sensation
  • Fatigue
  • Nausea
  • Anxiety
  • Vomiting
  • Hypertension
  • Feeling intoxicated
  • Feeling very excited or happy

These side effects typically are the most pronounced immediately after taking Spravato but dissipate within two hours of administration.

Spravato also has some serious and rare potential side effects, including:

  • Respiratory depression or arrest
  • Dissociation
  • Sedation
  • Hypertension
  • Increased suicidal thoughts
  • Bladder issues
  • Cognitive problems
  • Abuse/misuse

Because of the potential side effects, esketamine is only administered in controlled clinical settings in which the patient can be observed for two hours. The two-hour observation and monitoring period occurs because that is when the side effects of this drug are most pronounced. If the patient experiences side effects during this time, the medical professionals will promptly intervene.

Patients are carefully screened before they will be administered Spravato. The provider will review their medical history and ask questions about the medications they take, any history of drug or alcohol abuse, allergies, and depression symptoms. They will also look for other medical conditions, including cardiovascular disease, which could be affected by Spravato before approving the patient.

Success Stories and Testimonials

Spravato has several success stories and testimonials from real patients posted on its website, including Nicole S., Ben L., and Allison. Nicole is a 23-year-old female diagnosed with treatment-resistant depression. She reported that before Spravato, she had dropped out of college after only two months, was lashing out at her mother, and sleeping for 18 to 20 hours per day. Nicole stated she used to wake up feeling like a negative six to begin her day but now wakes up feeling neutral. She has returned to college and is nearing the end of her first semester and said she now feels “light” as opposed to weighted down.

Ben L

Ben L. is a 40-year-old man diagnosed with treatment-resistant depression. Ben reports that his depression worsened in his 30s and left him in a downward spiral. He said he constantly heard an internal voice telling him he was worthless. However, with Spravato, Ben said he was able to find himself again and credits this medication for saving him.

Allison F.

Allison F. is a caregiver for her 22-year-old son, who has treatment-resistant depression. Before they found Spravato, Allison said that she had worked hard to try to find something that would work and alleviate his depression symptoms, but nothing had worked. She said that her son’s depression significantly worsened when he was a teenager, leading to him missing school and receiving a visit from a truancy officer.

Before his senior year, he had been a straight-A student and had received a college scholarship, but he was in danger of failing out of school. They tried multiple medications, but each would only work for a couple of months. After her son left for college, Allison found it to be a constant struggle trying to help him. They then tried Spravato, and his symptoms improved after a couple of weeks. Her son showed better hygiene, was attending class more consistently, and was enjoying gardening.

FAQs

Is Spravato covered by insurance?

Whether Spravato is covered by your insurance depends on your policy. Since it is an FDA-approved treatment for treatment-resistant depression, that makes it likelier that it will be covered. Check your policy to see if it includes a behavioral health benefit. You can also call your insurance company to learn whether this medication will be covered and what your copays might be.

Who should not take Spravato?

Spravato is contraindicated for people with the following conditions:

  • Recent history of drug/alcohol abuse
  • Aneurysm
  • Blood vessel connection disorder
  • Allergy to esketamine, ketamine, or another ingredient
  • History of brain hemorrhage
  • Cardiovascular disease
  • Breastfeeding, pregnant, or plans to become pregnant
  • Psychosis
Are there any restrictions on eating or drinking on treatment days?

To prevent nausea and vomiting, your provider will ask that you avoid eating anything for at least two hours before your appointment. You also should avoid drinking anything for 30 minutes before your treatment.

Contact Willapa Behavioral Health & Wellness

If you have treatment-resistant depression and have tried two or more anti-depressants with minimal results, you might be a candidate for esketamine treatment. We provide full-service mental and behavioral health treatment, including psychiatric prescribing and monitoring, mental health therapy, and more. We are a certified clinic with three locations in Raymond, Long Beach, and Montesano, Washington. To schedule a consultation and learn whether Spravato might be the right option for you, contact us today by filling out the contact form or calling our main office in Long Beach at (360) 642-3787.